The Use of Facial CT for the Evaluation of a Suspected Simple Dentoalveolar Abscess in the Emergency Department

Odontogenic infections leading to a simple dentoalveolar abscess (DA) are a common, non-traumatic dental condition (NTDC) encountered in emergency departments (ED). Simple DA is classified into two main types; the endodontic (periapical) abscess and the periodontal abscess. Endodontic abscess forms secondary to dental caries, after the necrosis of the dental pulp and subsequent infection of the root canal. In a periodontal abscess, the infection originates from the periodontal tissues or the gingiva.1 The ED sometimes serves as the primary care setting for the workup of simple DA, instead of outpatient dental clinics. This trend has resulted in an increase in the dental related ED visits, as a percentage of all ED visits.1 Published literature has advocated the use of the simple, cheap, and familiar technique of panoramic radiographs as the standard radiological technique in evaluating simple DA.2 However, in most ED settings, facial computed tomography (CT) has superseded the use of panoramic radiographs, because of its availability, easy access, and potential to offer greater anatomic detail. There are, however, issues associated with the routine use of CT in terms of increased turnaround time (TAT), radiation exposure, and technical/professional fees associated with routinely utilizing facial CT in the workup of DA. Okunseri et al3 state that patients who present to the ED with an NTDC would be better managed in an outpatient dental office setting, given the availability of definitive care and the likelihood of continuity of patient care. While there is extensive variability in the management and diagnostic algorithms applied to suspected simple DA in the ED setting across the country, advanced imaging has become much more common in the age of widely available multidetector CTs. Inappropriate and continuous use of the ED for NTDC burdens the health care system by lending to overcrowding, increasing care cost, longer wait times for patients with other urgent health conditions, and increased exposure to ionizing radiation.1,3 Though outpatient dental treatment would be ideal, in the event that these patients present to the ED, rapid, efficient, and effective care delivery is of the utmost importance. Our investigation examined the diagnostic utility of facial CT in patients with suspected simple DA, as well as the TAT, radiation exposure, and associated financial costs. The central hypothesis of this investigation was that facial CT rarely results in a change of patient management in the clinical setting of suspected simple DA.