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Necrotic pulp with acute apical abscess — ORE Part 1 MCQ

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HardRestorative DentistryNecrotic pulp with acute apical abscessORE Part 1

A 52-year-old man presents with a painful lower premolar and a buccal swelling. He reports malaise and has a temperature of 38.3°C. The tooth has a large carious cavity, gives no response to sensibility testing, and a periapical radiograph shows widening of the periodontal ligament space with an early apical radiolucency. He can swallow normally. What is the most appropriate immediate management?

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

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Correct answer: C — Establish drainage, provide local source control, and prescribe antibiotics

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

This is an acute apical abscess associated with a necrotic pulp. Buccal swelling, fever and malaise indicate spreading/systemic infection; because swallowing is normal, there is no stated airway compromise requiring emergency transfer. Management requires urgent local source control, usually drainage through endodontic access when feasible, with incision and drainage if there is a fluctuant soft-tissue collection. Antibiotics are justified as an adjunct because systemic features are present, but must not replace drainage. Antibiotics alone (A) fail to remove the source. Coronal restoration or crown preparation (B, C) does not treat the infected canal or drain the abscess. Chlorhexidine and delayed review (E) are inadequate and risk progression of infection.

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