i

REPUBLIQUE DU CAMEROUN
REPUBLIC OF CAMEROON
PAIX – TRAVAIL– PATRIE
PEACE – WORK – FATHERLAND
MINISTERE DE LA SANTE
MINISTRY OF PUBLIC HEALTH
PUBLIC

ST JOAN OF ARC

HIGHER INSTITUTE OF MEDICAL AND MANAGEMENT SCIENCES BUEA

SPECIALTY: DENTAL

ASSESSING THE FACTORS FAVOURING THE OCCURRENCE OF

THERAPY
DENTAL ABSCESS AND ITS COMPLICATIONS IN ADULT PATIENTS
AGE 18 -59 IN BUEA REGIONAL HOSPITAL

A Research Project Submitted To the Department Of Dental Therapy St.

Joanhimms, In Partial Fulfilment of the Requirements for the Award
Of A Certification in Dental Therapy

BY
GILEAN NGWEWOH
(20TOS-0107)

SUPERVISOR:
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Mr. KIVEN RENE AUGUST 2023

CERTIFICATION

Thıs research project entitled “ASSESSING THE FACTORS FAVOURING THE

OCCURRENCE OF DENTAL ABSCESS AND ITS COMPLICATIONS IN ADULT

PATIENTS AGE 18 – 59 years IN BUEA REGIONAL HOSPITAL” is the original

work of GILEAN NGWEWOH; submitted to St. Joan of Arc Higher Institute of Medical

and Management Sciences.

Sign:______________________________ Date:________________________

Mr. KIVEN RENE

(Supervisor)

Sign:______________________________ Date:________________________

(Head of Department)
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DEDICATIONS

To God almighty
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ACKNOWLEDGMENTS

Special thanks goes to my supervisor Mr. Dinnyuy Rene for his restless effort in guiding

and correcting my work.

I will like to thank the staff of St Joan of Arc Higher Institute of Medical and Management

Sciences, Malingo-Buea for their academic and moral assistance

I will also like to thank the staff and patients of Buea Regional Hospitals, who were very

instrumental in the completion of this work.

Special thanks to all my family and friends who assisted me in one way or the other during

the study period.

Above all, I thank God almighty for his grace upon my life.
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ABSTRACT
Dental abscess is a build-up of pus that forms inside the teeth or gums. The abscess
typically comes from bacterial infection, often one that has accumulated in the soft pulp of
the tooth. Bacteria exist in plaque, a by-product of food, saliva, and bacteria in the mouth,
which sticks to the teeth and damages the teeth and the gums. This study is designed to
assess the factors favouring the occurrence of dental abscess among adult patients attending
Buea regional hospital. The study involved 50 participants of the age 18 to 50years
Majority of the participants (82.5%) responded they do not use fluoride tooth paste,
(67.5%) consume lots of sugar foods and drinks, (75%) usually have dry mouth, (70%)
have cavities in the teeth. Also majority (72.5%) had loss a tooth with a few (42.5%)
reporting sinusitis and (47.5%) recorded osteomyelitis and bone infection as complications.
Most of the participants (87.5%) do not use mouth wash to reduce risk of plaque formation
(80%) do not visit the dentist regularly for proper checkup, (77.5%) do not floss or use
interdental tooth brush at least twice a day to clean between teeth and under gums, (77.5%)
do not use mouth wash to reduce risk of plaque formation, (77.5%) drink treated
fluorinated water. After recording a good number of complications and risk factors of
dental abscess amongst patients visiting Buea Regional Hospital, we therefore conclude
that the non-usage fluoride tooth paste and the consumption of lots of sugar foods and
drinks are the major risk factors for the development of dental abscess.
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TABLE OF CONTENTS

CERTIFICATION.......................................................................................................................... ii
DEDICATIONS............................................................................................................................ iii
ACKNOWLEDGMENTS............................................................................................................. iv
ABSTRACT................................................................................................................................... v
LISTS OF TABLES.......................................................................................................................ix
LISTS OF FIGURES..................................................................................................................... ix
LIST OF ABBREVIATIONS.........................................................................................................x
CHAPTER ONE
GENERAL INTRODUCTION
1.0 INTRODUCTION.......................................................................................................12

1.1 BACKGROUND.........................................................................................................12

1.2 STATEMENT OF THE PROBLEM........................................................................14

1.3 OBJECTIVES...........................................................................................................15

1.3.1 General objectives................................................................................................15

1.3.2 Specific objectives................................................................................................15

1.4 RESEARCH QUESTION...........................................................................................15

1.5 SIGNIFICANCE OF THE STUDY............................................................................16

1.6 SCOPE OF STUDY....................................................................................................17

1.7 DEFINITIONS............................................................................................................17

CHAPTER TWO
LITERATURE REVIEW
2.0 INTRODUCTION.......................................................................................................19

2.1 CONCEPTUAL REVIEW..........................................................................................19

2.2.1 Definition, epidemiology of dental abscess..........................................................19

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2.2.2 Causes of dental abscess.......................................................................................27

2.2.3 Pathophysiology of Dental Abscess.....................................................................28

2.2.4 Clinical manifestation of dental abscess...............................................................28

2.2.5. Risk factors of dental abscess..............................................................................29

2.2.6 Laboratory findings of dental abscess..................................................................41

2.2.7 Treatment of dental abscess..................................................................................42

2.2.8 Some complication of dental abscess...................................................................43

2.2.9 Prevention of dental abscess...............................................................................46

2.3 Theoretical review.......................................................................................................47

2.4 Emperical review.........................................................................................................49

CHAPTER THREE
METHODOLOGY
3.0 INTRODUCTION.......................................................................................................51

3.1 RESEARCH DESIGN................................................................................................51

3.2 STUDY AREA............................................................................................................51

3.3 STUDY POPULATION..............................................................................................51

3.3.1 Target population..................................................................................................51

3.4 SAMPLE SIZE............................................................................................................51

3.5 SAMPLING TECHNIQUE.........................................................................................51

3.6 INCLUSIVE CRITERIA............................................................................................52

3.7 EXCLUSIVE CRITERIA...........................................................................................52

3.8 INSTRUMENTATION...............................................................................................52

3.9 VALIDATION OF INSTRUMENT...........................................................................53

3.10 METHOD OF DATA COLLECTION......................................................................53

3.11 DATA ANALYSIS...................................................................................................53

3.12 ETHICAL AND ADMINISTRATIVE CONSIDERATION....................................54

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CHAPTER FOUR
RESULTS
4.1. SOCIODEMOGRAPHIC CHARACTERISTICS OF THE STUDY POPULATION
...........................................................................................................................................55

4.2. RISK FACTORS OF DENTAL ABSCESS IN ADULT PATIENTS ATTENDING

BUEA REGIONAL HOSPITAL......................................................................................56

4.3. COMPLICATIONS OF DENTAL ABSCESS IN ADULT PATIENTS

ATTENDING BUEA REGIONAL HOSPITAL..............................................................57

4.4. ATTITUDE AND PRACTICE RELATED TO DENTAL ABSCESS IN ADULT

PATIENTS ATTENDING BUEA REGIONAL HOSPITAL..........................................57

CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATON
5.1. DISCUSSION............................................................................................................59

5.2. CONCLUSION..........................................................................................................60

5.3. RECOMMENDATIONS...........................................................................................60

REFERENCE............................................................................................................................... 61
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LISTS OF TABLES
Table 1: Sociodemographic characteristics of study population..........................................54

Table 2: Risk factors of dental abscess in adult patients attending Buea Regional Hospital55

Table 3: Complications of dental abscess in adult patients attending Buea Regional Hospital

...............................................................................................................................................56

Table 4: Attitude and practice related to dental abscess in adult patients attending Buea

Regional Hospital..................................................................................................................57
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LIST OF ABBREVIATIONS

WHO World Health Organization

NCDs Non Communicable Diseases

ICDAS International Caries Detection And Assessment System

GERD Gastro Esophageal Reflux Disease

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CHAPTER ONE

GENERAL INTRODUCTION

1.0 INTRODUCTION
Dental abscess or tooth abscess is a build-up of pus that forms inside the teeth or gums. The

abscess typically comes from bacterial infection, often one that has accumulated in the soft pulp

of the tooth. Bacteria exist in plaque, a by-product of food, saliva, and bacteria in the mouth,

which sticks to the teeth and damages the teeth and the gums. If the plaque is not removed by

regular and proper brushing and flossing the bacteria may spread inside tissues of the tooth and

gums. This can eventually result in an abscess. (Google chrome)

1.1 BACKGROUND
Dental abscess was a poorly discussed topic of medical science until the late 1900s.this clinical

entity was frequently underestimated in terms of its morbidity and mortality. In the early 1600s

the London bills of mortality began listing the causes of death with teeth abscess being

continually listed as the fifth or sixth leading cause of death (Clarke JH et al., 1999). By 20 th

century, the potentials of dental abscess to spread and cause severe sepsis leading to death was

recognised (Carter L et al., 2006). In the United States, a large prospective study reported that 13

% of adult to death was recognised. An audit carried out at the Hull RoyL Infirmity between

1999 and 2004 showed an increase in the number of patients presenting with dental sepsis due

to dental abscess patients sought treatment for dental pain and abscess ,infection over 24 month

follow up (Boykin MJ et al., 2003). The incidence of dentoalveolar abscess was 6.4% among

children attending an outpatient dental clinic in Nigeria (Azodo CC et al., 2012). In India,

dental abscess affect 60-65% of the general population (J et al., 2009). In addition, periodontal

disease is estimated to occur in 50-90% of the population in India, depending on age. (Agaiwal V

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et al., 2010). Improve methods of diagnosis and reporting of the common problem are required to

allow exhaustive epidemiological analysis and its implication on health –care system. Dental

abscess has been considered as one of the priority health conditions because, in late stages, they

cause severe pain and are expensive to treat. This translates in to a loss of significant negative

impact on economic productivity (Golden AS et al., 2008). This various host factors play a

significant role in pathogenesis of dental infections and their complications.it has been observed

that there are specific`` at risk’’ population groups. In a retrospective series of 185 cases, Huang

et al. found a statistically significant correlation of acute dental abscess infection, complications

and death with medically compromising disease, such as diabetes, renal insufficiency ,hepatic

cirrhosis , myelotherapy (Huang TT et al., 2004). Dental or dentoalveolar abscess is a

domination used to describe localised collection of pus in alveolar bone at the root apex of the

tooth. It usually occurs secondary to dental caries, trauma, deep filling or failed root canal

treatment once the intact pulp chamber is breached, colonisation of the root canal occurs with a

diverse mix of bacteriological agents. These microorganisms are capable of forming biofilms in

root canals. Hence making application of the biofilms concept plausible in such infections (Shu

M et al., 2000). After entering the periapical tissues via the apical foramen, these bacterial are

capable of inducing acute inflammation leading to pus formation .pathogenesis of dentoalveolar

abscess is polymicrobial in nature ,comprising of various facultative anaerobes, such as the

varidans group streptococci and the streptococcus anginosus group and strict anaerobes,

especially anaerobic cocci, prevotella and Fusobacterium species (Nair PN et al., 2004). If not

treated at an early stage it may rapidly evolve and spread to adjacent anatomic structure, leading

to serious complication such as septicaemia, cavernous sinus thrombosis, brain abscess, shock

and occasionally to death .possibility of development of complications and the associated

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morbidity and mortality makes it an important public health problems.in this paper, current

knowledge of pathogenesis, diagnosis and management of dental abscess is reviewed. Also dental

abscess is considered as a very serious health issue in Cameroon due to it frequency and it also

lead to life threatening health condition and other complications and and talking about Cameroon

at Buea regional hospital there is increased frequency of dental abscess among patients regardless

of age, sex, and health conditions, dental abscess is considered a serious dental condition at Buea

regional hospital.

