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Vestibular Abscess I&D — ORE Part 1 MCQ

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EasyOral SurgeryVestibular Abscess I&DORE Part 1

A systemically well adult has had a painful swelling in the upper right buccal sulcus for 2 days. There is no dysphagia, trismus or breathing difficulty. Examination shows a fluctuant vestibular swelling adjacent to the upper right first molar. The tooth has a large carious lesion, is tender to percussion and gives no response to sensibility testing. What is the immediate management?

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

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Correct answer: C — Incise and drain the vestibular abscess under local anaesthesia, then treat the tooth definitively

This is an acute apical abscess: a non-vital, carious tooth is associated with a fluctuant vestibular collection. In a systemically well patient without airway compromise, the immediate priority is local drainage. SDCEP advises attempting incisional drainage as soon as possible when a fluctuant soft-tissue swelling is present; the source tooth is then managed by root canal treatment or extraction according to restorability and patient factors. Antibiotics alone are not first-line treatment when local drainage can be achieved. Extraction may ultimately be appropriate, but option E does not address the established fluctuant soft-tissue collection. Analgesics and chlorhexidine may be adjuncts but do not provide source control or drain pus.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Acute Dental Problems, 2nd edition (March 2026), “Acute apical abscess”. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/acute-apical-abscess/