Dental Abscess

[Annette]

Do you drain dental abscesses? Are you taught?

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[kbrown]

Do you drain dental abscesses? Are you taught?

Yup. Lanced one the other day. Sent home with abx, pain control and dental follow up.

 

[Seaglass]

Yes, do it all the time.

 

[primadonna22274]

Yes, and it's a very happy patient who gets the sudden relief from the dental block...and it's so satisfying to drain pus. And then antibiotics, pain relief and dental f/u ASAP. Dental abscesses are the only dental pain I don't mind seeing because they're obviously in need of a service we can provide and always grateful.

 

[kungfufishing]

Dental/inf alveolar blocks are among my favorite quick procedures. Near immediate tangible results for that 0300 legit "I cant sleep" toothache prior to draining the abscess if they have one.

 

[Dr.Evil1]

I believe that the December issue of ACEP News had a great article about dental blocks. Unfortunately that issue is no longer online but if you have it laying around it is great. I am married to a dentist so I have a immediate consult if I need one. The inferior alveolar block, mental nerve block and local blocks for upper teeth are about the only things that you need to deal with tooth pain. My wife does not recommend routinely doing palatal blocks as they are very painful and usually only necessary if you are doing an extraction or root canal. I only drain an abscess if I can see a large swelling and then it is only a stab incision. These won't heal completely until the tooth is extracted or a root canal is performed so they still need to get dentistry/oral surgery follow-up.

 

[Annette]

Thanks, Dr. Evil and everyone else. I've had a number of dental abscess pts admitted with no one to lance the damn thing. I can get them to a dentist as an outpt, but the abx take longer without draining the abscess. So, I get stuck keeping a pt inhouse awhile when they could have been out the next day.

 

[Apollyon]

Drainage of abscesses is curative. I could describe a technique to you (but would probably miss some important points) that is very simple to do to drain them, but you can go to MDConsult.com and see a Roberts and Hedges procedure book fully online, and it will have the procedure (it involves taking the cap off of an 18g needle and cutting off part of the cap, then putting the cap back on the needle, with the amount of needle exposed corresponding to how deep you want to go into the abscess). The cap works as a guard so you don't go too deep.

Now, if you go down to the ED and do this, you will 1. look like a rock star and 2. save an admission.

 

[southerndoc]

Now, if you go down to the ED and do this, you will 1. look like a rock star and 2. save an admission.

If you're fee-for-service, she would also have a billable procedure.

 

[Dr.Evil1]

Drainage of abscesses is curative. I could describe a technique to you (but would probably miss some important points) that is very simple to do to drain them, but you can go to MDConsult.com and see a Roberts and Hedges procedure book fully online, and it will have the procedure (it involves taking the cap off of an 18g needle and cutting off part of the cap, then putting the cap back on the needle, with the amount of needle exposed corresponding to how deep you want to go into the abscess). The cap works as a guard so you don't go too deep.

Now, if you go down to the ED and do this, you will 1. look like a rock star and 2. save an admission.

I think that you are describing a technique of draining a peritonsilar abscess so that you don't hit the carotid.

Again, I would not do anything more than drain small abscesses where I am able to see a defined swelling. This is a temporizing procedure and absolutely requires the patient to still get further evaluation from a dentist. The whole reason that they get these abscesses is that there is a source of infection (tooth) that needs to be treated still. You can drain the abscess all you want but until you remove the source you will get recurrence.

 

[Apollyon]

I think that you are describing a technique of draining a peritonsilar abscess so that you don't hit the carotid.

Again, I would not do anything more than drain small abscesses where I am able to see a defined swelling. This is a temporizing procedure and absolutely requires the patient to still get further evaluation from a dentist. The whole reason that they get these abscesses is that there is a source of infection (tooth) that needs to be treated still. You can drain the abscess all you want but until you remove the source you will get recurrence.

That's why I gave the cursory overview - just so she could find the right procedure in the book.

 

[Seaglass]

Here's a question for Annette - aren't you EM/IM? In that case, why don't you lance it . . .