Acute Alveolar Abscess: Causes, Symptoms, Treatment, and Complications

Acute Alveolar Abscess

Alveolar abscesses occur due to the spread of infection from the tooth’s root in periapical tissue. Initially, it forms a periapical abscess which later spreads through the cortical part of bone into soft tissues and forms an alveolar abscess.

Alveolar Abscess Pathology

Alveolar Abscess Clinical Features

• Alveolar Abscess is a common odontogenic infection and constitutes 2% of apical radiolucencies.
• Due to an acute abscess, there is pain in the affected tooth.
• Localized swelling and an erythematous change in overlying mucosa are present.
• The affected area of the jaw may be tendered during palpitation.
• Pain aggravates during percussion and when pressure is applied to the opposing tooth.
• The application of heat intensifies pain, whereas application of cold relieves pain temporarily.
• Pus discharging sinus often develops on alveolar mucosa over the affected root apex and sometimes on the skin overlying the jaw bone.
• Infection from acute periapical abscess often spreads to facial spaces, leading to space infections.

Alveolar Abscess Treatment

• Rest is given
• Incision and drainage under general anesthesia
• Appropriate antibiotics
• 4 fluids to correct dehydration.
• Extraction of the tooth at a later period
• Extraction of sinus when required.

Alveolar Abscess Complications

• Septicemia.
• Spread of infection into other spaces such as parapharyngeal spaces; sublingual and submandibular spaces causing Ludwig’s angina; edema of epiglottis and respiratory distress; spread to pterygoid space and along pterygoid muscles through emissary vein leading to cavernous sinus thrombosis; upper canine tooth abscess spreading to corner of eye causing angular vein thrombophlebitis which further progress to cavernous sinus thrombosis; sub masseteric abscess.
• Lower incisor abscess can cause abscess in the chin and median mental sinus; and chronic osteomyelitis of the jaw with discharging sinuses.
  Osteomyelitis is common in the mandible horizontal process near the mentum, presenting with pain, swelling, discharging sinuses, bone thickening, loose teeth, and trismus. Sequestrum is commonly seen.