dental disorders
How To Drain a Tooth Abscess
Step by Step Description of Procedure
Wear sterile gloves and a mask and safety glasses, or a face shield. Retract soft tissues (eg, cheek or tongue) to expose the abscess. Provide anesthesia Use gauze to thoroughly dry the area. Use suction as needed to keep the area dry. Use a cheek or tongue retractor as needed to visualize the area. Apply topical anesthetic with cotton-tipped applicators, and wait 2 to 3 minutes for the anesthesia to occur. Do a site-appropriate nerve block, but only if the anesthetizing needle will not track the infection into uninfected tissue (refer to How To Do an Inferior Alveolar Nerve Block ; Alternatively (or if the nerve block is not adequate), do local infiltration (field block) around the abscess: Inject 1 to 2 mL into the mucosa anterior and posterior to the abscess, and then at sites along the circumference. Do not pass the needle into any infected tissue. Allow sufficient time for anesthetic to take effect (5 to 10 minutes). While awaiting onset of anesthesia, have the patient do a 30-second swish-and-spit with 0.12%chlorhexidineoral rinse. Ifchlorhexidineis not available, swab the incision site with povidone iodine. Consider sedation or other anesthesia if needed. Incise and drain the abscess Palpate the abscess to determine its extent and the area where maximum dependent drainage can be obtained. Make a 1- to 2-cm incision into the abscess near its most fluctuant point but not into necrotic or friable tissue if possible. Try to enter perpendicular to underlying bone. Use suction and gauze squares to remove the exuding pus. Insert a hemostat into the full depth of the abscess space. Open the jaws to break up any loculations. Do this in multiple directions to open into the entire space. With each entry, once the jaws are opened, do not close them while in the abscess space, to avoid crushing vital structures and keep the jaws open as you remove the hemostat. Copiously irrigate the abscess space with sterile saline using a large syringe with a plastic IV catheter attached. Do not irrigate forcibly; all fluid introduced should be seen to passively flow back out and be suctioned up. For larger infections, insert a segment of Penrose drain (1 cm diameter) or a substitute (eg, a cut strip of sterile glove) to the full depth of the abscess space and secure it with a single nonabsorbable suture (eg, 3-0 silk) in healthy tissue near the edge of the incision. 