Chronic Apical Periodontitis

An apical abscess can complicate pulp necrosis. Acute or chronic forms can develop, and an acute abscess may cause mild to severe pain, swelling and marked tenderness to touch.

Almost all dental infections begin with dental caries. Bacteria can leave the oral cavity and enter previously sterile spaces, producing conditions that include pulp necrosis and periapical abscesses.

Irreversible pulpitis may progress through ischaemia to necrosis of the dental pulp. Infection from the root canal can then create a local collection of pus around the periapex.

Diabetes, periodontal disease, obesity, older age, poor oral hygiene and barriers to dental care are associated with a higher risk of dental abscesses or poorer infection outcomes.

Examination looks for redness, swelling or pus extrusion. Dental radiographs can reveal a periapical abscess and areas of disease that visual inspection cannot show.

Periapical abscesses require incision and drainage when extraction is not the selected option. The infection source is treated with a dental procedure, rather than relying on antibiotics alone.

A large abscess or deep-space infection can require hospital admission, parenteral antibiotics and operative intervention. The extent of infection changes the level of care needed.

Dental infection can spread into the deep neck spaces and cause airway compromise. Fever, facial oedema, trismus, dysphagia or dysphonia can accompany deeper spread.

Good oral hygiene, reducing sugar-containing foods and early identification and treatment reduce the prevalence of dental infections. Managing tobacco use and diabetes is also part of infection risk reduction.