A microbiological and clinical review of the acute dentoalveolar abscess.

Early microbiological studies of acute suppurative dental infection implicated streptococci or staphylococci as the causative microorganisms but recent studies suggest that the microbial flora of acute dentoalveolar abscess is usually polymicrobial, predominantly involving CO2-dependent streptococci, strictly anaerobic Gram-positive cocci and strictly anaerobic Gram-negative bacilli. These differences are probably due to poor sampling techniques and inadequate culture methods used in the early investigations. It is now accepted that specimens should be obtained by aspiration to avoid contamination and processed promptly using strict anaerobic culture. Traditionally the bacterial strains isolated have been regarded as members of the normal oral commensal microflora but it is becoming increasingly apparent from experimental infections that they have pathogenic properties. Although the vast majority of isolates have been found to be sensitive to a variety of antimicrobial agents there would not appear to be a uniformly effective drug. At the present time a penicillin, such as amoxycillin, would probably be the first choice antimicrobial agent with the addition of metronidazole if clinical improvement does not occur.