Dental abscess: The Daily PANCE Blueprint

The answer is A. Obtain CT head/neck, obtain cultures, give a fluid bolus, start IV amoxicillin / clavulanic acid, and consult an oral surgeon

A dental abscess is defined as the accumulation of purulent fluid in the periodontal tissue or dental pulp. The most common type is a periodical abscess. Due to tooth decay or trauma, bacteria start to overgrow and infect the pulp of the tooth, leading to a collection of pus. Clinical features include swelling/erythema, purulent discharge, tooth pain, etc. Red flags of a severe/spreading infection include trismus, lymphadenopathy, headache, neck pain, swelling of the face/neck, and fevers. CT head/neck should be obtained if these red flags are present. An oral surgeon or dentist should consult for I&D of the abscess. IV antibiotics should b started (e.g., Augmentin, penicillin, etc). This patient in the question has sepsis from his abscess; therefore, blood cultures should be obtained and a sepsis fluid bolus should be given.