Fast Five Quiz: What Do You Know About Dental Health?

Jeff Burgess, DDS, MSD

Disclosures

October 16, 2017

Depending on the severity of abscess based on clinical presentation, the following is recommended:

  • Periapical radiography is the first level of investigation. It provides a localized view of the tooth and its supporting structures. Widening of the periodontal ligament space or poorly defined radiolucency may be noted.

  • Panoramic radiography (pantomography) is most helpful in emergency situations because it provides the most information on all teeth and supporting structures.

No laboratory studies are required for uncomplicated (ie, simple) dental abscesses. Complicated abscess with accompanying cellulitis requires the following:

  • The CBC count may reveal leukocytosis with neutrophil predominance.

  • Obtain a blood culture (aerobic and anaerobic) before initiating parenteral antibiotics.

  • Needle aspirate is indicated for Gram stain and aerobic and anaerobic cultures.

CT is preferred over MRI for rapid visualization of odontogenic infections. CT may be used in severe fascial plane infections to determine the extent, size, and location of the infectious process. Soft-tissue planes may be seen; with increasing infection, inflammation, and fat-streaking, the planes may be difficult to differentiate from adjacent muscle. CT helps elucidate abscesses, venous thrombosis, and lymph node involvement.

In dental infections, a CBC count with differential is not mandatory, but a large outpouring of immature granulocytes may indicate the severity of the infection.

For more on the workup of dental disease, read here.

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