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10. Medical and minor surgical procedures
Dental infections
Infectio n arising as a seco nd ary co m p licatio n o f an inflam m atio n o f the d ental p ulp .
T he severity and the treatm ent o f d ental infectio ns d ep end o n their evo lutio n: lo calised
to the infected to o th, extend ed to ad jacent anato m ical structures o r d iffuse infectio ns.
Clinical features and treatment
Infection localised to a tooth and its surroundings (acute dental abscess)
– Intense and co ntinuo us p ain.
– O n exam inatio n: sw elling lim ited to th e gum surro und ing th e infected to o th .
P urulent exud ate m ay be p resent d raining either thro ugh the ro o t canal, o r thro ugh
the p erio d o ntal ligam ent (lo o sening the to o th) o r thro ugh a gingival fistula. T here are
no signs o f the infectio n extend ing to ad jacent anato m ical structures no r general signs
o f infectio n.
– T reatm ent:
• T reatm ent is o nly surgical (the so urce o f infectio n is inaccessible to antibio tics): ro o t
canal therap y (d isinfectio n o f the ro o t canal) if p o ssible o r extractio n o f the t1o o th.
• P ain: paracetamol o r ibuprofen P O (see Pain, p age 2 9 ).
Infections extending to adjacent anatomical structures (acute dento-
alveolar abscess)
L o cal sp read ing o f an acute d ental abscess into the surro und ing bo ne and tissue.
– P ainful gingival and buccal swelling with warm and tend er sk in, d evelo p ing into a
rip e abscess: intense p ain, with trism us, p articularly if the infectio n is in a p o sterio r
to o th, p resence o f general signs (fever, fatigue, cervical ly m p had eno p athy ).
– I n p atients with acute gangreno us cellulitis (crep itatio ns o n p alp atio n), treat as an
infectio n extend ing into the cervico -facial tissues (fo llo wing p age).
– T reatm ent: 10
• F irst surgical: incisio n and d rainage o f the p us o r extractio n o f the to o1 th.
• T hen antibio tic treatm ent fo r 5 d ay s fo llo wing the p ro ced ure: amoxicillin P O
C hild ren: 5 0 m g/ k g/ d ay in 2 d ivid ed d o ses
A d ults: 2 g/ d ay in 2 d ivid ed d o ses
Notes:
I f the d ental p ro ced ure h as to be d elay ed (lo cal anaesth esia no t p o ssible d ue to
inflam m atio n, significant trism us), start with antibio tic treatm ent, but the d ental
p ro ced ure m ust be co m p leted in the fo llo wing d ay s.
I f there is no im p ro vem ent within 4 8 to 7 2 ho urs after the d ental p ro ced ure, d o no t
change antibio tic, but start a new p ro ced ure o n the to o th.
• P ain: paracetamol o r ibuprofen P O (see Pain, p age 2 9 ).
1 For techniques of dental extraction, see the MSF handbook, Minor surgical procedures in remote areas.
287
Dental infections
Infectio n arising as a seco nd ary co m p licatio n o f an inflam m atio n o f the d ental p ulp .
T he severity and the treatm ent o f d ental infectio ns d ep end o n their evo lutio n: lo calised
to the infected to o th, extend ed to ad jacent anato m ical structures o r d iffuse infectio ns.
Clinical features and treatment
Infection localised to a tooth and its surroundings (acute dental abscess)
– Intense and co ntinuo us p ain.
– O n exam inatio n: sw elling lim ited to th e gum surro und ing th e infected to o th .
P urulent exud ate m ay be p resent d raining either thro ugh the ro o t canal, o r thro ugh
the p erio d o ntal ligam ent (lo o sening the to o th) o r thro ugh a gingival fistula. T here are
no signs o f the infectio n extend ing to ad jacent anato m ical structures no r general signs
o f infectio n.
– T reatm ent:
• T reatm ent is o nly surgical (the so urce o f infectio n is inaccessible to antibio tics): ro o t
canal therap y (d isinfectio n o f the ro o t canal) if p o ssible o r extractio n o f the t1o o th.
• P ain: paracetamol o r ibuprofen P O (see Pain, p age 2 9 ).
Infections extending to adjacent anatomical structures (acute dento-
alveolar abscess)
L o cal sp read ing o f an acute d ental abscess into the surro und ing bo ne and tissue.
– P ainful gingival and buccal swelling with warm and tend er sk in, d evelo p ing into a
rip e abscess: intense p ain, with trism us, p articularly if the infectio n is in a p o sterio r
to o th, p resence o f general signs (fever, fatigue, cervical ly m p had eno p athy ).
– I n p atients with acute gangreno us cellulitis (crep itatio ns o n p alp atio n), treat as an
infectio n extend ing into the cervico -facial tissues (fo llo wing p age).
– T reatm ent: 10
• F irst surgical: incisio n and d rainage o f the p us o r extractio n o f the to o1 th.
• T hen antibio tic treatm ent fo r 5 d ay s fo llo wing the p ro ced ure: amoxicillin P O
C hild ren: 5 0 m g/ k g/ d ay in 2 d ivid ed d o ses
A d ults: 2 g/ d ay in 2 d ivid ed d o ses
Notes:
I f the d ental p ro ced ure h as to be d elay ed (lo cal anaesth esia no t p o ssible d ue to
inflam m atio n, significant trism us), start with antibio tic treatm ent, but the d ental
p ro ced ure m ust be co m p leted in the fo llo wing d ay s.
I f there is no im p ro vem ent within 4 8 to 7 2 ho urs after the d ental p ro ced ure, d o no t
change antibio tic, but start a new p ro ced ure o n the to o th.
• P ain: paracetamol o r ibuprofen P O (see Pain, p age 2 9 ).
1 For techniques of dental extraction, see the MSF handbook, Minor surgical procedures in remote areas.
287
