Anamnestic data may point out recent trauma or dental procedures, e.g., deep fillings or root canal treatment. However, DA may also develop as a complication of caries, and affected individuals may not report any prior symptoms [1].

Local swelling and toothache predominate the clinical picture in case of acute DA. The affected tooth is very sensitive to percussion, and the patient may describe acute pain on biting [2]. Moreover, patients may present with constitutive symptoms like malaise, fever, and lymphadenopathy [3]. Trismus has been observed and has been associated with spreading dental infection [4]. The spread of the disease may also cause intraoral swelling and spontaneous drainage of pus or cellulitis, depending on the route of propagation. Patients may develop life-threatening sepsis [5] [6]. Airway obstruction due to swelling of submandibular tissues has been described and may require emergency attention [7]. Chronic disease is not usually associated with any complaints, but symptoms may develop upon an exacerbation of the inflammatory process.

DA diagnosis is based on radiographic imaging. In most cases, plain radiography yields reliable results [2]:

• The most common form of DA is the apical abscess, which is related to an endodontic infection. It may only affect teeth devoid of a vital pulp, either due to caries, trauma, or root canal treatment. Radiographs may thus depict anomalies consistent with the disease’ etiology, e.g. radiolucency in the crown in case of caries [8]. The infection may spread to adjacent bones and osseous tissue may be destructed. This development corresponds to the appearance of periapical radiolucent foci in radiographic images. Of note, local bone resorption is primarily an indicator of chronic DA, and affected individuals are usually asymptomatic. Radiographic findings may be absent in patients suffering from acute DA unless the latter has been preceded by chronic infection.
• An accumulation of pus in periodontal tissues is referred to as a periodontal abscess. This type of DA is less common. If a periodontal abscess is located close to the gingival surface, a bulge may be noted during early stages of the disease. Bone resorption is to be expected in patients suffering from chronic disease. Here, osseous lesions are observed periodontally [9]. Otherwise, clinical and radiographic features largely resemble those observed in cases of apical DA.

Additional techniques, namely sonography, computed tomography and magnetic resonance imaging may be employed to assess a possible route of spread of the infection [4] [10].

Laboratory analyses of blood samples may be carried out. Leukocytosis and anomalies consistent with dehydration may indicate a spreading infection [4]. Concentrations of inflammatory parameters like C-reactive protein are usually enhanced.

An aspiration through the intact disinfected mucosa is best suited for bacterial culture and sensitivity testing [4]. However, the determination of pathogens causing DA poses a major challenge. Multiple species are involved in this process, and culture conditions should be chosen to facilitate the growth of anaerobic and aerobic bacteria [2] [11]. Alternatively, causative pathogens may be identified using molecular biological techniques.

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