Acute Periapical Abscess

Once periapical pathology sets in, the tissues surrounding the tooth (including the alveolar bone) are affected, culminating in liquefaction necrosis and formation of a tooth abscess. The abscess can present as a dental emergency with varying degrees of cellulitis and fascial space infection.

The tooth in question is tender to touch and there is increase in local temperature. The patient may present with pyrexia and regional lymphadenitis with inability to chew on the affected side. Infection with periorbital edema due to an upper premolar or molar infection needs urgent attention for infection and pain control.

The root apices of the lower second molar are anatomically located in the bone more caudal than the mylohyoid muscle, also known as the oral diaphragm. An infected lower second molar has the propensity to trigger a space infection called Ludwig's angina.

Ludwig's angina is an emergency and presents with boardlike rigidity of the floor of the mouth, with elevation of the tongue and respiratory embarrassment, pyrexia, pain, and swelling of the face. The condition requires hospitalization and management by a maxillofacial surgeon.

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