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Periapical Abscess — ORE Part 1 MCQ

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ModerateEndodonticsPeriapical AbscessORE Part 1

A patient presents with an acute apical abscess associated with the lower left first molar. There is a 2 cm submandibular swelling. The patient has no trismus, dysphagia, dyspnoea or systemic illness, and their temperature is 37.2°C. The tooth is restorable. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Establish drainage through the tooth and prescribe amoxicillin

Explanation lettering: B = shown as A · A = shown as B · E = shown as D · D = shown as E

The correct answer is A. A submandibular swelling is a neck swelling, which SDCEP lists as a sign of spreading infection in acute apical abscess. Therefore, antibiotics are indicated in addition to definitive local management. The source of infection should be controlled by drainage through the tooth where possible; a restorable tooth should not be extracted solely because an abscess is present. B would be appropriate for a localised abscess without facial or neck swelling or systemic features, but not here. C and E omit essential drainage, and routine dual-antibiotic therapy is not justified by this presentation. D unnecessarily sacrifices a restorable tooth; extraction may be an alternative means of source control only when retention is inappropriate.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of acute dental problems: Acute apical abscess, accessed 24 July 2026. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/acute-apical-abscess/