II. Pathophysiology

III. Symptoms

  1. Severe, persistent pain localized to affected tooth

IV. Signs

  1. Apical Abscess may be present
    1. Fluctuant swelling at Buccal mucosa or Palate
  2. Percussion with metal object elicits pain
  3. Regional Lymphadenopathy of the Head and Neck

V. Management

  1. See Dental Incision and Drainage (if abscess present)
  2. Root canal or Tooth Extraction by dentist
  3. Antibiotics not required in most cases after Incision and Drainage
    1. Start if Periodontal Cellulitis suspected
    2. For Cellulitis, Augmentin or Clindamycin are recommended

VI. Complications

VII. References

  1. Amsterdam in Marx (2002) Rosen's Emergency Med, p. 897
  2. Douglass (2003) Am Fam Physician 67(3):511-16 [PubMed]

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Ontology: Suppurative Periapical Periodontitis (C0031024)

Definition (NCI) Localized collection of pus in the tissues that enclose the root of a tooth.
Definition (MSH) Acute or chronic inflammation of tissues surrounding the apical portion of a tooth, associated with the collection of pus, resulting from infection following pulp infection through a carious lesion or as a result of an injury causing pulp necrosis. (Dorland, 27th ed)
Concepts Disease or Syndrome (T047)
MSH D010482
SnomedCT 196341005, 109603007, 34597006
English Abscess, Apical Alveolar, Abscess, Apical Dentoalveolar, Abscess, Periapical, Abscesses, Apical Alveolar, Abscesses, Apical Dentoalveolar, Abscesses, Periapical, Alveolar Abscess, Apical, Alveolar Abscesses, Apical, Apical Alveolar Abscess, Apical Alveolar Abscesses, Apical Dentoalveolar Abscess, Apical Dentoalveolar Abscesses, Dentoalveolar Abscess, Apical, Dentoalveolar Abscesses, Apical, Periapical Abscess, Periapical Abscesses, Periapical Periodontitides, Suppurative, Periapical Periodontitis, Suppurative, Periodontitides, Suppurative Periapical, Periodontitis, Apical, Suppurative, Periodontitis, Suppurative Periapical, Suppurative Periapical Periodontitides, Periapical abscesses, periapical alveolar abscess (diagnosis), dentoalveolar abscess (diagnosis), periapical alveolar abscess, dentoalveolar abscess, Periapical dental abscess, Periapical Abscess [Disease/Finding], alveolar abscess, abscess dentoalveolar, Tooth root periapical abscess, periapical abscess, periapical abscess (diagnosis), Dentoalveolar Abscess, Periapical Dental Abscess, Dentoalveolar abscess, Apical abscess, Periapical abscess, Periapical abscess (disorder), Suppurative apical periodontitis, Suppurative Periapical Periodontitis, dentoalveolar; abscess, abscess; apical, abscess; dentoalveolar, periapical; abscess
Dutch dentoalveolair abces, periapicaal dentaal abces, abces; apicaal, abces; dentoalveolair, dentoalveolair; abces, periapicaal; abces, Abces, periapicaal, Alveolair abces, apicaal, Dentoalveolair abces, apicaal, Periapicaal abces, Periapicale periodontitis, suppuratieve, Periodontitis, apicale suppuratieve
French Abcès dentaire périapical, Abcès avéolaire (apex dentaire), Abcès périapical, Abcès de l'apex dentaire, Abcès dento-alvéolaire, Abcès péri-apical, Parodontite apicale suppurée, Périodontite apicale suppurée, Abcès périapicaux
German periapikaler Zahnabszess, dentoalveolaerer Abszess, Periapikale Periodontitis, eitrige, Periodontitis, apikale, eitrige, Abszeß, periapikaler, Alveolarabszeß, apikaler, Dentoalveolarabszeß, apikaler, Periapikaler Abszeß
Italian Ascesso dentale periapicale, Ascesso dentoalveolare, Ascesso apicale alveolare, Periodontite suppurativa apicale, Ascesso apicale dentoalveolare, Periodontite suppurativa periapicale, Ascesso periapicale
Portuguese Abcesso dentoalveolar, Abcesso dentário periapical, Abscesso Alveolar Apical, Abscesso Dentoalveolar Apical, Abscesso Periapical, Abscesso Perirradicular, Periodontite Apical Supurativa, Periodontite Periapical Supurativa
Spanish Absceso dentoalveolar, Absceso dental periapical, absceso alveolodental, absceso alveolodentario, absceso apical, absceso periapical (trastorno), absceso periapical, periodontitis apical supurativa, Absceso Alveolar Apical, Absceso Dentoalveolar Apical, Absceso Periapical, Absceso Perirradicular, Periodontitis Apical Supurativa, Periodontitis Periapical Supurativa
Japanese 歯槽膿瘍, シコンセンシュウイノウヨウ, シソウノウヨウ, 根尖周囲膿瘍, 化膿性根尖歯周炎, 化膿性根尖性歯周炎, 根尖性歯槽膿瘍, 根尖歯槽膿瘍, 歯根尖周囲膿瘍, 歯根尖端周囲膿瘍, 歯根尖膿瘍, 根尖歯周炎-化膿性, 歯周炎-根尖性-化膿性, 歯槽膿瘍-根尖, 歯槽膿瘍-根尖性, 膿瘍-根尖周囲, 膿瘍-歯根尖
Swedish Periapikal abscess
Czech periapikální absces, Periapikální zubní absces, Dentoalveolární absces
Finnish Juurenkärkipaise
Russian ABSTSESS PERIAPIKAL'NYI, PERIAPIKAL'NYI PERIODONTIT GNOINYI, PERIAPIKAL'NYI ABSTSESS, DENTOAL'VEOLIARNYI ABSTSESS APIKAL'NYI, AL'VEOLIARNYI ABSTSESS APIKAL'NYI, PERIODONTIT VERKHUSHECHNYI GNOINYI, АБСЦЕСС ПЕРИАПИКАЛЬНЫЙ, АЛЬВЕОЛЯРНЫЙ АБСЦЕСС АПИКАЛЬНЫЙ, ДЕНТОАЛЬВЕОЛЯРНЫЙ АБСЦЕСС АПИКАЛЬНЫЙ, ПЕРИАПИКАЛЬНЫЙ АБСЦЕСС, ПЕРИАПИКАЛЬНЫЙ ПЕРИОДОНТИТ ГНОЙНЫЙ, ПЕРИОДОНТИТ ВЕРХУШЕЧНЫЙ ГНОЙНЫЙ
Polish Ropień przywierzchołkowy, Ropień zębodołowy, Ropień okołowierzchołkowy
Hungarian periapicalis dentalis abscessus, Dentoalveolar abscessus
Norwegian Dentoalveolær abscess, Periapikal abscess

