Thank you so much for covering this topic. I kind of hope I am not alone in feeling I could use some more training on the best way to actually accomplish the incision and drainage procedure for dental abscess. This chapter makes it sound like this I+D procedure is a chip shot, but I don't find that to be the true in many of my cases. I'm one of those rural EM types with no oral surgeon or dentist on call. The local dentists won't see the Medi-Cal/uninsured patients who make up the majority of my dental pain patients. The cases that come in nice, ripe and pointing are pretty straightforward, but it seems most patients come in before this stage. They've got swelling, I think I can feel a firm area in there. I grab our ultrasound and compare the affected side to the opposite side and it looks like there is fluid in there. So I block them up, incise, and get nada. Now what? I'm reluctant to just do more blind cutting for fear of a complication. So I start aspirating with an 18 gauge needle and still usually don't find any pus. This seems to happen most commonly with maxillary/incisior space infections, but is true of infections buccal to the mandible as well. Maybe Dr. Mason can post up something on EMRAP HD ? Thank you for any additional help you can provide.
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Lars E., M.D. - October 6, 2017 8:37 PM
Thank you so much for covering this topic. I kind of hope I am not alone in feeling I could use some more training on the best way to actually accomplish the incision and drainage procedure for dental abscess. This chapter makes it sound like this I+D procedure is a chip shot, but I don't find that to be the true in many of my cases. I'm one of those rural EM types with no oral surgeon or dentist on call. The local dentists won't see the Medi-Cal/uninsured patients who make up the majority of my dental pain patients. The cases that come in nice, ripe and pointing are pretty straightforward, but it seems most patients come in before this stage. They've got swelling, I think I can feel a firm area in there. I grab our ultrasound and compare the affected side to the opposite side and it looks like there is fluid in there. So I block them up, incise, and get nada. Now what? I'm reluctant to just do more blind cutting for fear of a complication. So I start aspirating with an 18 gauge needle and still usually don't find any pus. This seems to happen most commonly with maxillary/incisior space infections, but is true of infections buccal to the mandible as well. Maybe Dr. Mason can post up something on EMRAP HD ? Thank you for any additional help you can provide.