Hard palate abscesses are most commonly related to maxillary lateral incisors or palatal roots of the posterior teeth, especially maxillary 1st molar and premolars. The infection starts at the tooth apex and erodes through the palatal bone, accumulating into the palatal mucoperiosteum. The lesion is fluctuant, is usually very painful with a paramedian location, and typically does not cross the palate’s midline. Palatal abscesses need to be differentiated from other pathologies such as salivary gland tumors, neural tumors, cysts, fibromas, and torus palatinus.
Hard Palate Abscess. This palatal abscess originated from the palatal roots of teeth 6 and 7. The area was markedly fluctuant to palpation. (Photo contributor: R. Jason Thurman, MD.)
Hard Palate Abscess. A hard palate abscess originating from the palatal root of the patient’s right second molar. A large amount of purulence was expressed with incision. (Photo contributor: Lawrence B. Stack, MD.)
Management and Disposition
Treatment is the same as for any other orofacial abscess: incision and drainage, antibiotics, and dental follow-up are the mainstays of therapy. Definitive treatment, usually performed by a dentist, includes extraction or root canal therapy of the offending tooth. The patient’s tetanus status should be addressed.
Incision and drainage of this area should be done parallel to dentition, near the border of the gingivae or toward the midline, avoiding injury to the greater palatine neurovascular bundle.
The absence of fever does not preclude the diagnosis of palatal abscess.