31/08/2025
🔹 1. Periapical Abscess
Begins at the tooth apex due to pulp necrosis from deep caries or trauma. Tooth is non-vital, tender, and may drain through a sinus tract.
Treatment: Drain pus via root canal or extraction; incision & drainage if swelling is fluctuant.
Rx: Amoxicillin 500 mg TDS ×5 days ± Metronidazole 400 mg TDS; Ibuprofen 400 mg TDS for pain.
🔹 2. Periodontal Abscess
Forms in a deep periodontal pocket, often from calculus or food impaction. Tooth remains vital.
Treatment: Drain via pocket, scaling, and root planing.
Rx: Same antibiotics + Chlorhexidine 0.12% rinse BID ×7 days.
🔹 3. Gingival Abscess
Confined to gum tissue, caused by trauma or foreign objects.
Treatment: Remove irritant, irrigate, and drain.
Rx: Analgesics only; antibiotics rarely required.
🔹 4. Pericoronal Abscess (Pericoronitis)
Occurs around a partially erupted tooth (often wisdom teeth). Presents with pain, foul taste, and trismus.
Treatment: Irrigate under operculum, debride debris, prescribe antibiotics if systemic signs; extract tooth or remove flap after infection control.
Rx: Amoxicillin ± Metronidazole, Ibuprofen, warm saline rinses.
💊 Why These Medicines?
• Amoxicillin: First-line, broad-spectrum, penetrates bone well.
• Metronidazole: Adds strong anaerobic coverage (Prevotella, Fusobacterium).
• Clindamycin: Alternative for penicillin allergy.
• Ibuprofen + Paracetamol: Superior pain control and anti-inflammatory effect.
• Chlorhexidine: Kills bacteria and supports healing.
• Warm saline: Natural soothing and drainage aid.
👉🏻 Antacids to be prescribed as indicated
📌 Key Takeaway: Antibiotics are only adjuncts—definitive treatment is drainage via RCT, extraction, or incision. Quick intervention prevents severe complications.
