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If the tooth is to be removed, drainage will occur via the socket. Otherwise, if pus is already discharging from the periodontal pocket, this can be encouraged by gentle irrigation and scaling of the pocket whilst massaging the soft tissues. If this does not work, incision and drainage is required, as described in Dental abscess Treatment.
A dental abscess is a localized collection of pus associated with a tooth. The most common type of dental abscess is a periapical abscess, and the second most common is a periodontal abscess. In a periapical abscess, usually the origin is a bacterial infection that has accumulated in the soft, often dead, pulp of the tooth.
Incision and drainage (I&D), also known as clinical lancing, are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected paranasal sinus.
After stabilizing the patient's airway, extracting the infected tooth will typically promote adequate drainage and the infection will resolve shortly thereafter. If the infection involves multiple primary spaces or any of the secondary spaces previously mentioned, then incision and drainage with culture-guided antibiotics may be indicated.
A sublingual abscess may elevate the tongue and cause drooling or dysphagia (difficulty swallowing). There is usually little swelling visible on the face outside the mouth. If the space contains pus, the usual treatment is by incision and drainage. The site of the incision is intra-oral, made lateral to sublingual plica.
A periodontal pocket can become an infected space and may result in an abscess formation with a papule on the gingival surface. Incision and drainage of the abscess may be necessary, as well as systemic antibiotics; placement of local antimicrobial delivery systems within the periodontal pocket to reduce localized infections may also be considered.
Drainage can also be performed via the tooth socket, once the causative tooth is extracted. If neither of those measures succeeds, or they are impossible, incision and drainage may be required, in which a small incision is made in the soft tissues directly over the abscess at the most dependent point. A surgical instrument such as a pair of ...
If the space contains pus, the usual treatment is by incision and drainage. The site of the incision is extra-oral, and usually made 2–3 cm below, and parallel to, the inferior border of the mandible. Ludwig's angina is a serious infection involving the submandibular, sublingual and submental spaces bilaterally. [3]