Periapical Abscess — ORE Part 1 MCQ

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EasyPharmacology & TherapeuticsPeriapical AbscessORE Part 1

A patient presents with a dental abscess with localised swelling. There is no trismus, dysphagia, or systemic signs of infection. The tooth is restorable. According to SDCEP guidance, what is the most appropriate management?

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Correct answer: A — Extirpate the pulp and establish drainage; antibiotics are not indicated

Option A is correct. SDCEP guidance explicitly states 'do not prescribe antibiotics unless there are signs of spreading infection or systemic involvement.' This patient has localised swelling only—no trismus, dysphagia, fever, malaise, or lymphadenopathy—therefore antibiotics are not indicated. The primary management is to establish drainage by extirpating the pulp (accessing the tooth endodontically) and, if a fluctuant intraoral swelling is present, incisional drainage. This local approach is both effective and preferred, reducing unnecessary antibiotic use. Option E (amoxicillin alone) and C (co-amoxiclav) are incorrect because antibiotics should not be prescribed without evidence of spreading infection or systemic signs. Option C (combination antibiotics) is over-treatment for a localised, non-spreading abscess. Option B (extraction) is unnecessary—the tooth is restorable and can be treated endodontically.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Acute Apical Abscess (MADP). https://madp.sdcep.org.uk/content/conditions-library/acute_apical_abscess.html; SDCEP. Prevention and Treatment of Periodontal Diseases in Primary Care (Acute Conditions). https://www.periodontalcare.sdcep.org.uk/guidance/managing-disease/other-periodontal-conditions/acute-conditions/