Anamnestic data may point out recent trauma or dental procedures, e.g., deep fillings or root canal treatment. However, DA may also develop as a complication of caries, and affected individuals may not report any prior symptoms [1].

Local swelling and toothache predominate the clinical picture in case of acute DA. The affected tooth is very sensitive to percussion, and the patient may describe acute pain on biting [2]. Moreover, patients may present with constitutive symptoms like malaise, fever, and lymphadenopathy [3]. Trismus has been observed and has been associated with spreading dental infection [4]. The spread of the disease may also cause intraoral swelling and spontaneous drainage of pus or cellulitis, depending on the route of propagation. Patients may develop life-threatening sepsis [5] [6]. Airway obstruction due to swelling of submandibular tissues has been described and may require emergency attention [7]. Chronic disease is not usually associated with any complaints, but symptoms may develop upon an exacerbation of the inflammatory process.

• Severe Pain

  The main symptom of a dental abscess is a severe, throbbing pain. The pain usually comes on suddenly, gets gradually worse over a few hours or days, and causes teeth to be tender and sensitive. Read more about the symptoms of a dental abscess. [everestpharmacy.co.uk]

  Abscesses cause severe pain because pressure on the nerve increases as the pus increases. If left untreated, a dental abscess may burst through the skin of the face, or into the mouth. [teethrelief.org.uk]

  While this condition is usually associated with local swelling and moderate to severe pain, morbidity and mortality mainly result from the spread of the infection to other areas of the oral and maxillofacial region or even more distant tissues. [symptoma.com]

  The main symptom of a dental abscess is a severe, throbbing pain at the site of the abscess. The pain usually comes on suddenly and then gets gradually worse over a few hours or a few days. Read more about the symptoms of a dental abscess. [your.md]

• Sepsis

  It is imperative for emergency physicians to recognize the possibility of pediatric sepsis in the setting of acute maxillary or mandibular pain, as well as in patients for whom no clear focus of infection can be found. [ncbi.nlm.nih.gov]

  Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis. Updated December 13, 2017 [sepsis.org]

  The number of people who develop sepsis from a tooth abscess is not known. [livestrong.com]

• Chills

  The patient is a 7-year-old previously healthy boy who presented to the Emergency Department (ED) with "fever, mottling, and shaking chills." In the ED, he appeared systemically ill with fever, mottling, delayed capillary refill, and rigors. [ncbi.nlm.nih.gov]

  If someone develops fever, chills, nausea, or vomiting as a result of a dental abscess, see a doctor. [emedicinehealth.com]

  Fever, chills, and lack of appetite increase as the infection worsens. A condition called cementoma, in which excess bone forms around the root of a tooth or teeth, looks like an abscess during its beginning stage, but it is not. [healthy.net]

  Chills, diarrhea, fever, nausea, sweating, and vomiting may also accompany acute cases. [dentalinsurance.com]

• Fatigue

  Headache, fever and general fatigue. A significant amount of green and foul-smelling pus that eventually drifts out and the pain stops right after. [studiodentaire.com]

  Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain fatigue, organ dysfunction (organs don’t work properly) and/or amputations. [sepsis.org]

  Adverse effects as reported in one study were diarrhoea (one participant, placebo group) and fatigue and reduced energy postoperatively (one participant, antibiotic group). [doi.org]

• Weakness

  Call 911 Call 911 if any of these occur: Swelling spreads to the upper half of your face or neck You eyelids begin to swell shut Unusual drowsiness Headache or a stiff neck Weakness or fainting Difficulty swallowing or breathing When to seek medical advice [fairview.org]

  How Does a Weak Immune System Result in Tooth Decay? An imbalance in hormones leads to a weak immune system. When the endocrine glands (hormone secreting glands) function improperly, hormone gets imbalanced. [homeremediesforlife.com]

