A dental abscess (DA) refers to the accumulation of pus in the tissues around the tooth; in the periodontal tissues. 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.
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 .
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 . Moreover, patients may present with constitutive symptoms like malaise, fever, and lymphadenopathy . Trismus has been observed and has been associated with spreading dental infection . 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  . Airway obstruction due to swelling of submandibular tissues has been described and may require emergency attention . Chronic disease is not usually associated with any complaints, but symptoms may develop upon an exacerbation of the inflammatory process.
DA diagnosis is based on radiographic imaging. In most cases, plain radiography yields reliable results :
Additional techniques, namely sonography, computed tomography and magnetic resonance imaging may be employed to assess a possible route of spread of the infection  .
Laboratory analyses of blood samples may be carried out. Leukocytosis and anomalies consistent with dehydration may indicate a spreading infection . 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 . 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  . Alternatively, causative pathogens may be identified using molecular biological techniques.