Ontology: Periapical Periodontitis (C0031030)

Definition (MSH) Inflammation of the PERIAPICAL TISSUE. It includes general, unspecified, or acute nonsuppurative inflammation. Chronic nonsuppurative inflammation is PERIAPICAL GRANULOMA. Suppurative inflammation is PERIAPICAL ABSCESS.
Concepts Disease or Syndrome (T047)
MSH D010485
ICD10 K04.5
SnomedCT 39273001
English Apical Periodontitides, Apical Periodontitis, Periapical Periodontitides, Periapical Periodontitis, Periodontitides, Apical, Periodontitides, Periapical, Periodontitis, Apical, Periodontitis, Periapical, Apical periodontitis NOS, Periapical Periodontitis [Disease/Finding], periapical periodontitis, apical periodontitis, Apical periodontitis (disorder), Apical periodontitis, periodontitis; apical, Apical periodontitis, NOS
Swedish Periapikal tandlossning
Czech periapikální periodontitida
Finnish Periapikaalinen periodontiitti
Russian VERKHUSHECHNYI PERIODONTIT, PERIODONTIT VERKHUSHECHNYI, PERIAPIKAL'NYI PERIODONTIT, ВЕРХУШЕЧНЫЙ ПЕРИОДОНТИТ, ПЕРИАПИКАЛЬНЫЙ ПЕРИОДОНТИТ, ПЕРИОДОНТИТ ВЕРХУШЕЧНЫЙ
Japanese 根尖部歯周炎, 歯周炎-根尖性, 歯根尖炎, 根尖炎, 根尖性歯周炎
Italian Periodontite apicale, Periodontite periapicale
Croatian PERIAPEKSNI PARODONTITIS
Polish Zapalenie tkanek okołowierzchołkowych, Zapalenie ozębnej okołowierzchołkowej, Zapalenie przyzębia przyszczytowego
Norwegian Rotspissbetennelse, Periodontitt, apikal, Apikal periodontitt
Dutch periodontitis; apicaal, Periapicale periodontitis, Periodontitis, apicale, Periodontitis, periapicale
Spanish periodontitis apical (trastorno), periodontitis apical, Periodontitis Apical, Periodontitis Periapical
French Parodontite périapicale, Périodontite péri-apicale, Périodontite périapicale, Desmodontite périapicale
German Periapikale Periodontitis, Periodontitis, apikale
Portuguese Periodontite Apical, Periodontite Periapical