Minor collections (true “dental abscess”, sometimes known in lay terms as a “gum boil”) are manageable by simple incision and drainage under topical or conventional local anaesthesia. The source of the infection should be eliminated by extraction or, if the tooth is felt to be salvageable, root canal or periodontal therapy (possible in minor infections). Any pus present must be drained and samples cultured. All the involved tissue spaces should be explored. Antibiotics are an adjunct to drainage and should not be used in isolation.
The above scenario has nothing in common with the potentially lethal severe cervicofacial (affecting the neck and face) infections seen in the hospital environment. There early assessment and control of the airway is essential, involving anaesthesia. Securing the airway early (often combined with adequate drainage after awake flexible fibre optic intubation) is mandatory. Monitoring the airway and hydration of the patient are very important.
The risk here is that a combination of abscess formation and spreading cellulitis develops with airway compromise created both by direct pressure from the collection of pus in the abscess and the fluid swelling permeating throughout the surrounding soft tissues.
Next section: Abscess