Dental abscess as an end stage of dental disease is common is common in the community, and

patients with dental abscess are likely to seek care from their primary health provider. Once the

infection has spread beyond the confines of the jaws, there is an increasing risk of airway

obstruction and septicaemia. If treated with antibiotics alone, the infection will not resolve and

will become progressively worst.

1.2 STATEMENT OF THE PROBLEM

During my study i realised that dental abscess is the leading cause of death among dental patients.

Contrary to what Clarke JH said in 1999, he said that London bills began listing the cause of

death with tooth abscess being the continually listed as the fifth or sixth leading cause of death.

Abscess Poor oral hygiene in dental adult patients age 18 to 50 regarding dental abscess has been

identified. Poor oral hygiene, bad oral practices and high level of sugary foods and drinks

consumption have so many complications such as pain, Ludwig’s angina, brain abscess, bone

infections, blood infection especially in countries with poor oral practices and poor knowledge.

Also poor oral practices are associated with increase hospitalisation, treatment cost and adulthood

morbidity and mortality (Ngabo et al., 2016).

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In Africa studies have shown that poor dental practices contribute to the development of dental

abscess in adult patients, poor knowledge of oral health limit them from taking actions which will

prevent this infection. Good oral practices and appropriate knowledge has a paramount

importance to reduce dental abscess related morbidities and mortality. In addition studies has also

revealed that sociodemographic characteristics of adult patients contribute to poor ral practices

and hence leading to dental abscess

In Buea regional hospital, out of a population of 93 patients, 44 patients presented with dental

abscess. There is no study documented on the factors favouring the occurrence of dental abscess

and its complications in adult in Buea regional hospital, hence the need to conduct the present

study.

1.3 OBJECTIVES
1.3.1 General objectives
To assess the factors favouring the occurrence of dental abscess among adult patients

attending Buea Regional Hospital.

1.3.2 Specific objectives

 To assess the risk the factors of dental abscess in adult patients attending Buea Regional

Hospital

 To assess the complications of dental abscess in adult patients attending Buea Regional

Hospital.

 To assess the attitude and practice related to dental abscess in adult patients attending

Buea Regional Hospital.

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1.4 RESEARCH QUESTION

 What are the risk factors of dental abscess in adult patients attending Buea Regional

Hospital?

 What are the complications of dental abscess in adult patients attending Buea Regional

Hospital?

 What is the attitude and practice related to dental abscess in adult patients attending Buea

Regional Hospital?

1.5 SIGNIFICANCE OF THE STUDY

The result gotten from this study will be used as a baseline to understand the complications as

well as the risk factors that predisposed patients to dental abscess which will encouraging policy

makers to educate the populations on the various measures which can be taken to prevent this

medical condition, by organising campaigns. This result will compel health policy makers to step

up efforts in the area of education, seminars, and workshops with the view to raise awareness to

adults regarding dental abscess.

The results on the factors that favours the occurrence of dental abscess and it complications will

be useful to adult population and caregivers. Appropriate oral hygiene practices will be

encouraged and will allow these patients to carry out these practices in a well-established

direction. On the other hand, inappropriate practices will be call for adjustment and improvement

and provide enlightenment efforts to achieve better results.

The findings will be useful to the general public who need appropriate information on dental

abscess. Researchers will benefit from the study. They can build on the findings for further

research in this area of knowledge. The data concerning this study may help enrich the pool data

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on the subject matter. Such data may also be beneficial to both health and education ministry and

may form the basis for future policy formulation and modifications.

1.6 SCOPE OF STUDY

The study will be carried out on the factors that favours the occurrence of dental abscess and its

complication in adult age 18 to 50 at Buea regional hospital.

1.7 DEFINITIONS
Dental abscess: is a collection of pus in the alveolar bone at the root apex of the tooth or

structure supporting tooth (gums). Dr. Akshima Sahi. ( 12 January 2023)

 Periapical abscess refers to the collection of pus at the tip of tooth root. Bernard

J.Hennessy ( 18 november 2013)

 Periodontal abscess: this is described as a localised accumulation of pus within the

gingival wall of periodontal pocket. Yousefi Y,Meldrum J, Jan AH on 17 june 2022.

 Gingival abscess: this is an abscess on the gums 2. Dr. Mark S IN 16 June 2022.

 Periodontitis abscess related origin: it usually appearbas an exacerbation of untreated

periodontal disease or during periodontal treatment. Yousefi Y. Meldrum J,Jan AH (17

June 2022)

 Abscess of non-periodontal origin: it is frequently developed due to the impaction of

foreign objects such as a piece of dental floss or abnormalities of root anatomy .Bernard

J.Hannessy.(18 November 2013)

 Single abscess: it is an abscess usually cause by a local obstruction .Valencia Higuera.

( 12 July 2010)

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 Multiple abscesses: it is an abscess associated with systemic disease such as diabetes and

patients taking antibiotics treatment for non-oral issues with untreated for periodontal

disease.Valencia Higuera.( 12 July 2010)

 Pericoronal abscess: this is an abscess that develops from a partially erupted tooth.

Yousefi Y. ( 17 June 2022)

 Self-inflicted gingival injury abscess (which can lead to an abscess): this refers to

abscess which is cause by habits such as biting of nails and trauma due to abject like pin,

pen. Eur J Dent (3 april 2009)

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CHAPTER TWO
LITERATURE REVIEW

2.0 INTRODUCTION
This chapter shows the literature search strategies used, both empirical and theoretical literature

about factors that favours the occurrence of dental abscess in adult patient age 18 to 50, the

conceptual frame and lastly the identified gaps in the literature about the topic is shown on this

chapter

2.1 CONCEPTUAL REVIEW

2.2.1 Definition, epidemiology of dental abscess
Dental abscess:

Dental abscess usually happens when pus build up beneath your teeth or gums. Dental abscesses

are a common clinical problems in many species laboratory primates multiple etiological factors

are involved in the development of this condition including excessive dental wear, dental carries,

dental fracture, periodontal disease, and endodontic procedure (Kilgore et al., 1998).

Any process that lead to exposure of the pulp cavity or tooth root can result in colonization of

bacteria, leading to the development of abscess. A diet high in sugar can be at risk factors

because it encourage bacteria to adhere in to the tooth structure which produce harmful toxins

which can lead to dental abscess

Types of dental abscess

 : Pulpal or periapical abscess

Dental abscess often arise from pulpal necrosis secondary to dental caries is commonly

known as dental decay or cavity.This is the direct destruction of the tooth substance by acidic

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bacteria product of normal oral flora. A carious tooth may not initially be painful. The

product of inflammation eventually reaches the dental pulp as the disease process progresses

and the tooth will become sensitive. This is known as pulpitis. Patients will report non-

localizable and intermittent symptoms. This process may initially be reversible by routine

dental treatment ( e.g filling) .But the pulp will rapidly necrosis and die if it became infected.

If the infection is not treated, product from the necrotic pulp may escape the confines of the

tooth via the apical foramen and begin to involve the periodontal ligament and surrounding

alveolar bone, this is known a periapical abscess and makes the infected tooth tooth easily

localised by patient complaint of spontaneous or constant sensitivity and or tenderness to

gentle percussion. The infection could likely be halted by at this stage of pathophysiologic

process with a root canal which is essentially an incision and drainage procedure on the side

of the tooth. If left unchecked, however, the bacteria product of a periapical infection and the

host’s immune response to it can lead to a progressive distruction of the dental supporting

tissues including the alveolar bone. At this point tooth will become increasingly mobile. The

infection will follow the path of least resistance as it penetrates through the alveolar in to the

surrounding soft tissue. It may be perforate laterally to form vestibular abscess. Alternatively

it may perforate medially to form a palatal or lingual abscess further spread will be detected

by the proximity of the muscle attachments on a facial plain. Here the appropriate treatment

for an abscess tooth depends on the extent of the infection. It may include; incision and

drainage, extraction, endodontic treatment or the combination of the two .An incision and

drainage is warranted when the infection process extent outside the alveolar bone. The

extension of infectious product outside the root apex can lead to a multitudes of clinical signs

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throughout the head and neck, swelling, erythema ,warmth fluctuance and spontaneous

drainage of purulence or generalised cellulitis may be present.

 Periodontal abscess:

This refers to abscess on the surrounding tissues of the tooth. It can also be termed the

local collection of pus within yhe tissues of the periodontium Poor oral hygiene and poor

nutrition lead to local inflammation of the tissue surrounding and attaching the tooth to it

socket, allowing bacteria penetration. Early periodontal disease is isolated to the gingival

known as gingivitis. Alveolar bone may be destroyed as the disease progresses, leading to

gingival pocket and tooth mobility. Food debris or plaque may trapped within this pocket and

create a localised infection known as periodontal abscess. Patient may complain of bleeding

foul odour, bad salty taste, loose tooth, pain, and swelling. Physical examination reveal

gingival tissue that may be erythematous or necrotic and bleed easily heavy accretion of the

dental plaque and calculus may be present. An abscess can be present as a focal swelling

tooth mobility, pain on percussion and purulence that is expressible from gingival sulcus. It

may be impossible with current dental caries, to differentiate a periapical abscess from

periodontal abscess without radiographs. True periodontal abscesses rarely spread beyond the

local dentoalveolar structure and rarely require an urgent referral.

 Gingival abscess:

It refers to abscess in the gums. The gums and mouth are normally full of both good and

bad bacteria. A build-up of harmful bacteria contributes to plaques and tartar which lead to

tooth decay, if these harmful bacteria find their way in to an area of open tissues, they may

take over multiplying and causing an infection. The body responds by sending white blood

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cells to fight the infection. To do so, they will cause swelling to try to cut off and eliminates

the bacteria. The result is a swollen, painful pocket of pus called an abscess. The are two

types of gum abscess i.e gingival abscess which only occur in the gum tissues, they do not

involve the teeth. And periodontal abscess which occur in the space between the teeth and the

gums. This is cause by bacteria infection due to tooth decay ,rough brushing, Brocken teeth

food stuck in the gum line or, when bleeding occurs in the gum line. Traumatic injury or any

excessive orthodontic force on the teeth can also cause gingival abscess. Gingival abscess

tend to involve the marginal gingival and result from entrapment of food and plaque debris

and subsequent staphylococcal, streptococcal, anaerobic or mixed bacterial overgrowth.

Localized swelling, erythema, tenderness, and fluctuance in the space between the tooth and

gingival ensue. There may be spontaneous purulent drainage from the gingival margin or an

area of abscess pointing. The initial management is after topical anaesthesia, to create a small

incision and irrigate with saline and drainage as well as removing any contaminants from the

area between the gums and teeth. When the patient has any sign of plaque build-up or any

periodontal disease, the dentist may recommend specialized cleaning procedure to help

remove plaque and tartar build up. When the abscess is open and discharging pus, they may

simply apply pressure to the area to allow the pus to drain completely. Dentist will generally

order a dental panoramic x-ray to see if the abscess has cause any breakdown of the bone.

Bone loss may occur in a severe infection, or if the gum abscess goes without treatments for a

long time, If the bone loss is severe, the dentist may recommend procedure to help repair the

bone and surrounding tissues. If a gum abscess affects the inner pulp of the tooth, a person

may need a root canal. In some cases the dentist may also recommend extracting the tooth

next to the abscess. Oral antibiotic therapy, analgesics, and dental follow up are indicated.

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The patient tetanus status should be addressed. Patients with gingival abscess are usually

afebrile. Consider more extensive abscess formation and oral disease processes in the febrile

toxic appearing patients. A dentist may also recommend some simple home remedies to help

relieve the symptoms i.e. medication like ibuprofen which can reduce pain and swelling,

rinsing the mouth with warm salt water to reduce pain and sensitivity. Home remedies will

help manage the symptoms but the pucket of bacteria and pus will need treatment from the

dentist.

