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Abscess Systemic Signs Complete Plan — ORE Part 1 MCQ

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ModerateEndodonticsAbscess Systemic Signs Complete PlanORE Part 1

A patient presents with an acute periapical abscess associated with a restorable lower molar. Their temperature is 38.5°C and they report malaise; submandibular lymphadenopathy is present. There is no dysphagia, dyspnoea or voice change. Which management plan is most appropriate?

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

Reveal the answer and explanation

Correct answer: D — Drain through the tooth, prescribe an appropriate antibiotic and analgesia, then complete root canal treatment

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

A is correct. Fever and malaise indicate systemic infection, while submandibular lymphadenopathy is a sign of spreading infection; therefore an antibiotic is justified. SDCEP also advises drainage of an acute apical abscess through the affected tooth where possible. As the tooth is restorable, drainage followed by definitive root canal treatment preserves the tooth, with analgesia for pain control. B incorrectly relies initially on antibiotics without source control. C removes a restorable tooth and, in this clinical context, omits indicated antibiotic treatment. D does not address the infected root canal and chlorhexidine mouthwash is inadequate. E omits antibiotics despite systemic/spreading features and delays necessary acute infection control.

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/