Dental Abscess on POCUS: A Retrospective Case Series Analysis

Background: Point of care ultrasound (POCUS) has proven utility in confirming the diagnosis of skin and soft tissue abscesses. We studied the characteristics of 50 dental abscess on pediatric POCUS examinations and their outcomes. Methods: This was a convenience sample of cases collected in the pediatric emergency department from December 2020 to December 2024. All included patients were examined by an oromaxillofacial specialist and hospitalized. All cases had POCUS imaging performed at initial assessment by the first author. Results: The median age of the patients was 7 years (IQR = 5 years), and 31 (62%) were male. Forty (80%) received antibiotic prior to arrival. Thirty-five (70%) presented within 3 days from onset of pain, and 36 (72%) were referred to the pediatric emergency department by a dentist for oromaxillofacial evaluation. Four children (8%) experienced spontaneous drainage while inpatient, and eleven children underwent surgical drainage (22%). There was a significant correlation between maximal abscess height from bone and the need for surgical drainage (p = 0.011). A cutoff of 4.5 mm yielded a sensitivity of 72.7% and specificity of 69%, indicating that abscesses measuring greater than 4.5 mm are more likely to need surgical drainage. Conclusions: This was the first known study to describe POCUS findings in children determined to have dental abscess by an oromaxillofacial specialist and hospitalized for treatment. POCUS may have utility in identifying dental abscess, and may be useful in following the progress of abscesses under treatment. The majority of dental abscesses will resolve with antibiotic therapy, but abscesses above 4.5 mm may require drainage early in the course of treatment.