 Pericoronal abscess :

Refers to a localised, purulent infection within the gum tissue surrounding the

crown of a partially or fully erupted tooth. Usually associated with an acute episode of

pericoronitis around a partially erupted and impacted mandibular third molar ( lower

wisdom tooth ).A partially erupted or impacted third molar ( wisdom tooth ) is the most

common site of pericoronitis and pericoronal abscess .The accumulation of food and

debris between the overlying gingival flap and crown of the tooth creates of focus for

pericoronitis and subsequent abscess formation. The gingival flap becomes irritated and

inflamed, and the tissue repeatedly traumatized by the opposing molar tooth .The

inflamed gingival process may eventually become infected and form an abscess. Foul

taste , inability to close the jaw and fever may occur. Swelling of the cheek and angle of

the jaw and localized lymphadenopathy are also characterize. More advance disease may

spread posteriorly to the base of the tongue, oropharyngeal area, and deep cervical spaces

with resulting Ludwig angina and peritonsillar abscess. Superficial incision and drainage

of the abscess with warm saline irrigation, analgesia, and antibiotic coverage and possible

extraction of the involved tooth are indicated. Pericoronal abscess formation rarely occur

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in the pediatric population and tend to be late adolescent and adult processes; the

mandibular 3rd molar the most common involved tooth. Airway compromise is a rare but

potential complication from posterior extension of a pericoronal abscess.Pericoronitis is

an inflammatory condition that may accompany eruption of teeth, particularly around the

mandibular third molars. It may be associated with traumatic occlusion with its maxillary

counterpart that often complicates the existing pathology by repeated cheek biting and

consequent localized reactive proliferation of buccal mucosal. The inflamed operculum

covering the partially erupted or completely mandibular third molar may get infected by

microbial flora, predominantly anaerobes as it is often less accessible to routine oral

hygiene activities. In most cases, the symptoms are mild and infrequent, however

exacerbation may lead to abscess formation and /or lymphadenitis and subsequent spread

to facial spaces requiring immediate intervention.

 Self-inflicted gingival injury abscess :

Self-injury behaviour (SIB) has described as an act of unassisted and deliberate injury to one’s

own body which is severe enough to cause tissue damage. Although the traumatic injuries of the

gingiva (accidental, latrogenic, and factitious traumatic lesions) , were included in the recent

classification (AAP 1999) (. G. A., 1999). Self-inflicted behaviour pertaining to periodontal

tissues has been reported separately (A Dilisiz et al., 2019). And is termed gingival

artefacta.Gingival artefacts classified in to3 types :

a) Injury superimposed upon a pre-existing lesions (or irritation)

b) Injuries secondary to another established behaviour (such as thumb sucking)

c) Injuries of unknown or complex etiology (often based on some emotional disturbance or

psychological illness). This classification was further modified by Stewart (Stewart, 1976)

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as minor: superficial gingival lesions resulting from rubbing or picking the gingiva with

fingernails or sharp objects such as as pins, key, coins, and marbles. Some open carious

teeth in the oral cavity act as a site for insertion of foreign bodies ,which can be infected

or create a path ways for bacteria penetrate pepepenetrate in to the self-inflicted oral

injury can be premeditatedaccidentaorcan causing pain ,swelling, and abscess formation.

Resulting from an uncommon habit. These injuries usually result from a foreign object or

a patient fingernail biting that habitually causes an erosion of the gingival tissue in the

specific area (Blaton PL et al., 1997). There are varying degrees of self-injurious

behaviour from simple fingernail biting to extreme in self-mutilation (Lucavechi T et al.,

2007), (CB et al., 2000) (R. S. , 1986) , (Creath CJ et al., 1995) (Ayer W et al., 1974) In

the present case, the mechanical trauma caused by the almost constant self-injurious

behaviour is considered to have been the primary etiologic factor. Habitual fingernails

biting are a common behaviour among children. This is probably true but such injuries are

not limited to children, also diagnosed adolescents and adults. The etiology of self-

inflicted gingival injury in adults some emotional disturbance (SD., 1995) (Golden AS et

al., 2008). Proper history, detailed clinical examination, and radiographs are necessary

to detect the cause and give an appropriate diagnosis. A radiograph is also necessary to

detect the correct size, type, and position of the foreign object.

Dental abscess of non-periodontal origin: This is a type of dental abscess that frequently

develop due to the impaction of foreign object, such as piece of dental floss, or abnormalities of

the root anatomy.

Dental abscess can occur when bacteria enters the in to part of the tooth through either a deep

cavity or a chip or crack in your tooth. Abscesses can develop relatively quickly as little as one or

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two days after first sign of infection they may progress undetected and therefore untreated, and

develop for weeks or even ,months. Dental abscess formation can occur in different stages which

include;

Enamel decay: plaque is what cause a build-up of bacteria in the mouth, which then lead to the

development of pus and finally, a dental abscess. If we do not brush as frequently or thoroughly

enough to eliminate plaque from our teeth and along the gum line, plaque can build up on gums

and tooth surface. Acid can form and erode the tooth enamel. Once tooth decay occurs, a cavity is

form.

Dentin decay: if you do not visit your dentist soon enough to have the cavity filled, bacteria

continue to penetrate through the enamel and enter the dentin (sub layer)

Tooth pulp infection: after the bacteria has destroy the dentin , it can then enter the inner pulp of

the tooth .when this happens, the nerves within the tooth become non vital and the body immune

system start to attack the infection ,pus then develops around the dying root, causing the dental

abscess.

Abscess formation: in the later of tooth decay, after the bacteria has entered the pulp of the tooth

or made its way deeper in to the gums or jaw bone, you may notice pain surrounding the tooth,

along with gum redness and swelling. A severe abscess can also trigger fever.

Epidemiology of dental abscess:

The epidemiology of dental abscesses are quite common. A study found that dental abscess

infection admission in hospital occurred at the rate of 1 per 2600 per population in the united

states (Wang YH et al., 2021). This data is not only suggestive of the high prevalence of poor

dental health which is the major predisposing factor to developing a dental abscess. But it also

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shows that there are racial and likely socioeconomic factors at play. Provider practices may shift

because of the population, racial distribution, and socioeconomic demographics of the

community (Sudan J et al., 2018), (Burczynska A et al., 2017)

2.2.2 Causes of dental abscess

This can be cause by infection in your mouth, or a teeth that has not grown out of your gums

(impacted tooth). Dental abscess can also because poor oral hygiene i.e plaque can build up on

your teeth if not floss or brush your teeth regularly bacteria will adhere in the tooth surface where

they release harmful toxins which cause dental abscess. One can also get dental abscess by

consuming lots of sugary foods or starchy foods and drinks, this can encourage bacteria growth in

plaques and may lead to decay that result to dental abscess. Dental abscess can also be cause by

an injury or previous surgeries on your teeth or gums here, bacteria can penetrate in to any

damage parts of the teeth or gums .Dental caries , dental trauma, and poor oral hygiene are the

most frequent cause of dental abscess break down in the protective enamel of tooth allows for

oropharyngeal bacteria to enter the tooth cavity (pulp cavity ) causing a local infection .As this

infection within the pulp cavity grows within the limited space of the tooth , it Move to the root

canal and inferior in the mandible or superiorly in to the maxilla depending on the location of the

infected tooth. Another causes include genetic causes such as amelogenesis imperfect that

predispose individuals to weakened enamel, more susceptible to wear. Mechanical causes tooth

grinding breaks down tooth enamel, chemical irritants such as smoke from methamphetamine,

immunosuppression arising from chemotherapy, or chronic immunosuppressive medical

condition such as HIV/AIDs can predispose individual to dental abscess (Jenkins GW et al.,

2018), (Neves ETB et al., 2019).

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2.2.3 Pathophysiology of Dental Abscess

Teeth are essential composed of three layers, the layers from the outside working inward are the

enamel, the dentin and the pulp. The dentin and the pulp are living tissue that is sensitive to

noxious stimuli. The crown is covered with enamel while the root is covered with a substance

known as cementum. Cementum help attach the tooth to the surrounding alveolar bone via the

periodontal ligament (PDL). The neurovascular supply enters the pulp through the apical foramen

at the root apex. The pulp contains only pain transmitting neuronal fibers, while the periodontal

ligament contains both pain sensitivity and pressure sensitivity fibres. Dental abscess arises when

bacteria penetrate the normal anatomic and physiology barriers of the tooth surrounding

structures. This lead to a localised collection of purulence contain within the tooth ( pulpal

abscess) or around the apex of the tooth (periapical abscess) .Alternatively a dental abscess may

localised to the supporting structure of the tooth (periodontal abscess) or strictly to the adjacent

soft tissues (pericoronitis).

2.2.4 Clinical manifestation of dental abscess

Some clinical manifestation of dental abscess include the following ; fever, pain, or discomfort

with hot or cold temperature , swelling on the face, cheek and neck, foul odour in your mouth,

salty fluid in your mouth, foul tasting, severe, constant throbbing toothache that can spread to

your jaw bone , neck and ear, sudden rush of foul smelling and foul tasting, salty fluid in your

mouth and pain relief, if the abscess ruptures, pain that radiates to your ear, neck, jaw ,pain that

get worst when lying down, pain while chewing or biting food, redness of the face, discoloured

or loose teeth, foul breath, tender or swollen lymph nodes ,weakening of tooth in it normal

position , a dental abscess should be considered when patients report severe pain , admit to poor

dental hygiene and lack of adequate dental follow up. Admit to dental trauma that was not

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repaired, localised pain that is reproducible with palpation, facial erythema, trismus, dysphagia,

fever, lymphadenopathy. signs that should immediate illicit concern are altered mental status,

painful mouth and tongue, difficulties in swallowing ,difficulties opening the mouth, nausea or

vomiting, severe headache, itching or burning sensation of the skin, double vision or loss of

vision confusion, dooping eyelids, pain usually sudden onset worsening over hours to days,

tenderness of the tooth to percussion and mobility or pressure from biting ,unpleasant taste in the

mouth, fever, malaise, swelling (localised or spreading),altered tooth appearance i.e the affected

tooth may be elevated, Brocken or show signs of decay, anorexia, sinusitis, osteomyelitis, airway

compromised, purulence drainage.

2.2.5. Risk factors of dental abscess

There may also include some risk factors that can exposed one to dental abscess they include the

following ;a

Diet high in sugar:

When diets high in sugar is consumed, it attracts bacteria and this bacteria produce harmful

toxins that form plaque which is a sticky substance that attached on the tooth surface ,if this

plaque is not remove by routine brushing or saliva, it will eventually become acidic and wears

away the enamel of the tooth where bacteria easily penetrate to the dentin ,from the dentin to the

pulp which can infect the pulp leading to an increase risk of dental abscess, the mouth naturally

includes more than 70 different species of bacteria, some of which are harmless and usually serve

beneficial purposes. In contrast others are toxic and aim to destroy your dental health. As a result,

the mouth becomes a battleground between these bacteria. High sugar consumption in any form

or shape sets off a chain reaction in your mouth, which is where the danger starts. As a result

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once harmful bacteria come in to contact with sugar, acid is produced in your mouth, and the

demineralisation process begins. During this process, acids damage your tooth enamel, a firm,

shiny, white outer coating of your teeth that covers the underlying tissues. As a result, minerals

like calcium phosphate are lost from dental enamel leaving the dentin exposed to heat, cold,

acidic, and sticky foods, stimulating the nerves and cells inside the tooth, causing organising pain

and discomfort. Fortunately, the mouth have a naturally preventive mechanism against

demineralization damage by neutralizing acids, establishing a protective layer on the tooth

surface, and promoting remineralisation by naturally providing calcium phosphate, and fluoride

to enamel and dentin. However when you consume a lot of sugar, more acid is produced which is

too much for the saliva to handle, resulting in a gradual loss of minerals. The intensity of acid

attacks damage the hard and shining covering of the tooth enamel over time, causing various

dental and oral health issue. The mouth has a PH level that you must maintain a healthy

equilibrium, just like your body and blood do. However an imbalance arises when you consume

too many sugary items and have too much acid in your mouth.

