Dental Abscess

Definition:
Abscess is a (semi) liquid collection of pus lined by granulation tissue (if acute) or granulation tissue and fibrosis (if chronic).

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Pathological features:
- Contain PMNs/macrophages, lymphocytes (live and dead), bacteria (dead and viable), and liquefied tissue substances.
- May lead to rupture (‘pointing’), discharge into another organ (fistula formation), or opening onto an epithelial surface (sinus) .
- Incomplete treatment due to resistant organisms (myocbacteria) or poor treatment may lead to a chronic abscess.
- Complete elimination of the organisms in a chronic abscess without drainage can lead to a ‘sterile’ abscess (‘anti-bioma’).

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Typical causes:
- Suppuration of tissue infection (e.g. renal abscess from pyelonephritis).
- Contained infected collections (e.g. subphrenic abscesses).
- Haematogenous spread during bacteraemias (e.g. cerebral abscesses).

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Diagnosis:
Deep abscesses are characterized by swinging fever, rigors, high WCC, and i CRP. Untreated they lead to catabolism, weight loss, and a falling serum albumin. Ultrasound, CT, MRI, or isotope studies may be necessary to confirm the diagnosis.

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Treatment:
- Drain the pus e.g. incision & drainage (perianal abscess), radiologically guided drain (renal abscess), closed surgical drainage (chest empyema), or surgical drainage and debridement (intra-abdominal abscess).
- IV antibiotics (course may be prolonged).

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