The acute dental abscess is frequently underestimated in terms of its morbidity and mortality. The risk of potential serious consequences arising from the spread of a dental abscess is still relevant today with many hospital admissions for dental sepsis. The acute dental abscess is usually polymicrobial comprising facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group, with predominantly strict anaerobes, such as anaerobic cocci,Prevotella and Fusobacterium species. The use of non-culture techniques has expanded our insight into the microbial diversity of the causative agents, identifying such organisms as Treponema species and anaerobic Gram-positive rods such as Bulleidia extructa, Cryptobacterium curtum and Mogibacterium timidum. Despite some reports of increasing antimicrobial resistance in isolates from acute dental infection, the vast majority of localized dental abscesses respond to surgical treatment, with antimicrobials limited to spreading and severe infections. The microbiology and treatment of the acute localized abscess and severe spreading odontogenic infections are reviewed
The acute dental abscess is frequently underestimated in terms of its morbidity and mortality. The acute dental abscess usually occurs secondary to dental caries, trauma or failed root treatment. After the intact pulp chamber is breached, colonization of the root canals occurs with a diverse mix of anaerobic bacteria. The walls of the necrotic root canals become colonized by a specialized mixed anaerobic biofilm (Chavez de Paz, 2007). While asymptomatic necrosis is common, abscess formation occurs when these bacteria and their toxic products enter the periapical tissues via the apical foramen and induce acute inflammation and pus formation (Nair, 2004). The root canal microbiota is the main stimulus for the development of acute symptoms. The main signs and symptoms of the acute dental abscess (often referred to as a periapical abscess or infection) are pain, swelling, erythema and suppuration usually localized to the affected tooth, although the abscess can frequently spread causing a spreading odontogenic infection which can be accompanied by sepsis syndrome. The role of bacteria in the pathogenesis of the lesion is undisputed but modern diagnostic techniques have not identified a single causative pathogen. The dentoalveolar abscess is polymicrobial comprising various facultative anaerobes, such as the viridans group streptococci and the Streptococcus anginosus group, and strict anaerobes, especially anaerobic cocci, Prevotella and Fusobacterium species. The presence of anaerobes both cultivable and uncultivable tends to predominate. The vast majority of dental abscesses respond to surgical treatment, such as drainage of pus and elimination of the source of infection, with antibiotic use limited to severe spreading infections. The microbiology of the acute dentoalveolar abscess and its treatment in the light of improved culture and diagnostic methods are reviewed.
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