According to a study from Finland published in 2014,eating sugary foods or drinks a day was

linked to 31 percent higher risk of cavity forming on your teeth ,which is a risk factor of dental

abscess.

Dry mouth:

Dry mouth ( hyposalivation) which can be due to sides effects of drugs can increase your risk

of tooth decay which can lead to dental abscess, dry mouth is a feeling that there is not enough

saliva in the mouth. People get dry mouth when the glands in the mouth that produce saliva are

not working properly ( salivary gland hypofunction) saliva do not only lubricates the mouth but

also helps to fight infections, so a reduction in the amount of saliva puts u at high risk of

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discomfort in the mouth and also may increase tooth decay and other oral health issues. There are

3 most common causes of hyposalivation i.e, medications, chronic anxiety or depression and

dehydration. Saliva is a mixture of secretions from the major ( i.e parotid, submandibular,

sublingual) and minor salivary glands (Navazesh M et al., 1992) In healthy individuals, the daily

production of saliva normally ranges from 0.5-1.5 liters (Ying Joana ND et al., 2015). Saliva is

99% water and contains a number of electrolytes ( e.g sodium, potassium, calcium, bicarbonates,

phosphate) and organic components (e.g immunoglobulins, proteins, enzymes, mucins) (Furness

S et al., 2013). In addition to keeping tissue moist and helping to digest food , saliva cleanses the

oral cavity, making it possible to chew and swallow food, maintain the neutral PH , and prevent

demineralisation (Plemons JM et al., 2014). Salivary proteins and mucins contribute to the

lubrication and coating of oral tissue ,protecting the mucosa from chemicals, microbial, and

physical injury (Mittal S et al., 2011). Without adequate salivary flow, tooth decay will occur

where tooth may develops cavities through which bacteria penetrate the tooth to it soft tissue

which can lead to dental abscess. Reduced saliva flow can interfere with chewing and swallowing

certain foods which may result in malnutrition. The most common cause of xerostomia is the use

of certain medications (Cohen Brown G et al., 2018). Some medication can contribute to or

exacerbate oral dryness medications such as, antihistamine, antihypertensive drugs,

decongestants, pain medication, diuretics, muscle relaxants and antidepressants. Xerostomia can

also be cause by, head and neck cancer radiotherapy, chemotherapy or head and neck cancer

radiotherapy can be acute i.e develop during therapy or chronic , i.e developed months to years

after therapy (S., 2013). These therapies can cause xerostomia /salivary gland hypofunction via

direct toxicity to salivary gland and oral tissues or indirect damages due to regional of systemic

toxicity. Aging can also be another cause of xerostomia, about 30% of patienst older than 65

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years and up to 40% of patients older than 80 years; this is primarily an adverse effects of

medications , xerostomia is common in older patients , is more likely to occur to those with an

intake or more than tour daily prescription medications. Brocken, chipped, or cracked teeth can

allow bacteria to seep in and spread to the pulp.

Partially erupted:

Another factors that predispose individual to a dental abscess is a partially erupted tooth, most

commonly a wisdom tooth, where bacteria get trapped between the crown and soft tissues

causing inflammation. Other risk factors that predisposed individual to weaken enamel, more

susceptible to wear. Mechanical causes tooth grinding breaks down enamel .Medical condition

like Sjogren syndrome the cause dry mouth which accelerate oropharyngeal microbial growth

which can be a risk factors of dental abscess. Although sjogren disease is a systemic condition

that can affect any body or system, the primary symptoms are dry mouth and dry eyes. Sjogren

disease causes chronic inflammation and dysfunction, resulting in salivary gland damage. (U.S.,

2019)

HIV/AIDs:

Chronic immunosuppressive medical condition such as HIV/AIDs can predispose individual to

dental abscess (Jenkins GW et al., 2018). (Neves ETB et al., 2019) If you, or someone you

know, is living with HIV/AIDS, the American dental association recommends that dental health

care be parts of all HIV/AIDS treatment plan. That is because people living with HIV/AIDS are

more susceptible for infections including dental infection which can affect their overall health.

HIV (human immunodeficiency virus) is a virus that attacks a specific types T cells known as the

CD4 cells. T cells are an important part of the body immune system which is needed to fight

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infection. If left untreated, HIV can destroy so many CD4 cells that a person can no longer fight

off infections and disease. AIDS ( acquired immunodeficiency syndrome) is the last state of HIV

infection where the immune system is so weak that infection can came in. Your mouth may be

the first part of your body to be affected when infected with HIV. Because infection with HIV

will weakened your immune system, this means an HIV patient will be susceptible to infection ,

which can cause pain and tooth loss in the oral cavity, dry mouth , red painful gums, ulcerative

periodontitis which can increase risk of dental abscess. Dental abscess related HIV can be painful

which can cause trouble chewing or swallowing. This may prevent you from taking your HIV

medication. It can also result in malnutrition, as you have trouble eating and absorbing enough

essential nutrients.

High alcohol consumption:

High alcohol consumption can also be a risk factors of dental abscess, people with an alcohol

addiction are at risk of oral health consequences. Alcohol dehydrates the body by inhibiting the

production of chemical ADH, which regulates the amount of urine you excrete. Drinking alcohol

actually cause the kidney to expel more water than it would normally, causing dehydration

throughout the body. It can cause atrophy of salivary glands, thus decreasing the flow of saliva

which means your mouth produced less saliva, and alcohol is the most cause of sialadenosis of

the parotid gland. This condition causes swelling of the parotid gland and decreases the secretion

of saliva. Saliva naturally help to wash away bacteria , so if there is no enough saliva in the

mouth, the bacteria will stay in the mouth, attacks the hand tissues of the teeth, soft tissue of the

teeth and this infection can progressively lead to dental abscess.

Smoking cigarrete:

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Smoking cigarrete can also be another risk factor of dental abscess, smokers are more prone to

the accumulation of plaque and dental decay. Teeth comes in contact with nicotine, tar and other

harmful chemicals found in cigarrete. The substance chip away at your teeth defence by

weakening the teeth enamel and leaving them more susceptible to decay than of non-smokers. To

make maters worst smoking decreases the body’s immune system response to infection. When

you smoke your immune system constantly fights against the inflammation and damage cause by

tobacco products. This will make you prone to gum disease which can progressively become

gingival abscess as bacteria from decay accumulates in the teeth. Dental abscess can also be

exacerbated by smoking .With abscess, a pocket of pus develops at the tooth and caused by

infection. With smoking, your body is less able to fight this infection. Recent research confirms

that smoking negatively affect the quality of saliva. Substances from cigar rete destroy the

protective macromolecules of saliva, enzymes, and proteins, and thus saliva loses its protective

roles. Also when you inhale cigarrete smoke, the smoke in the mouth triggers your salivary

glands and causes them to over produce. This lead to increase saliva in the mouth for a short

time. Bacteria in your mouth can use this saliva to take a trip around your gums. As these bacteria

move around the mouth they can settle on your teeth, gum line, creating a build up of tartar

plaque. Over time, this build up can contribute to gum disease, tooth decay and other periodontal

disease such as periodontal abscess. Smoking also lead to injury of the oropharyngeal mucosa,

thereby increasing the likelihood of developing dental abscess formation. Smoking may also

increase the risk of abscess by altering the tonsillar bacteria flora. Nicotine is a dangerous and

highly addictive chemical. It can cause an increase in blood pressure, heart rate, flow of blood to

the heart and narrowing of the arteries ( vessels that carries blood ). Nicotine may also contributes

to the hardening of the arterial walls which in turn may lead to heart attack. When you smoke

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nicotine stimulates adrenal glands to release adrenaline, also called epinephrine. This hormones

stimulates the central nervous system, leading to increase blood pressure, heart rate and

breathing. Most importantly some smokers may notice that their gums bleeds easily after

brushing and flossing. This is no coincidence; in fact, this is yet another side effect of smoking.

Cigarrete smoking restricts blood vessels in your gums, making it more difficult for them to

function properly. As a result a smoker gum may become inflamed or infected more often than a

non-smerker’s. Also the tar and nicotine in cigarretes can easily settle in to your tooth enamel and

stain them.

Malnutrition:

Malnutrition can also be a risk factor of dental abscess i.e malnutrition affects the oral health and

a poor oral health in turn. Malnutrition may alter the homeostasis, which can lead to disease

progression of the oral cavity, reduce the resistance to the microbial biofilm and reduce the

capacity of tissue healing. It may even affect the development of the oral cavity. Recent studies s

suggested that, enamel hypoplasia, salivary gland hypofunction and saliva composition changes

may be the mechanism through which the malnutrition is associated with caries and other dental

disease. Some vitamin deficiency and it effects includes the following;

 Protein/calorie malnutrition-slower and smaller tooth development, saliva issues

 Vitamin A- oral soft tissue development, reduced tooth formation, deficient enamel

formation which can be an exposed risk factor of dental abscess.

 Vitamin D, K1/calcium –lower calcium levels, reduced teeth mineralisation, delayed tooth

eruption, poor jaw development.

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 Vitamin C- poor dentin (inner tooth) development, lower collagen, slower wound healing,

bleeding gums.

 Vitamin B1 (Thiamine) –cracked lips, cracking and inflammation in corners of the mouth.

 Vitamin B2 (Riboflavin)/vitamin B3 (Niacin)-tongue inflammation, cracking and

inflammation in the corners of the mouth, gums infection.

 Vitamin B6- Gum disease (periodontitis ), anaemic tongue, oral soreness and irritation.

 Vitamin B12- cracking and inflammation in corners of the mouth, bad breath

( halitosis) ,mouth ulcer, detachment of connective tissues supporting teeth. A main

symptoms of dental abscess is halitosis.

 Iron-saliva issues, swollen inflamed tongue, swallowing problem.

Obesity: A recent study suggest that people suffering from obesity had nearly double the chance

of developing oral conditions, fat cells increase chemical signals and hormones, affecting

metabolism, which lead to an increase in inflammation. Inflammation decrease blood flow to the

gums and accelerate disease progression. Most theories suggest that fat cells produce many

chemical signals and hormones that can increase inflammation in the body, decrease the

effectiveness of the immune system, and increase your susceptibility to dental disease. Other

theories point to the possible eating habits of overweight people and the connection to simple

sugar that the mouth convert to plaque, as plaque accumulate in the teeth and gums bacteria can

progress to the soft tissues of the teeth, surrounding tissue of the teeth and may progress to dental

abscess.

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Poor oral hygiene:

Poor oral hygiene can also be a risk factor of dental abscess: lack of proper care of the teeth and

gums like not brushing the teeth twice a day and not flossing can certainly increase the risk of

tooth decay, gum disease, tooth abscess, and other dental abscess complications. Normally the

body’s natural defence and good oral health care, such as daily brushing and flossing, keep

bacteria under control. After eating, some food particles attached on the surfaces of the teeth

which later become sticky called plaques. The bacteria in plaque use the sugar and starch in what

you eat and drink to make acids. This acid begins to eat and wear away the minerals of your

enamel. Over time the plaque can harden to tartar. Besides damaging your teeth, leading to

complicated infections. Plaques and tartar can also irritate your gums and cause gum disease or

abscesses.

