Overview
Pulpal abscess is a localized collection of pus within the dental pulp, often resulting from untreated caries, trauma, or previous dental procedures, leading to severe pain, swelling, and potential systemic complications 1.Diagnosis
Clinical signs: Severe tooth pain, swelling, fever, and purulent discharge 1.
Radiographic findings: Periapical radiolucency, possibly with associated bone destruction 1.
Laboratory tests: Elevated white blood cell count may indicate systemic involvement 1.Management
First-line treatment: Drainage of the abscess, either through incision or root canal treatment 1.
Root canal therapy: Essential for definitive management, aiming to eliminate infection and preserve tooth structure 1.
Antibiotics: Consideration for severe cases or systemic involvement; specific drug classes not detailed in provided abstracts 1.
Pain management: Analgesics such as NSAIDs for pain relief 1.Special Populations
Pediatrics: Management focuses on conservative approaches initially, with close monitoring for systemic effects 1.
Elderly: Increased vigilance for systemic complications; tailored antibiotic therapy based on comorbidities 1.Key Recommendations
Drain the abscess and initiate root canal therapy for definitive treatment (Evidence: Strong 1).
Consider systemic antibiotics in cases with significant swelling or signs of systemic infection (Evidence: Moderate 1).
Tailor pain management strategies to patient age and comorbidities (Evidence: Expert opinion 1).References
1 Sabeti M, Ghobrial D, Zanjir M, da Costa BR, Young Y, Azarpazhooh A. Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta-analysis. International endodontic journal 2024. link