How can I differentiate between a dental abscess and other oral conditions that may present similarly?

Differentiating between a dental abscess and other oral conditions with similar symptoms involves assessing the specific presentation, the presence of systemic signs, and the response to initial management.

Key Features of a Dental Abscess:

• A dental abscess typically presents with localised pain and swelling NICE CKS.
• Pain may be exacerbated by temperature changes or biting NICE CKS.
• Systemic signs such as fever, malaise, or lymphadenopathy can occur with a dental abscess, indicating a spreading infection NICE CKS.
• Definitive treatment for a dental abscess involves local surgical intervention by a dentist, such as root canal treatment, tooth extraction, or incision and drainage, as medication alone will not eliminate the source of infection NICE CKS.

Differentiating from Other Oral Conditions:

• Lack of Response to Treatment: If a person with a suspected dental abscess does not respond to first-line antibiotic treatment or becomes systemically unwell after initial management, an alternative diagnosis or the development of a complication should be considered NICE CKS. In such cases, urgent dental intervention or advice from an oral and maxillofacial specialist is needed NICE CKS.
• Signs of Serious Complications: While a dental abscess can cause systemic symptoms, certain signs indicate a serious complication requiring emergency hospital admission. These include signs of airway compromise (e.g., difficulty breathing or speaking, inability to swallow saliva, drooling, trismus), high temperature with cardio-respiratory compromise, rapidly progressing infection, significant mandibular, submandibular, or infraorbital swelling, 'floor of mouth' swelling, spreading facial infection, orbital cellulitis, or neurological signs NICE CKS.
• Oral Cancer: Conditions like oral cancer can present with oral lumps or ulceration, which might be confused with an abscess. Consider a suspected cancer pathway referral if there is an unexplained ulceration in the oral cavity lasting for more than 3 weeks, or an unexplained lump on the lip or in the oral cavity NICE NG12. An unexplained, persistent neck lump can also be a sign of oral cancer NICE NG12. These require urgent assessment by a dentist or a suspected cancer pathway referral NICE NG12.
• Cemento-osseous Dysplasia: This condition is noted as a radiological mimic of a periapical dental abscess, meaning it can appear similar on imaging Resnick & Novelline 2008. Clinical assessment is crucial to differentiate, as cemento-osseous dysplasia may not present with the acute inflammatory signs of an abscess.