Diabetes mellitus is another risk factor of dental abscess, and it’s a systemic disease

characterised by increased blood glucose level and abnormalities of lipid metabolism due to

absence or decrease level of insulin. It affects all the body organs and their functions either

directly or indirectly. Diabetes mellitus is a term applied to heterogeneous group of disorder that

share the characteristics of altered glucose tolerance or impaired lipid and carbohydrate

metabolism. It develops as result of either deficient production of insulin. It can be divided in two

types: Type I or insulin – dependent diabetes mellitus and Type II or non- insulin dependent

diabetes mellitus. Type I is cause by the destruction of insulin producing B-cells of pancreas.

Type II is due to impaired insulin function rather than deficiency (Colledge et al., 1995). The

probable influence of diabetes on the onset and development of oral disease has been studied by

many investigators. (Lund, 1968) Observed that basic the basic structural changes in the diabetic

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periodontium are the presence of calcified bodies in and around small bllod vessels of the

gingiva. Most striking changes in uncontrolled diabetes are reduction in defence mechanism and

increase susceptibility to infection leading to complicated oral disease. According to the opinion

of many clinicians, periodontal diseases or abscess follows no consistent pattern. Very severe

gingival inflammation, deep periodontal pockets, rapid bone loss, and frequent periodontal

abscess often occur in diabetic patients with poor oral hygiene. Numerous studies have shown

increase prevalence and severity of periodontal abscess in Type I diabetic (A., 1992). Diabetes

has impaired defence mechanism involving micro- and macro-vasculatures. The increased

susceptibility to infection and reduced healing capacity with altered collagen metabolism may

explain the increased level of periodontal abscess. The negative effect of diabetes mellitus on the

immune system have been extensively investigated. This effect impact greatly on the host’s

ability to prevent tne establishment of, and bring resolution to a variety of head and neck

infections. The main etiological factor in diabetes mellitus that lead to dysfunction in immune

system is hyperglycaemia. All the major cell types involve in the in the immune defence are

affected. Cellular elements of the innate immune system, including neutrophils and

monocytes/macrophages, have altered function. In the neutrophils, functions such as adherence,

chemo taxis, and phagocytosis may be down-regulated. This result in s less effective defence

against a microbial challenge. The neutrophils from diabetic patients also produce less free

oxygen radicals, which reduced their ability to make toxic metabolite for release against

microbes. Monocytes and macrophages may have up –regulated catabolism of pro-inflammatory

cytokines as well as increased production of matrix metalloproteases, such as collagenase. This

creates an imbalance that is detrimental to the containment of head and neck infections. High

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level of blood glucose can affect blood circulation and even lead to nerve damage, which further

slows healing.

Previous dental procedures can also be a risk factor of dental abscess; some dental procedures,

if not carried out correctly or if mistakes are made during treatment, can result in a dental

infection that can be not only painful, but can also cause more damage to the oral cavity.

I.e. gum infection after dental procedures. If your gums or an area of gums feels painful, tender,

swollen, or you noticed a strange taste, pus or blood in your mouth, it could a sign that u have an

infection. If you have recently had dental treatment, it’s not unusual to noticed minor pain or

sensitivity in your gums during the days immediately afterwards, but if the pain does not go away

on its own after couple of days, it may be that you have develop an infection. Dental injection

site, although rare, some people do experience an infection at the site of an injection for

anaesthesia they had during dental procedure. An infection is not always necessarily due to your

dentist making a mistake of delivering a poor level of care, sometime this type of infection could

be cause by needle breakage or trauma cause by administering the injection. Which could also be

considered as dental negligence? Infection after dental cleaning treatment, it is quite normal to

have some sensitivity for a couple of days afterwards. However, if the pain does not fade on its

own or get worst, it might be possible that there is an infection. The process of dental cleaning

can sometimes make your gums bleed slightly. Although it’s rare this can sometimes causes an

infection to develop days after the procedures, if this infection is not treated immediately, it can

aggravate leading to gingival abscess. If you have had a surgical dental procedure, depending on

the specific treatment you have had, you can usually expect some residual pain and sensitivity for

few days afterwards. Procedures of this type include some extraction, dental implant, or some

root surgeries. However if you notice that the pain is getting worse, or you experience other

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symptoms like swelling, foul odour in the affected area or salty taste in the mouth or you notice

that you have temperature, this could be a sign that you have develop an infection which can be

dental abscess and other oral infections. If you notice any of these signs mention above after

dental extraction, dental implant surgery, you need to seek dental treatment as soon as possible so

that infection can be stopped from getting worse or spreading. If you find that you have a dental

infection after dental extraction or any dental procedures, it does not necessarily mean that your

dentist did anything wrong when they carried out the treatment. However if a dentist used

equipment’s incorrectly or made errors during the procedure, this may cause dental infection

( dental abscess) after dental procedures. You may still develop an infection when the standard of

care which was provided by the dental practitioner was inadequate.

Misuse of drugs can also be another risk factor of dental abscess, the prevalence of drug

addiction is increasing globally. Drug abuse damages many parts of the body such as the oral

cavity, lungs, liver, brain and even the heart addicts suffer from physical, emotional, and

behavioural problems. Their nutrition is also compromised. Many of the abused substances have

devastating consequences on oral health cocaine can result to buccolingual dyskinesia, which is

commonly known as cracked dancing or boka torcida (twisted mouth). In the case of heroin

abuse, increase number of decayed , missing and filled teeth can be detected in the mouth. This

can result from chronic malnutrition, poor oral hygiene due to impaired motor function and

neuropathologic secondary to infection. Abuse drugs such as opiates lead to suppression of pain

responses causing patients to ignore the signs of tooth decay, periodontal disease and limited

access to dental care. (EF., 2008) Opiates, amphetamines are xerostomic, meaning that they

reduced saliva production that protect against dental decay and periodontal infections Drug

addicts should always be tested for human immunodeficiency virus and hepatitis as they

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repeatedly use unsterilized needles, which if infected with HIV, they will become infected and

this increase their risk on being infected as this disease (human immunodeficiency virus )

suppresses their immune system there by making the body to be unable to fight against pathogens

making them exposed to dental abscess and other dental conditions. Regular use of cocaine may

have severe orofacial effects, such as perforation of the nasal septum, palate, gingival lesion, and

erosion of tooth surfaces which makes it easier for bacteria to reach the tooth root surfaces and

other tooth surrounding structures which can lead to dental abscess. Another factor associated

with development of dental disease in addicts is their nutritional impairment. It has been found

that 21% of drug addicts do not take proper nutrition, which the body need some nutrients to be

able to fight for infection. Drug addict neglect their oral hygiene because of physical and

emotional dependence on drugs. Drugs like cocaine also increases tooth grinding (bruxism)

which further wears away the tooth enamel which is the hardest part of teeth and it’s 96%

mineralised, when this part is destroyed, the dentin which is less mineralised than enamel become

exposed and giving a part ways for bacteria ti infect the dentin, get in to the pulp which is the

softest part of the tooth, to the tooth where they may infect the tooth root, which can lead to

periapical abscess and other dental diseases.

2.2.6 Laboratory findings of dental abscess

There are some examinations and laboratory findings performed by the dentist in other to

diagnose dental abscess i.e. the dentist will closely look at the teeth, mouth, gums ,labial ,lingual,

buccal area of the teeth ,percussion because a tooth that has dental abscess at it roots is generally

sensitive to touch and pressure. Recommend x-ray; an x-ray of the affected tooth can help

identify an abscess. The dentist may also use x-ray to determine whether the infection has spread,

causing abscess in other areas. Recommend a CT scan (computer tomographic scan) ,if the

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infection has spread to other areas within your neck, a CT scan may be used to see how severe

the infection is. A sample of pus may be collected and taken to the laboratory for testing; this

allows the specific bacteria causing the abscess to be identified, which can help determine the

best way of treating the specific bacteria. Usually obtain at the time of tooth removal or during

tooth treatment is the most reliable specimen, organism grown directly from this specimen are

most likely to represent the causative pathogen, identification of resistance organism does not

necessarily mean the patient need additional alternative antibiotics if they have already responded

to surgical treatment. Therefore culture result is unlike to alter management for the majority of

patients with dental abscess but may be useful in cases unresponce to initial treatment. A blood

test can also be done or culture to know the specific bacteria causing the abscess.

2.2.7 Treatment of dental abscess

Treatment: Before treatment we have to explain the procedure to the patient , its

risk ,complications and benefits to the patient and /or the representative .Obtain dental

radiographs if infection and informed consent for the procedure. Provide adequate anesthesia and

direct infiltration in to the area of purulence.

Treatment methods of dental abscess: the goal of the treatment is to cure the infection, save the

tooth , and prevent complications. antibiotics medication can be prescribe to fight the infection,

warm salt water rinse may help ease the pain, over the counter pain relievers may relieve your

toothache such as diclofenac , anti-pyretic drug like paracetamol for fever.do not place aspirin

directly on your tooth or gums, this increases irritation of the tissue and can result to mouth ulcer,

a root canal can be recommended in attempt to save the tooth, where the cavity is created on the

tooth to help drained the abscess, an extraction can also be perform when the infection is severe

and also if the tooth is already excessively mobile. Abscess may be drained under local or general

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anesthesia depending on the size and location of the infection, an incision is made near the

abscess to drain the accumulated pus and debris where the area is left open and covered with a

gauze dressing to allow the wound to continue draining .Some of the Dental abscess may not

require admission to the hospital and administration of intravenous (IV) antibiotics unless the

patient present disturbing features that includes, fever, dyspnea or airway compromise secondary

to swelling. Most dental abscesses can be treated with antibiotic to cover gram negative.

Facultative, anaerobes and strict anaerobes (Stephens MB et al., 2018). Some antibiotics that can

be used to treat dental abscess include; Penicillin and cephalosporins .There is increasing

antimicrobial resistance due to B-lactamase production. This increase in resistance would make

using penicillin in conjunction with other antimicrobial such as metronidazole or an antibiotic

with an extended spectrum like ampicillin-sulbactam and amoicillin-clavulanate more

appropriate, dosing cefoxitin 1 to 2 g every 8 hours, dosing cefotan 2 g every 12 hours.

2.2.8 Some complication of dental abscess

Some complications of dental abscess include the following;

Tooth loss, if the infection spread to the gums and the underlying one that hold the tooth in

place, the result can cause tooth loss. The infection will eventually damage these supporting

structures leading to mobility of the tooth, A Tooth abscess will not go away without treatment. If

the abscess ruptures the pain may improve a lot making you thing that the problem has gone

away but you still need to get dental treatment. If abscess is not drained, the infection may spread

to your jaw and to other areas of your head and neck. If the tooth is located near the maxillary

sinus, two large space under your eyes and behind your cheeks. You can also develop an opening

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between the tooth abscess and the sinus, this can cause an infection in the sinus cavity . it is not

uncommon for an untreated tooth abscess to cause an infection within the sinuses, located

directly above the upper jaw. In such cases, the sinuses may fill with the pus and drainage that is

coming from the infected upper molar. Discomfort or throbbing pain would typically alert you

that a dental abscess has happened and prompt you to see your dentist .the abscess has reach a

point and should be treated before it worsen, spread of infection to soft tissue ,blood infection

(sepsis),a life threatening infection that spread throughout your body, spread of infection to jaw

bone ,and also to other body areas which can cause pain ,brain abscess, inflammation in the heart

and pneumonia. If you have a weakened immune system and you leave abscess untreated you are

at higher risk for infection to spread throughout the body.