  “The tooth is compromised it’s pretty weak and we need to go ahead and put this covering over the tooth to help it be solid,” Arndt said. Extraction In some cases, extracting the tooth makes the most sense. [pennlive.com]

• Nausea

  If someone develops fever, chills, nausea, or vomiting as a result of a dental abscess, see a doctor. [emedicinehealth.com]

  Chills, diarrhea, fever, nausea, sweating, and vomiting may also accompany acute cases. [dentalinsurance.com]

  Nausea was experienced by 7% of the amoxicillin group following the second 3g dose (none in the phenoxymethylpenicillin group) in the adult study [ Lewis et al, 1986 ]. [web.archive.org]

  Common signs and symptoms associated with hookworm disease include mild abdominal pain or discomfort, intestinal cramps, colic, nausea and diarrhea that begins once the worms mature in your intestines. [livestrong.com]

• Dysphagia

  […] can include: tenderness of your tooth and surrounding area sensitivity to very hot or cold food and drink an unpleasant taste in your mouth bad breath (halitosis) a general feeling of being unwell difficulty opening your mouth difficulty swallowing (dysphagia [nidirect.gov.uk]

  […] surrounding area, especially to touch and on biting, intense, throbbing pain which disturbs sleep sensitivity to food and drink that is very hot or very cold, fever difficulty in opening your mouth (known as trismus), difficulty in swallowing (known as dysphagia [singhealth.com.sg]

  Symptoms can include: swelling pain when moving the tongue neck swelling fever difficulty swallowing (dysphagia) difficulty breathing In severe cases, you may have trouble breathing or experience an abnormal breathing sound, caused by a blocked airway [everestpharmacy.co.uk]

  […] and drainage, root treatment, or extraction and therefore it is important to arrange for prompt dental surgery rather than prescribe unnecessary antibiotics Patients presenting with signs of sepsis, facial swelling, trismus (limited mouth opening), or dysphagia [bmj.com]

  The examination should include other causes of the presenting complaint as it may not be dental in origin; for example, tonsillar and salivary gland infections may cause lower facial swelling and dysphagia, and acute sinusitis or ear infections can cause [racgp.org.au]

• Vomiting

  If someone develops fever, chills, nausea, or vomiting as a result of a dental abscess, see a doctor. [emedicinehealth.com]

  Chills, diarrhea, fever, nausea, sweating, and vomiting may also accompany acute cases. [dentalinsurance.com]

  Sepsis may also be recognized by the presence of chills, a fast heart rate, nausea or vomiting. When severe, sepsis typically produces a low blood pressure, lightheadedness, confusion, loss of consciousness and difficulty breathing. [livestrong.com]

  With advanced infection, you may experience nausea, vomiting and chills. Fever and facial swelling may indicate that the infection has spread deeper into your jaw and surrounding tissue, or even to other areas of your body. [yourdentistryguide.com]

• Dental Abscess

  The term dentoalveolar abscess comprises 3 distinct processes, as follows: A periapical abscess that originates in the dental pulp and is usually secondary to dental caries is the most common dental abscess in children. [emedicine.medscape.com]

  /d/dental-abscess/diagnosing-a-dental-abscess.html Further Reading All Dental Abscess Content Dental Abscess Causes and Prevention Dental Abscess Symptoms Last Updated: Nov 8, 2018 Written by Cashmere Lashkari Cashmere graduated from Nowrosjee Wadia College [news-medical.net]

  SUBJECTS AND METHODS: Among a sample of over 24 000 patients visited at the emergency dental unit, 688 subjects were diagnosed with dental abscess and enrolled in the study. [ncbi.nlm.nih.gov]

• Difficulty Opening the Mouth

  […] your mouth or swallowing Eventually the abscess can break open, letting the pus drain. [merckmanuals.com]

  Less common symptoms that require rapid treatment are fever, abscesses that originate in the wisdom tooth and difficulty opening the mouth. [fi.glosbe.com]

