Should We Wait for Development of an Abscess Before We Perform Incision and Drainage?

There are no prospective endodontic studies to determine the outcome of an incision and drainage (I&D) procedure for swelling in healthy, endodontic patients. The purpose of this prospective, randomized, single-blind study was to compare the postoperative course of I&D with drain placement versus a mock I&D procedure with mock drain placement after endodontic debridement in swollen emergency patients with symptomatic teeth and a pulpal diagnosis of necrosis.

Eighty-one adult emergency patients presenting with clinical swelling received either penicillin or, if allergic, clindamycin and complete endodontic debridement, and then were randomly divided into 2 treatment groups: I&D with drain placement or a mock I&D procedure with mock drain placement. At the end of the appointment, all patients received a combination of ibuprofen/acetaminophen and, if needed, an opioid-containing escape medication. Patients recorded their pain and medication use for 4 days postoperatively. Success was defined as no or mild postoperative pain and no use of an opioid-containing escape medication. Success was evaluated using repeated measure mixed model logistic regression.

Both groups had a decrease in postoperative pain and medication use over the 4 days. The mock I&D group had significantly higher success than the I&D group (odds ratio = 2.00; 95% confidence interval, 1.16–3.41). The success rate was 45% with the mock I&D and 33% with the I&D.

After endodontic debridement, patients who received a mock I&D procedure with mock drain placement had more success than patients who received I&D with drain placement. Both groups clinically improved over 4 days.

To prospectively compare changes of body temperature, white blood cell count, fibrinogen, and C-reactive protein between odontogenic infections in which the responsible tooth was removed and odontogenic infections in which the treatment included no extraction.

The sample was composed of patients admitted to the authors' maxillofacial unit for odontogenic infection from 2010 through 2013. One hundred seventy-nine patients were categorized into an extraction or a non-extraction group based on whether the causative tooth was non-restorable or restorable, respectively. Non-restorable teeth were extracted at admission of the patient. Otherwise, the treatment protocol, including incision of the involved space in conjunction with intravenous antibiotics, was the same for the 2 groups. The parameters were measured and recorded at admission and 2 days later. Data records were statistically analyzed by comparing the change of the parameters studied between the extraction and non-extraction groups. P values less than .05 were regarded as statistically significant.

One hundred seventy-nine patients fulfilled the inclusion criteria and were enrolled in the study. The mean age of the patients was 39.1 years (minimum, 14 yr; maximum, 81 yr; standard deviation, 15.4 yr). One hundred nine patients (60.9%) were male, and 70 (39.1%) were female. Differences in the mean decrease of axillary temperature, white blood cell count, fibrinogven, and C-reactive protein between the 2 groups were 0.178, 2,300, 1.01, and 0.64, respectively. All these differences were statistically significant (P =.02, .001, .001, and .001, respectively). Also, the mean hospital stay in the extraction group was 1.05 days shorter than in the non-extraction group, with the difference being statistically significant (P = .006).

In odontogenic maxillofacial infections, extraction of the causative tooth is associated with a faster clinical and biological resolution of the infection.