Untreated dental abscess can also lead to osteomyelitis which is an infection of the bone

cause by infection; it can also cause clothing of the blood vessels. Osteomyelitis may also occur

as a result of bacteria blood stream infection, sometime called bacteraemia or sepsis that spread

to the bone. Osteomylitis occurs when bacteria from nearby infected tissue or an open wound

circulate in your blood and settle in bone, where they multiply. Osteomyelitis can occur from a

nearby infection due to a traumatic injury, frequent medication injections, a surgical procedures

or use of prosthetic devices. Individual with weakened immune system are more likely to develop

osteomyelitis. This includes people with sickle cell or HIV or that receiving immunosuppressant

therapy. Osteomyelitis can be acute which comes on suddenly and also chronic osteomyelitis is a

bone infection that does not go away with treatment, or vertebral which affect the spine and cause

chronic back pain that gets worse when you move. Osteomyelitis can also cause bone death also

called osteonecrosis, bone death can occur if swelling from the infection cut off blood flow to

your bone. Osteomyelitis may cause stunt bone growth.

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Ludwig angina can be another complication of untreated dental abscess, it is a diffused cellulitis

found in the submandibular area, sub mental area, and the sublingual area, which is a serious

infection that compromised part of the face and lower jaw. This condition can progress enough to

block the airways and cause death. Ludwig angina is a bacterial infection that affects your neck

and the floor of the oral cavity. It is not contagious. It typically starts from a tooth infection

(abscessed tooth). This rare type of cellulitis can spread rapidly, causing a life threatening

swelling that can affect the ability to breath. Ludwig angina is a diffuse cellulitis in the

submandibular, sublingual, and sub mental space characterised by the propensity to spread

rapidly to the surrounding tissues.

Brain abscess can also be a complication of untreated dental abscess. A brain abscess is a

clinical emergency because of the significant risk of long term term morbidity and mortality

associated with it despite medical advances (C-T.Ong et al., 2017). Whatever the patients age,

brain abscess requires medical and surgical treatment (Z.Sahbudak Bal, 2017). Such abscesses

correspond to a focal infection in the brain parenchyma, characterised by localised oedema and

inflammation causing a well circumscribed accumulation of pus (H.P Goodkin et al., 2002). In

the direct extension, oral infection ( dental abscess ) spread along the facial planes.

Haematogenous spreading occurs along the facial, angular, ophthalmic or other veins which lack

valves, through the cavernous sinus and in to the cranium. Brain abscess are rare but can be life

threatening infections. Recent progress in microbiological classification and identification has

indicated that they are sometimes cause by dental abscess and dental treatment. It has been

postulated that oral microorganism may enter the cranium by several pathways: 1) by direct

extension, 2) by hematogenous spread, 3) by local lymphatics, and 4) indirectly, by extra oral

odontogenic infection. In the direct extension, oral infection spread along the facial planes.

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Hematogenous spreading occurs along the facial, angular, ophthalmic, or other veins which lack

valves, through the cavernous sinus and in to the cranium. Another hematogenous pathway is

through the general circulation. Oral bacteria may cause systemic infection, e.g. endocarditis,

and then indirectly initiate brain abscess.

Heart damage can also be a complication of dental abscess. If left untreated, a tooth abscess can

also cause a condition known an endocarditis. Endocarditis is the inflammation of the inner layer

of the heart. Permanent heart damage can occur if the bacteria attach to the inside of the heart and

grow. There are two ways an infection can spread to the heart or affect it indirectly. The first

mechanism is bacteria traveling through the blood stream. Dental abscess or tooth decay, in

particular, expose the capillaries found near the root of the teeth to bacteria. Consequently

infectious bacteria travel through the bloodstream and reach the heart, where they can multiply

and produce toxins that can cause life threatening endocarditis. The infection and inflammation

may lead to the death of cardiac tissues, which in turn, can cause a fatal heart attack. If tooth

abscess is left untreated, it can not only lead to pain but can also lead to death, especially those

who already have pre-existing conditions or a history of heart ailments. The second, indirect

mechanism through which bacteria can affect the heart is by causing the immune system to over

react. Inflammation per se is not cause by bacteria but by your body’s response to them. The

immune hyper reaction can trigger multiple tissue damage across the heart

2.2.9 Prevention of dental abscess

Some prevention of dental abscess include; use floss or interdental brush at least once a day to

clean between your teeth and under your gums line, because flossing helps remove plaques

beyond your toothbrush’s reach.

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Brush your teeth with fluoride tooth paste at least twice a day brushing for at least two minute

each time, do not forget to brush your tongue to remove bacteria. Fluorides are substances, which

protect the teeth against mineral loss, contribute remineralisations of enamel and prevent

formation of acid,

Avoid eating too much sugary food and drinks particularly when before going to bed.

Visit your dentist regularly for proper check-up, and professional cleaning which is the only way

to remove tarter and it allows your dentist to detect other symptoms before they become chronic

and more painful

Drink water that contains fluoride.

Replace your tooth brush every 3 to 4 months, or whenever the bristle are frayed, consider using

antiseptic or a fluoride mouth wash to add an extra protection against tooth decay and dental

infection ( dental abscess)

Brush your teeth continuously for at least 2 minutes.

Quit smoking: smoking is strongly associated with dental abscess and other dental condition as it

weakens the immune system, making it harder to fight infection.

Use mouth wash: mouth wash can help reduce plaque, prevent gingivitis and reduces the speed

that tartar develops.

Consume a healthy and balanced diet.

2.3 Theoretical review

The theoretical frame work is a foundational review of existing theories that serve as a road map

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Dental abscess was a poorly discussed topic of medical science until the late 1900s. This clinical

entity was frequently underestimated in terms of its morbidity and mortality. Dental or

dentoalveolar abscess is a domination used to describe localised collection of pus in the alveolar

bone at the root apex of tooth. It usually occurs secondary to dental caries, trauma, deep fillings

or failed root canal treatment. Once the intact pulp chamber is breached, colonization of the root

canals occur with a diverse mix of bacteriological agents. These microorganisms are capable of

forming biofilms in root canal, hence making application of biofilm concept plausible in such

infection (Shu M et al., Development of multi species consotia biofilms of oral bacteria as an

enamel and root caries model system, 2000). After entering the periapical tissues via the apical

foramen, these bacteria are capable of inducing acute inflammation leading to pus formation. The

pathogenesis of dentoalveolar abscess is polymicrobial in nature. If this dental abscess is not

treated in early stage it may rapidly evolve and spread to adjacent anatomic structure, leading to

serious complication.

Periodontal abscess is the third most frequent dental emergency, representing 7-14% of all the

dental emergencies. Numerous aetiologies have been implicated: exacerbation of foreign objects,

the factors altering root morphology. The diagnosis is done by the analysis of the signs and

symptoms and by the usage of supplemental diagnosis aids. Evidences suggest that the micro-

flora which are related to periodontal abscesses are not specific and they are usually dominated

by gram negative strict anaerobes. Periodontium is the general term use to describe the tissues

that surround and support the tooth structure. The periodontal tissue includes the gums, the

cementum, the periodontal ligament and the alveolar bone. Among several acute conditions that

can occur in the periodontal tissues, the abscess deserves special attention. Abscesses of the

periodontium are localised acute infection which is confined to the tissues of the periodontium.

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Abscesses of the periodontium have been classified primarily base on their anatomical location

on the periodontal tissues. There are four types (Meng et al., 1999) of abscess which are

associated either the periodontal tissues: 1) gingival abscess which is associated with the

periodontal tissues, involve the marginal gingiva or the interdental papilla, 2) pericoronal abscess

which are localised purulent infection within the tissues surrounding the crown of partially

erupted tooth, 3) combined periodontal abscess / endodontic abscesses are the localised,

ciecumscribed abscesses originating from either the dental pulp or the periodontal tissue

surrounding the tooth involve tooth root apex and/or the apical periodontium and 4) periodontal

abscess which are localised purulent infection within the tissue which is adjacent to the

periodontal pocket that may lead to the destruction of the periodontal ligament and the alveolar

bone.

2.4 Emperical review

In the early 1600s, the London bills of mortality began listing the cause of death with teeth being

continually listed as the fifth or sixth leading cause of death (JH. C. , 1999). By 20 century, the

potentials of dental abscesses to spread and cause severe sepsis leading to death was recognised.

An adult carried out at the Hull Royal infirmary between 1999 and 1994 showed an increase in

the number of people presenting with oral and maxillofacial surgery service with dental sepsis

(Carter L et al., 2006). In the united states, a large prospective study reported that 13% of adult

patients sought treatment for dental pain and infection over a 24 months follow up (Boykin MJ

G. G., 2003). The incidence of dentoalveolar abscess was 6.4% among adult attending an

outpatient dental clinic in Nigeria (Azodo CC et al., Dentoalveolar abscess among children

attending a dental clinic in nigeria, 2012). In India, dental abscess affect 60-65% of the general

population (J., 2009). In addition, periodontal diseases ( periodontal abscess) is estimated to

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occur in 50-90% of the population in India (Agaiwal V et al., 2010). Improve methods of

diagnosis and reporting of this common problem are required to allow exhaustive

epidemiological analysis and its implications on health care system. Nevertheless, oral disease

has been identified as one of the priority health condition because, in late stages, they cause

severe pain and are expensive to treat. This translates in to loss of man hours, which has a

significant negative impact on economic productivity (Golden AS et al., 2008). The various host

factors play a significant role in pathogenesis of dental abscess and their complications.it has

been observe that there are specific at risk population groups, in a retrospective series of 186

cases, Huang et al. found a statistically significant correlation of acute dental abscess,

complications and death with medically compromising disease, such as diabetes, renal

insufficiency, hepatic cirrhosis, myelo-proliferative disorders, and chemotherapy (Huang TT et

al., 2004). Most studies report a male preponderance of the severe odontogenic infection in both

adult (Flynn TR et al., 2006).

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CHAPTER THREE
METHODOLOGY

3.0 INTRODUCTION
Research methodology is a way to systemically solve the research problem.it may be understood

as a science of studying how research is done scientifically.

3.1 RESEARCH DESIGN

A cross sectional study was be carried out.

3.2 STUDY AREA

The study was carried out in Cameroon precisely at Buea regional hospital which is in Fako

division and located in the South west region of Cameroon. This town is located at the foot of the

mount Cameroon. This town is endowed with good climate which attracted many people from

other parts of the country. The rich volcanic soil equatorial and an almost round rain falls makes

buea soil a fertile land for agriculture.

3.3 STUDY POPULATION

Adult patients age 18 to 50 years presenting with dental abscess.

3.3.1 Target population

Adult patients attending Buea regional hospital.

3.4 SAMPLE SIZE

Sample size was 50 participants

3.5 SAMPLING TECHNIQUE

A convenient sampling technique was applied in my research.

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3.6 INCLUSIVE CRITERIA

 Adult patients age 18 to 59 attending Buea regional hospital presenting with dental

abscess.

 Any dental adult patients age 18 to 59 attending Buea regional hospital presenting with

dental abscess and willing to take part in the study.

3.7 EXCLUSIVE CRITERIA

 Severely ill and unconscious patients

3.8 INSTRUMENTATION
The main instrument for data collection was structured questionnaires develop by the

investigator and following specific objectives. The questionnaire was structure in 5 different

sections which is aimed:

To assess the prevalence of dental abscess in adult patients age 18 to 50 in regional hospital

Buea

To assess risk factors favouring the occurrence of dental abscess in adult patient age 18 to

50

To assess the complication of dental abscess in adult patient age 18 to 50

To test adult patients age 18 to 50 on the presenting signs and symptoms of dental abscess

To assess patient on the preventive measures taken to prevent dental abscess

 Data collection tools

1. Human resources

 An investigator by name Gilean Ngwewoh a third year dental student of St

.Joan of Arc Buea to carry out the study

 A memory director by name Mr Rene.

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2. Material resources;

 A survey sheet which was used to collect data from the practitioner.

 Note pad to collect data.

 USB cable for transferring data.

 A word excels laptop for writing thesis and recording of data.

 A blue pen for doing calculation.

 Alcoholic gel for hands disinfection

 Medicated face mask to protect the mouth and nostrils.

