426 Section 12/ Dental Pharmacologyabscess is incision and drainage or RCT or
extraction supported by antimicrobial and
NSAlD’s.
Cellulitis- Proliferation of epithelial cell
cysts may convert the granuloma into a
periapical cyst. The pus in the periapical
abscess may track through the alveolar
bone into soft tissues, causing cellulitis and
bacteremia, or may discharge into the oral
cavity, into the maxillary sinus, or through
the skin of the face or submandibular area.
Maxillary infection also may spread to the
periorbital area, increasing the risk of other
serious complications including loss of
vision, carvernous sinus thrombosis and
CNS involvement.
Outpatient with localized cellulitis
should be treated by the physician with
antistreptococcal oral antibiotics e.g. oral
penicillin and in case of penicillin allergy,
macrolide antibiotics may be substituted
with appropriate pain medication.
Definitive theraphy is root canal treatment
or extraction.
In severe infection, patients be
hospitalized under the direct supervision
of physician and treatment should be
started immediately with intravenous
broad- spectrum antibiotics and surgical
drainage if abscess formation is detected.
Peridontal disease- It is an inflammatory
destruction of the periodontal ligament and
supporting alveolar bone and the main
etiologic agent is bacterial plaque. Multiple
bacteria are implicated but after progressing
the disease, gram negative anaerobes
predominate. It is characterized by
throbbing pain with erythema and swelling
over the affected tissue. At this stage, if left
untreated, the abscess may rupture or less
commonly, progress to cellulitis.
The treatment is drainage and debride-
ment of the infected perdontal area sup-
ported with antibiotics.
Pericoronitis- It is the inflammation of
soft tissues surrounding the crown of a
partially erupted tooth and most
commonly, a wisdom tooth. It generally
occurs when bacterial plaque and food
debris accumulate beneath the flap of gum
covering the partially erupted tooth. It is
characterized by inflammation, often
complicated by trauma from the opposing
tooth, leads to swelling of the flap,
tenderness, pain and a bad taste due to pus
oozing from beneath the flap.
In localized pericoronitis, hot saline
mouthwashes and irrigation under the flap
can resolve symptoms in most of the cases.
Severe disseminated cases with spreading
cellulitis should be treated with penicillin
and appropriate medication for pain.
Dental trauma- Dental trauma is
extremely common in children with injuries
to their primary or permanent teeth.
Examination of any injury should focus on
related soft tissue injuries and the need for
suturing, signs of tooth loosening,
displacement or fracture or any other
disturbance in the bite or other signs of
alveolar fracture. The complete diagnosis
require dental radiograph (x-rays) and
need follow up with the dentist for
complete diagnosis, treatment and long-
term care.
Tooth fracture may involve the crown,
root or both and with or without the
exposure of the pulp. Fracture exposing the