  Other symptoms can include: tenderness of your tooth and surrounding area sensitivity to very hot or cold food and drink an unpleasant taste in your mouth bad breath (halitosis) a general feeling of being unwell difficulty opening your mouth difficulty [nidirect.gov.uk]

  The right side of his face was severely swollen, to the point he couldn’t open his right eye, and he had difficulty opening his mouth enough for us even to take a look and identify the problem tooth. [smilesbypayet.com]

• Halitosis

  Other symptoms can include: tenderness of your tooth and surrounding area sensitivity to very hot or cold food and drink an unpleasant taste in your mouth bad breath (halitosis) a general feeling of being unwell difficulty opening your mouth difficulty [nidirect.gov.uk]

  Bad breath (halitosis) : factors that affect the mouth and cause bad breath. Toothache : how can toothache be avoided? Last updated 29.01.2016 Nigel Carter Chief executive British Dental Health Foundation [netdoctor.co.uk]

  Symptoms include a rapid onset of: Inflammation Pus formation Sour or metallic taste Halitosis (bad breath) Spontaneous pain Sensitivity to percussion Discomfort when biting or chewing Swelling of associated tissues Questions the dentist will often ask [dentagama.com]

  […] labialis) Dental abscess Dental plaque Denture Irritations and Infections Denture stomatitis (prosthetic stomatitis) Dry socket Erosion Fluorosis (dental) Gingival hyperplasia Gingival pocket Gingivitis Gum Disease (Periodontal Disease) Gum recession Halitosis [studiodentaire.com]

• Sweating

  Chills, diarrhea, fever, nausea, sweating, and vomiting may also accompany acute cases. [dentalinsurance.com]

  There are likely to be fever like symptoms; dizziness, hot and cold flushes, agitation, sweating, and swelling all around the face and neck. This occurs because there is an infected part of the mouth and bacteria has accumulated there. [carefreedental.com]

• Suggestibility

  It is suggested that initially establishing drainage after dental treatment would have prevented the sequela that ensued. [ncbi.nlm.nih.gov]

  A tender, fluctuant area at the base of a tooth suggests a pointing abscess. [merckmanuals.com]

• Facial Swelling

  In this present case, a 51-year-old woman arrived at the public health department with high fever and facial swelling. The findings suggested a dental origin and the patient was directed to dentistry. [ncbi.nlm.nih.gov]

  […] upper facial swelling. [racgp.org.au]

• Facial Pain

  Author information 1 Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. [email protected] Abstract In the imaging evaluation of Emergency Department patients presenting with facial pain, there is a condition [ncbi.nlm.nih.gov]

  Dental and facial pain. In: Benzon HT, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW, eds. Practical Management of Pain. 5th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 31. Pedigo RA, Amsterdam JT. Oral medicine. [nlm.nih.gov]

• Facial Edema

  If treatment is delayed, the infection may spread through adjacent tissues, causing cellulitis, varying degrees of facial edema, and fever. The infection may spread to osseous (bony) tissues or into the soft tissues of the floor of the mouth. [healthcentral.com]

• Headache

  Findings of particular concern are Headache Fever Swelling or tenderness of floor of the mouth Cranial nerve abnormalities Red flag finding of headache suggests sinusitis, particularly if multiple upper molar and premolar (back) teeth are painful. [merckmanuals.com]

  Call 911 Call 911 if any of these occur: Swelling spreads to the upper half of your face or neck You eyelids begin to swell shut Unusual drowsiness Headache or a stiff neck Weakness or fainting Difficulty swallowing or breathing When to seek medical advice [fairview.org]

  Headache, fever and general fatigue. A significant amount of green and foul-smelling pus that eventually drifts out and the pain stops right after. [studiodentaire.com]

• Meningism

  Complications range from contiguous or haematogenous spread of infection and include potentially fatal conditions 1-4 : osteomyelitis meningitis and cerebral abscess Ludwig angina deep neck space infections odontogenic infections most commonly (~80%) [radiopaedia.org]