 3. An internet key to do online research.

3.9 VALIDATION OF INSTRUMENT

Questionnaires was structured and taken to the supervisor who corrected them to ensure that

it measures what the researcher set out to measure. Five questionnaires will be presented in

Yaoundé to evaluate it validity.

3.10 METHOD OF DATA COLLECTION

The purpose of the study was explained to participants, those willing to participate signed a

consent form. Questionnaires were then administered allowing the participants to make

independent choices.

3.11 DATA ANALYSIS

Data analysis was done using SPSS version 20 software and the results obtained were presented

in the form of graphs and / or tables using Microsoft Excel 2013 software.

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3.12 ETHICAL AND ADMINISTRATIVE CONSIDERATION

 Approval to carry out the study was obtained from St Joan of Arc Higher Institute of

Medical and Management Sciences

 Approval was also obtained from the hospital administration.

 The objective of the study was explained to the participants.

 All information gotten from the participants was kept confidential.

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CHAPTER FOUR
RESULTS

4.1. SOCIODEMOGRAPHIC CHARACTERISTICS OF THE STUDY

POPULATION
The study involved 40 patients of varied ages and both sexes, 19 (47.5%) of the participants were
females, while 21 (52.5%) were males. The ages of the participants ranges from 20 to above 50
years, the highest number of participant were in the age group of 41-50years. Most of the
participants were married 14 (35%), majority were school dropouts 22 (55%), and Christians 31
(77.5%) and unemployed persons also recorded the highest participants as shown on table 1
below.
Table 1: Sociodemographic characteristics of study population

PARAMETERS FREQUENCY PERCENTAGE

Gender: -
Female 19 47.5%
Male: 21 52.5%
Age: -
21-30 11 27.5%
31-40 10 25%
41-50 12 30%
>50 7 17.5%
Marital Status: -
Married 14 35%
Single 10 25%
Divorced 6 15%
Widowed 6 15%
Concubine 4 10%
Level of Education: -
Primary 1 2.5%
Secondary 5 12.5%
University 12 30%
Dropout 22 55%

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Religion:-
Catholic 10 25%
Presbyterian 9 22.5%
Baptist 7 17.5%
Pentacostal 5 12.5%
Islam 9 22.5%
Occupation:-
Unemployed 23 57.5%
Self Employed 8 20%
Skilled Worker 6 15.%
Unskilled Work 3 7.5%

4.2. RISK FACTORS OF DENTAL ABSCESS IN ADULT PATIENTS

ATTENDING BUEA REGIONAL HOSPITAL
Majority of the participants (82.5%) responded they do not use fluoride tooth paste, (67.5%)

consume lots of sugar foods and drinks, (75%) usually have dry mouth, (70%) have cavities in

the teeth. Details are presented in table 2 below.

Table 2: Risk factors of dental abscess in adult patients attending Buea Regional Hospital

RISK FACTORS YES (%) NO (%)

Brush twice a day 70 30
Use fluoride tooth paste 17.5 82.5
Smoke cigarrette 32.5 67.5
Consume lots of sugar foods and drinks 67.5 32.5
HIV positive 12.5 87.5
Usually have dry mouth 75 25
Have cavities in the teeth 70 30
Have partially erupted tooth 30 70
Obese 15 85
Suffering from diabetes mellitus 20 80
Recent dental procedure 37.5 62.5

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4.3. COMPLICATIONS OF DENTAL ABSCESS IN ADULT PATIENTS

ATTENDING BUEA REGIONAL HOSPITAL

From the 40 participants sampled, majority (72.5%) had loss a tooth with a few (42.5%) reporting

sinusitis and (47.5%) recorded osteomyelitis and bone infection. Details are presented on table 3

below.

Table 3: Complications of dental abscess in adult patients attending Buea Regional Hospital

RISK FACTORS YES (%) NO (%)

Loss of tooth 72.5 27.5
Sinusitis 42.5 57.5
Sepsis 2.5 97.5
Pneumonia 20 80
Osteomyelitis and bone infection 47.5 52.5
Brian abscess 5 95
Heart damage 2.5 97.5

4.4. ATTITUDE AND PRACTICE RELATED TO DENTAL ABSCESS IN ADULT

PATIENTS ATTENDING BUEA REGIONAL HOSPITAL

Majority of the participants (87.5%) do not use mouth wash to reduce risk of plaque formation

(80%) do not visit the dentist regularly for proper checkup, (77.5%) do not floss or use

interdental tooth brush at least twice a day to clean between teeth and under gums, (77.5%) do

not use mouth wash to reduce risk of plaque formation, (77.5%) drink treated fluorinated water as

shown in table 4 below.

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Table 4: Attitude and practice related to dental abscess in adult patients attending Buea
Regional Hospital

RISK FACTORS YES (%) NO (%)

Floss or use interdental tooth brush at least twice a day to clean 22.5 77.5
between teeth and under gums
Visit the dentist regularly for proper check up 20 80
Drink treated fluorinated water 77.5 22.5
Replaces tooth brush every 3 to 4 months 47.5 52.5
Mouth wash to reduce risk of plaque formation 12.5 87.5
Brush with fluoride toothpaste at least twice a day 22.5 77.5
Brush continuously for 2 to 3 minutes 37.5 62.5

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CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATON

5.1. DISCUSSION
This study showed a predominance of males than females. This doesn’t reflect the proportion of

patients in most hospitals as females are usually greater than males. The high rates of males

recorded in this study could be due to sampling method used. These results are contrary to that

reported in a similar study in Cameroon by Azodo and Agbor (2015) who stated that females are

predominant than males.

The risk factors recorded in this study were the non-usage fluoride tooth paste, consume lots of

sugar foods and drinks, persistent dry mouth and cavities in the teeth. The observed results could

be due to sample size and errors during sampling. Similar studies have recorded the non-use of

fluoride toothpaste and consumption of sugar foods as the major risk factors of dental abscess in

children.

The most common complication being tooth loss recorded in this study could be due to the fact

that the participants sought medical care which prevented the infection from spreading. This

study also recorded a good number of osteomyelitis and bone infection, this results are in line

with that of Andreas et al who recorded severe osteomyelitis of the jaw bones. (Andreas et al.,

2021). The observed results could be due to absence of access to basic dental and oral healthcare

as well as poor orientation on the importance of proper dental health.

The poor attitude and practices related to dental hygiene recorded in this study can be due to lack

of basic knowledge on the importance of dental health coupled with limited access to limited

access to dental facilities and lack of finance.

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5.2. CONCLUSION
After recording a good number of complications and risk factors of dental abscess amongst

patients visiting Buea Regional Hospital, we therefore conclude that the non-usage fluoride tooth

paste and the consumption of lots of sugar foods and drinks are the major risk factors for the

development of dental abscess.

5.3. RECOMMENDATIONS
 Further studies should be carried in other unmask the bacteria species and strains causing

dental abscess

 More studies should be carried out in other to device new treatment procedures for dental

abscess

 Dental health education should be incorporated in to the curriculum for teaching primary

schools

 Parents should take an active role in teaching their children good dental practices

References

59
 60

., G. A. (1999). system for periodontal diseaseand conditions. dental research, 99, 315-349.

A Dilisiz et al. (2019). Self inflicted gingival injury due to habitual fingernails scratching. National library of
medicine, 13, 139-150.

A. Dilisiz and T. Aydin. (2009). Self inflicted gingival injury due to habitual figernails scratching : a case
reported with a 1 year follow up.

A., H. (1992). Periodontal condition in insulin dependant diabetes mellitus.

Agaiwal V et al. (2010). Prevalence of periodontal diseases in india. dental research, 4, 7-16.

Ayer W et al. (1974). Self mutilating behaviors involving the oral cavity. Dental research, 2, 330-333.

Ayer WA, L. M. (1974). Self mutilating behaviors involving the oral cavity.

Azodo CC et al. (2012). Dentoalveolar abscess among children attending a dental clinic in nigeria. dental
research, 35, 6-41.

Azodo CC et al. (2012). Dentoalveolar abscess among children attending a dental clinic in Nigeria. dental
research, 14, 55-71.

Azodo CC et al. (2012). Dentoalveolar abscess among children attending a dental clinic in Nigeria. Dental
research, 14, 55-71.

Azodo CC, C. N. (2012). Dentoalveolar abscess among children attending a dental clinic in nigeria. Dental
research, 4, 7-16.

Azodo CC, C. N. (2012). Dentoalveolar abscess among children attending a dental clinic in Nigeria.

Azodo CC, C. N. (2012). Dentoalveolar abscess in children attending a dental clinic in Nigeria.

Bhatia S, B. G. (1998). A broken needle in the pterygomandibular space: Report of a case and review of
the literature. Dent Update , 35–7.

Blair G S, M. J. (1985;). Local anaesthesia in dental practice I. A clinical investigation of a selfaspirating

system. Br Dent J, 159: 75-77.

Blaton PL et al. (1997). oral factitious injuries. Dental research, 44, 59-80.

Blaton PL, H. W. (1997). Oral factitious injuries.

Boykin MJ ,Gilbert GH, Tilashalski KR. Shelton BJ et al.,. (2003). Incidence of endodontic treatment.
dental research, 29, 9-809.

Boykin MJ et al. (2003). incidence of endodontic treatment. Dental research, 11, 101-150.

60
 61

Boykin MJ, G. G. (2003). Incidence of endodontic treatment.

Boykin MJ, G. G. (2003). Incidence of endodontic treatment.

Brown RS, P. S. (2002 ). Evaluating a dental patient for local anaesthesia allergy . Compend, 125–38.

Burczynska A et al. (2017). periapical abscess. dental research, 71(3), 428-417.

Burczynska A, S. I. (2017). Periapical abscess ,ethiology,pathogenesis and epidemiology.

C.-T. Ong, C.-F. T.-S.-C. (2017). Epidemiology of brain abscess in taiwan.

Carter JH et all. (1999). toothache and death. Dental research, 3-11.

Carter L et al. (2006). Alarminh increase dental sepsis. dental research, 200, 243.

Carter L, S. D. (2006). Alarming increase in dental sepsis.

Carter L, S. D. (2006). Alarming increase in dental sepsis.

CB et al. (2000). inflicted gingival injury due to habitual fingernails bitting. dental research, 11, 15-31.

CB., K. (2000). Inflicted gingival injury due to habitual fingernail bitting.

Clarke JH et al. (1999). tooth abscess and death. dental research, 47, 3-11.

Cohen Brown G et al. (2018). diagnosis and treatment of salivary gland disorders. Clinical diagnosis, 14,
299-310.

Cohen-Brown G, S. J. (2018). Diagnosis and treatment of salivary gland disorders.

Colledge et al. (1995). principle of medicine. dento-medico, 3, 19-28.

Colledge, N. R. (1995). Principle and practices of medicine.

Crean SJ, P. A. (1999 ). Neurological complications of local anaesthetics in dentistry . Dent Update, 344–9.

Creath CJ et al. (1995). Gingival swelling due to fingernails bitting habit. dental research, 3, 222-232.

Creath CJ, S. S. (1995). A case report : Gingival swelling due to a fingernail-biting habit.

C-T.Ong et al. (2017). Epidermiology of brain abscess in taiwan. National library medicine, 12, 7-59.

Decloux D, O. A. (2020 Sep 17;). Local anaesthesia in dentistry:. a review. Int Dent J. .

Dhanrajani PJ, J. O. (2002). Trismus: Aetiology, differential diagnosis and treatment. Dent Update, 88–94.

Dunbar D, R. A. (1996; ). Anesthetic efficacy of the intraosseous injection after an inferior alveolar nerve
block. J Endodont , 22: 481-486.

61
 62

E., G.-G. G. ( 1973; ). Mandibular conduction anesthesia: a new technique using extra-oral landmarks.
Oral Surg, 36: 321-328.

