Plaque is a precipitate of denatured salivary proteins that allow bacteria to adhere to the enamel of teeth. In immunocompromised patients, bacteria may spread hematogenously to invade the pulp of the tooth. Complicated abscess CBC may show leukocytosis with neutrophil predominance. Obtain culture before initiating parenteral antibiotics. Needle aspirate for Gram Stain and culture.
Plain radiography represents the first level of investigation because it is readily available.
Lateral and anterior-posterior neck views may reveal a soft tissue neck mass impinging on the airway. CT scan with intravenous contrast is the most accurate method to determine the location, size, extent, and relationship of the inflammatory process to the surrounding vital structures. Aspiration Confirm presence of the abscess by needle aspiration. If pus is obtained, do not aspirate more than 1 or 2 drops. Leave the abscess as large as possible to make the area easier to find for further management.