Dental abscesses in primary dentition represent one of the most common pediatric dental emergencies. They can lead to severe pain, swelling, and systemic involvement if not treated promptly.
馃搶 Recommended Article :
Dental Article 馃斀 Facial Cellulitis vs. Angioedema in Dental Emergencies: Key Differences, Severity, and Management ... Facial cellulitis and angioedema are two potentially life-threatening conditions frequently encountered in dental emergencies. Although both present with facial swelling, they differ significantly in etiology, clinical presentation, and treatment approach.This article reviews evidence-based approaches (2025) for diagnosis, management, and prevention, highlighting the importance of early intervention to preserve oral and general health.
Advertisement
✅ Introduction
A dental abscess is a localized collection of pus resulting from bacterial infection within the tooth or surrounding tissues. In primary teeth, it typically originates from untreated dental caries or pulp necrosis. According to current pediatric dentistry literature, acute and chronic abscesses can compromise both the primary and developing permanent dentition (Cunha-Cruz et al., 2023). The 2025 evidence emphasizes minimally invasive management, antibiotic stewardship, and preventive protocols to reduce recurrence and systemic spread.
馃搶 Recommended Article :
Dental Article 馃斀 Odontogenic Infections in Children: Updated Diagnosis, Treatment and Prevention Guidelines (2025) ... This academic article presents an updated overview of their causes, clinical presentation, therapeutic approach, and prevention strategies, based on current evidence and international recommendations.✅ Etiopathogenesis
Dental abscesses usually result from bacterial invasion through carious lesions reaching the pulp chamber. Streptococcus mutans, Prevotella, and Fusobacterium nucleatum are frequently isolated pathogens (Alves et al., 2024). Factors such as poor oral hygiene, dietary sugars, and previous untreated pulpitis accelerate progression to infection.
✅ Clinical Presentation
The most common features include:
▪️ Localized pain, tenderness, and swelling.
▪️ Gingival redness and fluctuation.
▪️ Possible lymphadenopathy or fever in advanced cases.
▪️ In radiographs: periapical radiolucency and bone resorption.
Pediatric patients often show behavioral changes such as irritability, difficulty eating, or sleep disturbance.
馃搶 Recommended Article :
Dental Article 馃斀 Antibiotic Selection in Pediatric Dental Infections: Updated Clinical Criteria for U.S. Dentists ... However, antibiotic prescription in pediatric patients requires careful consideration of the likely pathogens, the child’s age and weight, medical history, drug allergies, and antibiotic pharmacokinetics.✅ Diagnosis
Diagnosis is based on clinical and radiographic examination. Periapical radiographs and cone-beam CT (when indicated) help determine the extent of infection. Differential diagnoses include cellulitis, gingival abscess, pericoronitis, and periodontal abscess.
✅ Treatment Modalities (Evidence-Based 2025)
The 2025 consensus recommends an integrated management plan focusing on infection control, symptom relief, and tooth preservation when possible:
1. Drainage: Through pulp chamber, gingival incision, or extraction if non-restorable.
2. Antibiotic Therapy: Reserved for spreading infections or systemic symptoms.
▪️ First-line: Amoxicillin or Amoxicillin-Clavulanate.
▪️ Alternatives (allergy cases): Clindamycin or Azithromycin.
3. Pain Management: Paracetamol or Ibuprofen according to pediatric dosage.
4. Definitive Pulp Therapy: Pulpectomy or extraction for chronic lesions.
5. Follow-Up: Monitor healing and prevent involvement of permanent successors.
馃搳 Comparative Table: Differences Between Dental Abscess and Other Odontogenic Infections
| Condition | Main Features | Distinctive Factors |
|---|---|---|
| Dental Abscess | Localized pus collection, pain, swelling, possible systemic signs | Originates from pulpal necrosis or deep caries; may cause sinus tract formation |
| Cellulitis | Diffuse, rapidly spreading swelling with systemic involvement | No pus collection; requires systemic antibiotics and possible hospitalization |
| Gingival Abscess | Localized swelling of gingiva near the marginal area | Does not involve the tooth pulp; often due to foreign body impaction |
| Periodontal Abscess | Pus accumulation in periodontal pocket with pain and tooth mobility | Associated with chronic periodontitis; vital pulp |
| Pericoronitis | Inflammation around partially erupted tooth (often mandibular molar) | Occurs in eruption stage; linked with food impaction and soft tissue inflammation |
The 2025 evidence prioritizes conservative management over empirical antibiotic use, highlighting that overprescription contributes to antimicrobial resistance (Araujo et al., 2025). Minimally invasive dentistry, such as lesion sterilization and tissue repair (LSTR) and calcium hydroxide–based therapies, has shown success in maintaining primary teeth until exfoliation. Early detection, combined with parental education and caries prevention programs, significantly reduces the prevalence of abscesses in children.
✍️ Conclusion
Dental abscesses in primary teeth remain a major challenge in pediatric dentistry, yet early diagnosis and evidence-based management ensure favorable outcomes. The clinician’s goal is to control infection, preserve dental structure, and protect the developing permanent tooth germ.
馃搶 Recommended Article :
PDF 馃斀 Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation ...In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient.馃攷 Recommendations
▪️ Prioritize drainage over antibiotics unless systemic symptoms occur.
▪️ Employ radiographic monitoring to assess healing and successor tooth development.
▪️ Educate caregivers on oral hygiene, diet, and preventive visits.
▪️ Implement antibiotic stewardship protocols in all pediatric dental practices.
▪️ Refer severe or spreading infections to pediatric hospitals for multidisciplinary care.
馃摎 References
✔ Alves, M. R., Pereira, A. C., & Ribeiro, D. C. (2024). Microbiological analysis of odontogenic abscesses in children. International Journal of Paediatric Dentistry, 34(2), 157–165. https://doi.org/10.1111/ipd.13310
✔ Araujo, F. A., Lima, C. R., & Mendes, F. M. (2025). Antibiotic stewardship in pediatric dental infections: An evidence-based approach. Pediatric Dentistry Journal, 45(1), 20–30. https://doi.org/10.1016/j.pdj.2025.01.004
✔ Cunha-Cruz, J., et al. (2023). Dental infections in children: Epidemiology and management. Journal of Clinical Pediatric Dentistry, 47(4), 189–197. https://doi.org/10.17796/1053-4625-47.4.4
馃搶 More Recommended Items
► Allergic manifestations to local anaesthetic in pediatric dentistry: Prevention and management
► Odontogenic Infections and Their Link to Systemic Diseases: What Should We Monitor?
► Key Differences Between Pediatric and Adult Odontogenic Infections: Updated Clinical Guidelines