Classification
Periapical Abscess (Localized)
Pus collection limited to periapical region; vestibular fluctuant swelling
- • Localized vestibular swelling
- • Point tenderness
- • Fluctuant on palpation
- • Responds to I&D + drainage through canal
Spreading Infection (Cellulitis)
Diffuse spread through fascial planes without localized pus collection yet
- • Firm, non-fluctuant diffuse swelling
- • More severe systemic signs
- • Facial asymmetry
- • Requires IV antibiotics; I&D often not yet possible
Ludwig's Angina
Bilateral submandibular, sublingual, and submental space infection
- • Floor of mouth elevation
- • Drooling (dysphagia)
- • Stridor or muffled voice
- • Airway emergency — immediate intubation risk
Descending Necrotizing Mediastinitis
Spread along carotid sheath into mediastinum; highest mortality
- • Chest pain and dyspnea with dental swelling
- • Fever >39°C
- • CT neck/chest shows mediastinal air
- • Mortality up to 30–40% even with treatment