Decompression of a dental abscess
Decompression of a dental abscess is something that is rare but beneficial with large lesions. Endodontists and oral surgeons are probably the main two specialists with training in this area.
Steps for decompression of a dental abscess
The steps for decompression depend to some degree on where it is in the mouth. There needs to be some way to maintain the opening to allow drainage and healing of the lesion.
- Aspirate with a 18 gauge needle.
- Incisional biopsy trying to get as large a piece(s) of the lesion as possible.
- Curettage lesion
- Saline rinses of lesion
- Place some sort of tubing into the lesion and stabilize it with sutures. Examples from literature are 3.5mm long pediatric endotracheal tube, polyvinyl tubing, radiographic latex tubing, cannula, customized removable denture, iodoform gauze, and orthodontic stainless steel tube.
What does the patient need to do?
After a few days of healing the patient will remove the tubing and flush the inside of the lesion and the tubing daily with saline. They will need to trim the length of the tubing as the lesion heals and the defect fills in. Eventually the tubing will not longer stay in place.
What causes the need for decompression?
A large lesion is often one that we may want to treat with decompression instead of immediate removal. Anything larger than 2.5 cm or any through and through lesion are lesions that will have unpredictable healing potential with root canal treatment alone. Lesions is critical areas as also candidates, such as near the nasal floor, IAN, and adjacent root apex. There are several types of lesions that benefit from this procedure. The diagnosis will help determine the appropriate course of action. Some large radicular lesions of odontogenic nature benefit from decompression as it makes the lesion smaller and more manageable surgically. The root canal is usually done at the same time for these lesions.
Other names in the literature for decompression
Decompression is not a new procedure, it has been around around for over a century. Decompression is also seen as marsupialization and exteriorization. The term fistulative surgery is also in endodontic literature. Tian JOE 2019 has a nice case study with lots of info.