  […] can close the airway and cause suffocation; septicaemia, which is an infection of the blood; brain abscesses, which often require surgical drainage, intracranial pressure relief, and Hyperbaric Oxygen Therapy, and other bacterial infections such as meningitis [lafayettedentalexcellence.com]

  Another complication, usually from upper teeth, is a risk of septicaemia (infection of the blood) from connecting into blood vessels, brain abscess (extremely rare), or meningitis (also rare). [en.wikipedia.org]

  Extremely rare complications include brain abscesses and meningitis. …even in cases where an abscess spontaneously drains or releases the stored up pus, the infection will not go away without proper treatment and care. [dentalinsurance.com]

• Insomnia

  There is however, one particular painful episode that can unravel even the toughest of people: a stomach churning, insomnia inducing, mind altering toothache that never seems to go away not matter what you do. [drbautista.ca]

  […] dental abscess include: pain in the affected area when biting or when touching the affected area sensitivity to cold or hot food and liquids a foul taste in the mouth fever a generally unwell feeling difficulties opening the mouth swallowing difficulties insomnia [medicalnewstoday.com]

• Trigeminal Neuralgia

  neuralgia shouldn't directly cause any swelling. [medhelp.org]

DA diagnosis is based on radiographic imaging. In most cases, plain radiography yields reliable results [2]:

• The most common form of DA is the apical abscess, which is related to an endodontic infection. It may only affect teeth devoid of a vital pulp, either due to caries, trauma, or root canal treatment. Radiographs may thus depict anomalies consistent with the disease’ etiology, e.g. radiolucency in the crown in case of caries [8]. The infection may spread to adjacent bones and osseous tissue may be destructed. This development corresponds to the appearance of periapical radiolucent foci in radiographic images. Of note, local bone resorption is primarily an indicator of chronic DA, and affected individuals are usually asymptomatic. Radiographic findings may be absent in patients suffering from acute DA unless the latter has been preceded by chronic infection.
• An accumulation of pus in periodontal tissues is referred to as a periodontal abscess. This type of DA is less common. If a periodontal abscess is located close to the gingival surface, a bulge may be noted during early stages of the disease. Bone resorption is to be expected in patients suffering from chronic disease. Here, osseous lesions are observed periodontally [9]. Otherwise, clinical and radiographic features largely resemble those observed in cases of apical DA.

Additional techniques, namely sonography, computed tomography and magnetic resonance imaging may be employed to assess a possible route of spread of the infection [4] [10].

Laboratory analyses of blood samples may be carried out. Leukocytosis and anomalies consistent with dehydration may indicate a spreading infection [4]. Concentrations of inflammatory parameters like C-reactive protein are usually enhanced.

An aspiration through the intact disinfected mucosa is best suited for bacterial culture and sensitivity testing [4]. However, the determination of pathogens causing DA poses a major challenge. Multiple species are involved in this process, and culture conditions should be chosen to facilitate the growth of anaerobic and aerobic bacteria [2] [11]. Alternatively, causative pathogens may be identified using molecular biological techniques.

Visit us for the finest NYC gum disease treatment. More Reviews Before and after photos on infected tooth causes pain abscess and swelling performed in our Gum Disease Treatment office. [nycdentist.com]

It is suggested that initially establishing drainage after dental treatment would have prevented the sequela that ensued. [ncbi.nlm.nih.gov]

Treatment varies, depending on what caused the abscess. Generally, treatment involves draining the pus, either with root canal treatment, removing the affected tooth or gum treatment. [everestpharmacy.co.uk]

Plain radiograph / OPG and CT well-defined lucency at or distal to the root apex, usually 2-4 the tooth or teeth involved often show signs of caries an empty socket may indicate recent extraction for infection Treatment and prognosis Some dental abscesses [radiopaedia.org]

