Clinical Manifestations
Clinical Manifestations
Localized dental abscess: the classic presentation is severe, throbbing pain that is constant and worsening, a visible soft tissue swelling that is tender to palpation, and a non-vital tooth with marked percussion sensitivity. As pus accumulates, the swelling becomes fluctuant — a soft, fluid-like quality detectable by bidigital palpation. The patient may report the taste of pus in the mouth if spontaneous intraoral drainage has occurred.
Systemic signs of localized infection include low-grade fever (37.5–38.5°C), malaise, and submandibular lymphadenopathy — tender, enlarged nodes below the mandible. These findings indicate infection beyond the alveolar bone but not yet in deep spaces.
Red flag symptoms requiring emergency hospital referral: trismus (inability to open >30mm, suggesting masticator space involvement), dysphagia (submandibular/lateral pharyngeal spread), dysphonia or muffled 'hot potato' voice (supraglottic edema), stridor (airway obstruction), elevated floor of mouth (Ludwig's angina), eye closure from swelling (orbital cellulitis potential), and high fever >39°C with tachycardia.
Orbital complications of maxillary or frontal sinus origin: periorbital edema, proptosis, restricted eye movement, and visual changes indicate orbital cellulitis or subperiosteal abscess requiring emergency ophthalmological and oral-maxillofacial surgery assessment.