It is one of the endodontic emergency.

1. IBRAHIM ABU BAKR MAKIGA

2. ACUTE ALVEOLAR ABSCESS
• It is inflammatory reaction in pulpal infection and necrosis characterized by
rapid onset ,spontaneous pain, tenderness of the tooth to pressure ,pus
formation and eventual swelling of associated tissues.

3. CAUSES
• Trauma
Chemical or mechanical
• Bacterial invasion of dead pulp
tissue from carious lesion
• Failed RCT
BACTERIOLOGY
• Streptococci
• staphylococci
•

4. WHAT IS THE COMMON CAUSE?

5. SYMPTOMS
• First symptom maybe Tenderness
of the tooth that maybe relieved
by continued slight pressure on
the extruded tooth to push it back
to the socket.

6. SYMPTOMS
• Later patient has severe
throbbing pain with swelling
of overlying tissue.
• The tooth become more
painful ,elongated and mobile

7. SYMPTOMS
As the infection
progresses the
swelling enlarges

8. SYMPTOMS
• If left untreated the infection may
progress to chronic apical abscess
wherein the contain pus may
break through to form a sinus
tract usually opening in the labial
or buccal mucosa.

9. SYMPTOMS
• It may further progress onto
osteomyelitis or cellulitis.
• General systemic manifestation
maybe seen
1.patient appear pale, weakened
from pain and loss of sleep.
2.Pyrexia and patient may complain
of headache

10. DIAGNOSIS
• By clinical examination and
subjective symptoms given by the
patient.
• RADIOGRAPHIC
shows defective restoration or
cavity
Shows widening of the pdl space

11. DIAGNOSIS
CONFIRMATION
• Electric pulp test or by thermal
test
• The tooth doesn’t respond to
electric pulp test or cold test
• Tender to percussion ,apical
mucosa is tender to palpation and
the tooth maybe mobile and
extruded

12. DIAGNOSIS
HISTOPATHOLOGY
Marked infiltration of PMNs
Rapid accumulation of exudate
Empty spaces where suppuration
has occurred

13. DIFFERENTIAL DIAGNOSIS
• PERIODONTAL ABSCESS
vital tooth
periodontal pocket formation
pus may exude from the sulcus on pressure
respond to vitality test
Caries may not be present

14. TREATMENT
START BY DOING WHAT IS NECESSARY,THEN WHAT IS POSSIBLE AND SUDDENLY
YOU ARE DOING THE IMPOSSIBLE
FRANCIS OF ASSISI

15. SURGICAL TREATMENT
• Immediate Rx is incision and
drainage
• Trephination maybe required
• If non restorable extraction is
indicated

16. ENDODONTIC TREATMENT
• Root canal treatment followed
by crown

17. PHARMACOTHERAPY
• ANALGESIC AND ANTI-INFLAMMATORY
NSAIDs
Ibuprofen 200-800mg
Diclofenac (sodium/potassium) 50-100mg
DYNAPA-AQ 75mg IM
OPIOIDS
Tramadol 50mg
Codeine 60mg

18. PHARMACOTHERAPY
• ANTIBIOTIC
Caps Amox 500mg or any
appropriate antibiotic

19. POST OPERATIVE INSTRUCTIONS
• Avoid chewing sticky foods .
• Avoid biting hard foods and hard substances.
• If possible, chew only on the opposite side of your mouth.
• Take medication as recommended by your dentist
• Rinse three times a day with warm salt water
• Maintain good oral hygiene