What Is the Prognosis for Dental Abscesses? The prognosis is good for resolution of a small dental abscess once it has ruptured or been drained. If the symptoms are improving, it is unlikely that the infection is getting worse. [emedicinehealth.com]

What is the prognosis for an abscessed tooth? The prognosis depends on the extent of the spread of infection. [medicinenet.com]

Radiographs may thus depict anomalies consistent with the disease’ etiology, e.g. radiolucency in the crown in case of caries. The infection may spread to adjacent bones and osseous tissue may be destructed. [symptoma.com]

A dental radiograph is of little help in the early stages of a dental abscess, but later usually the position of the abscess, and hence indication of endodontal/periodontal etiology can be determined. [en.wikipedia.org]

As soon as the etiologic factors have been eliminated the swelling is reduced. The healing process is usually uneventful and regeneration frequently occurs. [encyclopedia.com]

OBJECTIVES: The objective of this epidemiologic study was to estimate the healing time of acute dental abscesses and to evaluate the main variables involved in the healing process itself. [ncbi.nlm.nih.gov]

The use of antibiotics in dental practice is characterised by empirical prescription based on clinical and bacteriological epidemiological factors, resulting in the use of a very narrow range of broad‐spectrum antibiotics for short periods of time. [doi.org]

Conclusion Practitioners who are likely to treat patients with dental infections should understand the pathophysiology, management and complications of such infections. [racgp.org.au]

This will prevent the infection from spreading further into the jaw and bone tissue. Tooth Abscess Prevention The good news about a dental abscess is that it’s easily preventable! [growingsmilessa.com]

Preventative Dentistry Regular preventive care is essential to your dental health because it helps you avoid cavities, enamel wear, gum disease, and more. [drandersonpremierdental.com]

How can I prevent abscesses? Because of how dangerous an abscess can be, it’s important to practice good oral hygiene in order to prevent an abscess from developing. [lafayettedentalexcellence.com]

1. Azodo CC, Chukwumah NM, Ezeja EB. Dentoalveolar abscess among children attending a dental clinic in Nigeria. Odontostomatol Trop. 2012; 35(139):41-46.
2. Siqueira JF, Jr., Rocas IN. Microbiology and treatment of acute apical abscesses. Clin Microbiol Rev. 2013; 26(2):255-273.
3. Campanelli CA, Walton RE, Williamson AE, Drake DR, Qian F. Vital signs of the emergency patient with pulpal necrosis and localized acute apical abscess. J Endod. 2008; 34(3):264-267.
4. Robertson DP, Keys W, Rautemaa-Richardson R, Burns R, Smith AJ. Management of severe acute dental infections. Bmj. 2015; 350:h1300.
5. Fardy CH, Findlay G, Owen G, Shortland G. Toxic shock syndrome secondary to a dental abscess. Int J Oral Maxillofac Surg. 1999; 28(1):60-61.
6. Green AW, Flower EA, New NE. Mortality associated with odontogenic infection! Br Dent J. 2001; 190(10):529-530.
7. Lee WI, Lee J, Bassed R, O'Donnell C. Post-mortem CT findings in a case of necrotizing cellulitis of the floor of the mouth (Ludwig angina). Forensic Sci Med Pathol. 2014; 10(1):109-113.
8. Schwendicke F, Tzschoppe M, Paris S. Radiographic caries detection: A systematic review and meta-analysis. J Dent. 2015; 43(8):924-933.
9. Marquez IC. How do I manage a patient with periodontal abscess? J Can Dent Assoc. 2013; 79:d8.
10. Shuaib W, Hashmi M, Vijayasarathi A, Arunkumar J, Tiwana S, Khosa F. The Use of Facial CT for the Evaluation of a Suspected Simple Dentoalveolar Abscess in the Emergency Department. Clin Med Res. 2015; 13(3-4):112-116.
11. Shweta, Prakash SK. Dental abscess: A microbiological review. Dent Res J (Isfahan). 2013; 10(5):585-591.