Local measures
Local measures for control of infection
Suitable for:
- non-vital primary and permanent teeth with dental abscesses or periapical/periradicular periodontitis
Aim: To drain localised infection, thereby relieving pain and reducing the risk of the infection spreading and the need for antibiotics.
The majority of dental infections can successfully be managed by local measures. Antibiotics should not be first line treatment unless there are signs/symptoms of systemic involvement, spreading infection and/or the child is medically compromised.
For a child who presents with acute dental infection, the use of local measures to bring symptoms under control can be a useful approach to initially manage a distressed child. It is important to highlight to the child and parent/carer that these approaches do not resolve the source of infection, and that subsequent treatment will be necessary.
For primary teeth, consider using gentle hand excavation of carious tissue to drain infection without local anaesthesia to achieve an open communication with the necrotic pulp chamber.
- If drainage is achieved by this method, it is advisable not to place any form of dressing that would inhibit further drainage.
- For teeth that become tender prior to achieving drainage, a corticosteroid dressing may be placed. When placing such a dressing, a temporary restorative material that can easily be removed by hand instruments should be used. This allows easy removal of the dressing should it become necessary at future visits.
- Incision into the soft tissues to achieve drainage is rarely indicated in the primary dentition, and would require suitable anaesthesia to be administered.
For permanent teeth, consider accessing the pulp chamber to remove the necrotic pulp and/or achieve drainage.
- In circumstances where a larger fluctuant intraoral swelling is present, it may be appropriate to undertake incision of the swelling undertaken under local anaesthesia.