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§Differential diagnosis
Acute periapical abscess with buccal space involvementNon-vital tooth, tender to percussion, localised swelling
Periodontal abscessVital tooth, deep pocket, lateral swelling
Infected radicular cystLonger history, radiolucency with corticated outline
Canine space infectionSwelling obliterating the nasolabial fold
§Final diagnosis
Acute apical abscess of 16 with buccal space involvement
A non-vital, percussion-tender tooth with a diffuse facial swelling localises the source. Pulp vitality is the discriminator against a periodontal abscess, where the tooth typically remains vital.
§Investigations
01Periapical radiograph — periapical radiolucency and deep caries involving the pulp
02Pulp sensibility testing of 15, 16, 17
03Temperature, pulse and assessment of red flags (eye closure, trismus, dysphagia)
§Treatment plan
01Establish drainage — the primary treatment of an abscess
02Extraction of the unrestorable 16, or access and drainage if restorable
03Antibiotics only if there is spreading infection or systemic upset
04Analgesia and review in 24-48 hours
§Surgical procedure
01Extraction of 16 under local anaesthesia with drainage through the socket
02Amoxicillin plus metronidazole for 5 days given systemic features
§Follow-up & outcome
01Swelling substantially reduced at 48 hours
02Complete resolution at 1 week
03Prevention advice and restorative plan for remaining caries
§Clinical pearls / learning points
01Drainage, not antibiotics, treats an abscess.
02Look for the red flags of spreading infection: trismus, dysphagia, eye closure, raised floor of mouth.
03Always test vitality — it decides whether the problem is endodontic or periodontal.
§References
Flynn TR. Principles of management of odontogenic infections.