EF., C. (2008). Dental implications of narcotic addiction.

F., M. S. ( 1997.). Handbook of local anesthesia.4th ed. St. Louis: Mosby,.

Faura-Solé M, S.-G. M.-A.-E. (1999). Broken anesthetic injection needles: Report of 5 cases. Quintessence
Int, 461–5.

Flynn TR et al. (2006). Odontogenic infection. dental research, 8, 29-40.

Flynn TR, S. R. (2006). Odontogenic infections.

Furness S et al. (2013). Interventions for the management of dry mouth. clinical management, 1, 777-
782.

Furness S, B. G. (2013). Interventions for the management of dry mouth : non pharmacological
interventions.

G., H. P. (1986 November/ December issue.). Clinical anatomy of regional analgesia: an approach to
failure. Dent Update .

Garnier M, D. V. (2004.). Dictionnaire illustré des termesde médecine. Paris Masson;, 98:251.

Geoname. (2022).

Golden AS et al. (2008). Global affordability of fluoride toothpaste. Global health, 4, 7.

Golden AS, Y. R. (2008). Global affordability of fluoride toothpaste.

Golden S, C. A. (1962). Oral manifestation of psycho;ogical problem.

Goldman AS, Y. R. (2008). Global affordability of fluoride toothpaste.

Granger., S. (1988.). Longman Dictionary.

Gray R J M, L. A. (1987; ). Periodontal ligament injection: with or without a vasoconstrictor. Br Dent J,

162: 263-265.

H.P Goodkin et al. (2002). The superior alveolar injection technique. national library medicine, 54, 108-
135.

H.P. Goodkin, M. B. (2004.). Intracerebral abscess in children.

Harn SD, D. T. (2002). The superior alveolar injection technique: A report on technique variations and
complications. Gen Dent , 544–50.

62
 63

Huang TT et al. (2004). Deep neck infection. dental research, 26, 60-854.

Huang TT, L. T. (2004). Deep neck infection.

Huang TT, L. T. (2004). Deep neck infection.

IA, B. (1999). Allergic reaction to lignocaine. Br Dent J, 224–6.

J et al. (2009). Dental aducation and oral health prolems in india. National library medicine, 78, 233-256.

J, M. ( 1998). How to avoid local anaesthetic toxicity . Br Dent J, 334–6.

J., K. (2009). Dental education and oral health problem in India.

Jenkins GW et al. (2018). Dental abscess in pediatric patients. National library of medicine, 36(11), 774-
777.

Jenkins GW, B. D. (2018). Dental abscess in pediatric patients .

Jenkins GW, B. D. (2018). Dental abscess in pediatric patients. National library of medicine., 34(11), 774-
777.

JG, M. (1999). How to overcome failed local anaesthesia. Br Dent J , 15–20.

JG, M. (1999). How to overcome failed local anaesthesia. Br Dent J, 15–20.

JH., C. (1999). Toothache and death.

JH., C. (1999). Toothaches and death.

JP, R. (2000). Adverse reaction to dental local anaesthetic injection – «allergy» is not the cause. Br Dent J
, 380–4.

JSTOR. (November 2007).

Kaufman E, W. P. ( 1984;). Difficulties in achieving anesthesia. J Am Dent Asssoc , 108: 205-208.

Kaur. (2009). Dental education and oral health problems in india.

Kilgore et al. (1998). predisposing factors of dental abscess. 13, 1-11.

Kilgore, L. (1989). predisposing factors of dental abscess. 13, 1-11.

Kramp LF, E. P. (1999). Evaluation of Prilocaine for the reduction of pain associated with transmucosal
anesthetic administration. Anesth Prog , 52–5.

Lääketietokeskus. (2003). Pharmaca Fennica, 2550–1.

63
 64

Lofgren N. (1948). Xylocaine, a New Synthetic Drug. Hoeggstroms:.

Loomer, P. &. (2004). Computer-controlled delivery versus syringe delivery of local anesthetic injections
for therapeutic scaling and root planing. JADA, 135, 358–365.

López-Valverde A, d. V. (2011;2011:). The surgeons Halsted and Hall, cocaine and the discovery of dental
anaesthesia by nerve blocking. British Dental Journal., 485-487.

Lucavechi T et al. (2007). Self injurious behavior in patient with mental retardation. pubmed, 72, 7-10.

Lucavechi T, B. M. (2007). Self-unjurious behavior in the patient with mental retardation.

Lund, L. H. (1968). Relationship between periodontal state and diabetes.

Lustig JP, Z. S. (1999). Immediate complications of local anesthetic. J Am Dent Assoc , 496–9.

Madan GA, M. S. ( 2002). Failure of inferior alveolar nerve block. Exploring the alternatives. J Am Dent
Assoc, 843–6.

mahj. (2008). bbbbb. GAROUA: yao.

Matthews R, B. R. (1997). The efficacy of local anaesthetics administered by general dental practitioners.
Br Dent J, 182: 175-178.

McDonogh. (1996). An unususal case of trismus and dysphagia. Br Dent J, 465–6.

Meechan J G, M. J. (J1990;). Plastic dental local anaesthetic cartridges: a laboratory investigation. Br Dent
, 169: 54-56.

Meechan JG, R. J. (1997). Adverse effects of dental local anaesthesia. Dent Update, 315–8.

Meng et al. (1999). Periodontal abscess. dental research, 15, 550-565.

Meng., H. X. (1999). periodontal abscess.

Mittal S et al. (2011). The diagnostic role of saliva. 3, 314-320.

Mohammed, D. R. (2019). Local anaesthetics.

Nair PN et al. (2004). Pathogenesis of apical periodontitis and the causes of endodontic failures. dental
research, 15, 81-348.

National institute of general medical sciences. (12 Jul 20222).

Navazesh M et al. (1992). Clinical criteria for the diagnosis of salivary gland hypofunction. National
library of medicine, 71, 1363-1369.

64
 65

Neves ETB et al. (2019). Association between sence of coheranceand untreated dental caries in
preschoolers. National library of medicine., 69(2), 141-149.

Neves ETB, P. M.-G. (2019). Association between sence of coherence and untreated dental caries in
preschoolers.

Niwa H, H. Y. ( 1996). Systemic emergencies and their management in dentistry: Complications

independent of underlying disease. Anesth Prog, 29–35.

Ogle OE, M. G. ( 2012). Local anesthesia: agents, techniques, and complications. Local anesthesia:
agents, techniques, and complications, 133–ix.

Oulis C J, V. G. (1996;). The effectiveness of mandibular infiltration compared to mandibular block

anesthesia in treating primary molars in children. . Ped Dent , 18: 301-305.

P., R. J. (1976;). Inferior alveolar nerve blocks. The use of 5% lignocaine. . Br Dent J , 140: 413-414.

Plemons JM et al. (2014). Management of xerostomia and salivary gland hypofunction. clinical
management, 17, 89-135.

Plemons JM, H. I. (2014). A management of xerostomia and salivary gland hypofunction.

PN., N. (2004). Pathogenesis of apical periodontitis and the causes of endodontic failures.

Pogrel MA, T. S. (2000). Permanent nerve involvement resulting from inferior alveolar nerve block . J Am
Dent Assoc, 901–6.

R., S. (1986). Self injurious behavior : report of a case nad follow up.

R., V. G. (1997;). Intrapulpal injection. Factors related to effectiveness. Oral Surg, 83: 38-40.

Replogle K, R. A. (1997; ). Anesthetic efficacy of the intraosseous injection of 2% lidocaine (1:100000

epinephrine) and 3% mepivacaine in mandibular first molars. Oral Surg, 83: 30-37.

Roberts G J, H. H. (1997; ). Dental bacteremia in children. Ped Cardiol , 18: 24-27.

Roda RS, B. P. (1998). The anatomy of local anesthesia. Texas Dent J, 15–25.

Rood J P, P. S. (1982;). ocal anaesthetic failures due to an increase in sensory nerve impulses from
inflammatory sensitization. J Dent, 3: 201-206.

Rucci F S, P. P. (1995;). Effect of injection speed on anaesthetic spread during axillary block using the
orthogonal two-needle technique. Eur J Anaesth, 12:505-511.

Ryhanen J-M, L. K. (1997;). Soft tissue anesthesia with lidocaine, prilocaine and their combination. J Dent
Res , 76: 154.

65
 66

S., E. (2013). Dysphagia in rheumatological disorder.

SD., J. (1995). Habits affecting dental and maxillofacial growth and development.

Shu M et al. (2000). Development of multi species consotia biofilms of oral bacteria as an enamel and
root caries model system. National library medicine, 8, 210-250.

Shu M et al. (2000). Development of multi-species consortia biofilms of oral bacteria as an enamel and
root caries model system. 45, 27-40.

Shu M et al. (2002). Development of multi species consotia biofilmsof oral bacteria as an enamel and
root caries model system. dental research, 8, 210-253.

Shu M, W. L. (2000). Development of multi species consortia biofilms of oral bacteria as an enamel and
root caries model system .

Shu M, W. L. (2000). Development of multi-species consortia biofilms of oral bacteria as an enamel and
root caries model system.

Smith G N, W. R. (1983;). Clinical evaluation of periodontal ligament anesthesia using a pressure syringe.
J Am Dent Assoc , 107: 953-956.

Sruthi MA, R. M. (2021 Sep-Oct; ). Transpapillary Injection Technique as a Substitute for Palatal
Infiltration: A Split-mouth Randomized Clinical Trial. Int J Clin Pediatr Dent. , 14(5):640-643.

Stephens MB et al. (2018). Dental problems in primary care. clinical management, 42, 33-59.

Stephens MB, W. J. (2018). Dental problems in primary care.

Stewart, D. (1976). Minor self inflicted injuries to the gingivae.

Sudan J et al. (2018). Assessing clinical sequelae of untreated caries among 5,12 and 15 years old
children in ambala district. Dental research, 36(1), 15-20.

Sudan J, S. G. (2018). Assessing clinical sequele of untreated carries among 5 to 12 and 15 years old
school children in ambala district.

Sudan J. (2018). Assessing clinical sequele of untreated caries among 5-12 and 15 years old school
children in ambala district. Dental research, 36(1), 15-20.

Troisieme recencement generale de la population et de l'habitat. (2005).

U.S. (2019). Food and drug information dry mouth.

Vree TB, G. M. (2005). Clinical pharmacology and the use of articaine for local and regional anaesthesia.
Best Practice and Research in Clinical Anaesthesiology., 293-308.

66
 67

W., N. P. ( 1981;). Letter. . J Am Dent Assoc , 103: 692.

Walton R E, A. B. (1981;). Periodontal ligament injection: a clinical evaluation. . J Am Dent Assoc , 103:
571 - 575.

Wang. (2005). dental abscess admission the hospital occured at the rate of 1 per 2600 per population in
the united states.

Wang YH et al. (2021). Local anesthesia inoral and maxillofacial surgery. medical sciences, 1, 16-21.

Wang YH, W. D. (2021 Oct;). Local anesthesia in oral and maxillofacial surgery: A review of current
opinion. J Dent Sci., 16(4):1055-1065.

Wilson S, J. P. ( 1984; ). The inferior alveolar and mylohyoid nerves: an anatomic study and relationship
to local anesthesia of the anterior mandibular teeth. . J Am Dent Assoc, 108: 350-352.

YC., T. (2016). Dry mouth more common and less benign than thought.

Ying Joana ND et al. (2015). Dry mouth. clinical sciences, 12, 106-115.

Ying Joanna ND, T. W. (2015). Dry mouth an overview.

Z.Sahbudak Bal, E. E. (2017). brain abscess in children: a rare but serious infection.

Zeltser R, C. C. (2002). The implications of a broken needle in the pterygomandibular space: clinical
guidelines for prevention and retrieval. Pediatr Dent, 153–6.

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