Periodontal Abscess — ORE Part 1 MCQ

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ModeratePeriodontologyPeriodontal AbscessORE Part 1

A patient presents with an acute lateral periodontal abscess on the mesial aspect of the lower right first molar. There is a 7 mm probing depth on the mesial surface with suppuration. There is no evidence of spreading infection, cellulitis, lymphadenopathy, fever or systemic malaise. What is the most appropriate initial management?

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Correct answer: D — Subgingival debridement of the pocket under local anaesthesia with drainage of pus

The correct answer is D. SDCEP guidance is unambiguous: acute periodontal conditions (including abscesses) are managed by local measures first—specifically drainage of pus and mechanical debridement under local anaesthesia. This removes the source of infection and symptom relief. Antibiotics are not indicated in uncomplicated cases without evidence of spreading cellulitis, lymphadenopathy, fever or systemic malaise. Option C (amoxicillin) incorrectly prescribes antibiotics without drainage; moreover, phenoxymethylpenicillin (not amoxicillin) is now preferred first-line if antibiotics are necessary, due to narrower spectrum. Option A (extraction) is premature without conservative therapy. Option E (flap surgery) is inappropriate for acute abscess management—surgical approaches are later steps in chronic disease. Option B (metronidazole) also prescribes antibiotics prematurely and defers management for 1 week without immediate drainage, which is unsafe. The discriminating feature is recognition that drainage and local mechanical therapy (not antibiotics or surgery) is the evidence-based first step.

Reference: SDCEP Prevention and Treatment of Periodontal Diseases in Primary Care (2nd edition, 2025) and Management of Acute Dental Problems (2024). https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/acute-periodontal-conditions/