Diagnosis
Diagnosis
Diagnosis of dental abscess is primarily clinical: identifying the source tooth (non-vital, percussion positive), localizing the pus (fluctuant swelling), and assessing the extent of spread (clinical signs, trismus, dysphagia, systemic signs).
Periapical radiographs or panoramic radiograph identify the source tooth, periapical pathology, and bony involvement. For deep space infections or when spread is suspected, CT scan of the neck with IV contrast is mandatory — it delineates fascial space involvement, identifies pus collections amenable to drainage, and detects mediastinal extension.
Laboratory investigations for hospitalized patients: FBC (leukocytosis >15,000 suggests significant infection, >20,000 suggests severe infection), CRP, ESR, blood cultures if bacteremia suspected, glucose (diabetics have poor outcome), coagulation screen if sepsis suspected.
Microbiological culture of pus (aspirated via needle or swab from incision) guides antibiotic therapy for resistant or recurrent infections. Standard reporting includes Gram stain (Gram-positive cocci in chains = streptococci; mixed gram-positive/negative = polymicrobial) and sensitivities.