Dental Pain in Emergency Department Patients: Utilizing Point-of-Care Ultrasound for Dental Abscess Detection

Dental infections are common and patients with dental abscesses (DA) often require emergency department (ED) incision and drainage (I&D). Computed tomography (CT) is frequently used to diagnose DA but has drawbacks.

We sought to measure the accuracy of point-of-care ultrasound (POCUS) in identifying ED patients with DA compared to CT.

A prospective, observational, convenience study of adults presenting to the ED with atraumatic dental pain and facial swelling. Patients were approached for enrollment if the treating physician suspected DA and ordered a CT scan of the face. Patients with airway or hemodynamic compromise were excluded. Enrolled patients had POCUS examinations of the face performed by blinded faculty while awaiting CT. These were interpreted as abscess versus no abscess and retrospectively compared with concurrent CT. The medical record was reviewed for subsequent ED visits and oral surgery follow-up within 30 days.

A total of 29 patients were included in the final analysis. POCUS examinations were performed by 7 physicians. 66% of patients were female, 45% Caucasian. The sensitivity of POCUS for identifying DA was 1 (95% CI: 0.74-1), specificity 0.35 (95% CI: 0.13-0.64), PPV 0.63 and NPV 1. Nine patients had a DA on POCUS but only phlegmon or cellulitis on CT. One of these 9 patients had I&D yielding pus despite equivocal CT, and 2 others returned to the ED within 2 days with repeat CT showing definitive DA.

Preliminary data suggests POCUS is highly sensitive, but less specific compared to CT for evaluating suspected DA in ED patients.