An acute alveolar abscess is caused by bacterial infection or trauma that leads to pulpal necrosis. Symptoms include tooth tenderness, throbbing pain, swelling and sinus tract formation. Treatment involves draining the abscess by debriding and irrigating the root canals, or incising and draining the swelling. For severe cases, surgical trephination may be needed to drain accumulated exudate and relieve pain. The key steps are to establish drainage, debride the canals, and prescribe antibiotics if systemic symptoms are present.

1. ENDODONTIC TREATMENT
OF AN ABSCESSED TOOTH
Makerere University
BDS IV

2. Acute alveolar abscess
 An acute alveolar abscess is an inflammatory reaction to pulpal infection and
necrosis characterized by rapid onset, spontaneous pain, tenderness of the
tooth to pressure, pus formation, and eventual swelling of associated tissues.
 Causes
 Bacterial
 History of trauma
 Mechanical or chemical irritation

3. symptoms
 Tenderness of the tooth
 Severe throbbing pain
 Swelling
 Sinus tract

4. Systemic reactions
 Elevated temperature
 Malaise
 Nausea
 Dizziness
 Lack of sleep

5. Treatment
I. Debridement of Canals
II. Drainage of abscess
 Local anesthesia is not required and frequently contraindicated forcing
anesthetic solution into an acutely infected and swollen area may increase
pain and may spread infection
 Most of the pain that occurs during access cavity preparation is caused by
tooth movement resulting from vibration of the bur , therefore one should
stabilize tooth with finger pressure so that pain is reduced.
 Block may be used in such cases

6.  Access Opening :Establishing drainage through the access opening has been
recommended as a means of reducing pain following the treatment of
necrotic teeth presenting with swellings.
 The rubber dam is placed over the infected tooth.
 The access opening is completed painlessly by bracing the tooth with finger
pressure.
 The pulp chamber is irrigated profusely and debrided,
 forcing any solution or debris into the periradicular tissues should be avoided

7.  The root canal orifices are located using a No. 8, 10, or 15 K file or reamer as an explorer and
each root canal is instrumented within 1 mm of the root apex.
 Frequently, a purulent exudate escapes into the chamber and indicates that the root canal is
patent and draining; relief follows quickly.
 When periapical abscess does not drain through the root canal effectively, the clinician should
use a sterile precurved ISO No. 8 or 10 patency K-file and go beyond the apical constriction to
initiate drainage.

8.  If there is excessive drainage of blood and pus through the canals the clinician should patiently
allow the drainage to take place and irrigate the canals copiously.
 In such cases, it is recommended to place a sterile cotton pack in the access-opened pulp
chamber and make the patient wait in the hospital reception for some time to allow the
drainage to take place.
 The pack can then be removed and the canals re-irrigated before placing calcium hydroxide
medicament in the canals.
 The access is then sealed with a suitable temporary restoration such as IRM or Cavit.

9.  Prescribe suitable analgesics as the patient may have acute discomfort even after the initial
treatment
 Prescribe antibiotics in cases where the patient has accompanying systemic symptoms.
 When symptoms have subsided, the root canals are opened and reassessed before completing
the root canal therapy

11. Incision and Drainage
 The clinician should first dry the mucosa over the affected area and then
spray the tissue with a refrigerant topical anesthetic.
 sharp thrust of the No. 11 scalpel through the center of the soft,
fluctuant mass down to the solid cortical bone plate
 If the swelling remains hard or indurated, then the swollen tissue should
be bathed in warm saline rinses for 5 minutes every hour until it
becomes soft, fluctuant, and ready for incision

12. Needle Aspiration
 Needle aspiration has been defined as the use of suction to remove fluids
from a cavity or space.
 The procedure provides information regarding the presence, type, and
volume of exudate, cystic fluid, or blood present in the lesion
 the technique involves the administration of local anesthetic solution, and
then a syringe with an 18-gauge needle is used to aspirate the cystic contents
of a swelling.
 The advantages of this technique are reduced scarring, evaluation of volume
and character of aspirate, and lack of postoperative drain removal

13. SURGICAL TREPHINATION
 In cases where periapical drainage cannot be established surgical trephination
is done
 Trephination is the surgical perforation of alveolar cortical plate ( over the
root end) to release the accumulated tissue exudate that is causing pain
 A small adjacent incision is made to the tooth, the mucosa is retracted and no
6 round bur is used to penetrate cortical plate this provides the drainage
 Recent technique involves use of engine driven perforator to enter the
medullary bone without the need of incision

14. • Decompression involves trephination followed by the placement of
a drain tube for facilitating exudate drainage as well as for allowing
irrigation of the cyst cavity.