Leave the abscess as large as possible to make the area easier to find for further management. If unable to aspirate pus, manage medically until a more localized infection develops. Only if pus could be aspirated Packing a periapical abscess generally is not necessary. The flora at different oral sites varies. Anaerobes usually outnumber aerobes and facultative anaerobes.
Most odontogenic infections involve plaque organisms.
Supragingival plaque consists mainly of gram-positive facultative anaerobes or microaerophilic cocci and rods. Subgingival plaque consists of anaerobic gram-negative rods and motile form including spirochetes. Properly collect specimen for Gram stain and culture. Administer empiric antibiotic therapy. Hydrate the patient.