A dental abscess, or tooth abscess, is accumulation of pus that forms inside the teeth or gums of an individual. The abscess typically originates from a bacterial infection, often one that has accumulated in the soft pulp of the tooth. Bacteria exist in plaque in the mouth which sticks to the teeth and damages them, as well as the gums. If the plaque is not removed by regular and proper tooth brushing and flossing the bacteria may spread within the soft tissue inside the tooth or gums, eventually resulting in an abscess. Treatment should be obtained immediately or else the infection can increase and can even lead to death.
Types
There are three types of dental abscess:
-
Gingival abscess- the abscess is only in the gum.
-
Periodontal abscess- this abscess starts in the supporting bone tissue structures of the teeth.
-
Periapical abscess – this abscess starts in the soft pulp of the tooth.
Signs and Symptoms
Signs and symptoms of a dental abscess include:
-
Pain in the affected area when biting
-
Touching the affected area may be painful
-
Sensitivity to cold or hot food and liquids
-
A foul taste
-
Fever
-
General weakness
-
Difficulty in opening mouth
-
Difficulty in swallowing
-
Lack of sleep
The main symptom of a dental abscess is pain. This may be a throbbing pain, and is often intense. The pain usually starts suddenly, and becomes more intense over the subsequent hours or days. In some cases the pain may radiate to the ear, jawbone and neck.
Causes of a dental abscess
A dental abscess in most cases is a complication of a dental infection. Bacteria, often bacteria present in plaque, infect and make their way into a tooth.
Periapical abscess
Periapical abscess is an infection seen around the end of the root of the tooth. Bacteria enter the tooth through tiny holes caused by tooth decay that forms in the tooth enamel. The caries eventually break down the softer layer of tissue under the enamel, called dentine. If the decay continues, the hole will eventually penetrate the soft inner pulp of the tooth – infection of the pulp is called pulpitis. As the pulpitis progresses the bacteria make their way to the bone that surrounds and supports the tooth, called the alveolar bone, and a periapical abscess is formed.
Periodontal abscess
Periodontal abscess is an infection of the periodontium surrounding the tooth. When bacteria which are present in plaque infect the gums the patient has periodontitis. The gums become inflamed, which can make the periodontal ligament separate from the base of the tooth.
A periodontal pocket, a tiny gap, is formed when the periodontal ligament separates from the root. The pocket gets dirty easily and is very hard to keep clean. As bacteria build up in the periodontal pocket, periodontal abscess is formed.
Patients can develop periodontal abscesses as a result of a dental procedure which accidentally resulted in periodontal pockets. Also, the use of antibiotics in untreated periodontitis, which can mask the symptoms of an abscess, can result in a periodontal abscess.
Treatment
A dentist can identify the presence of an abscess and the cause for it. Treatment may involve typical dental procedures, and in some cases occasional surgery may be necessary.
Incision – the abscess needs to be cut out and the pus, which contains bacteria, should be drained away under local anaesthesia.
Treating a periapical abscess -Root canal treatment will be used to remove the abscess. A drill is used to bore a hole into the dead tooth so that the pus can come out. Any damaged tissue will be removed from the pulp. A root filling is then inserted into the space to prevent subsequent infections.
Treating a periodontal abscess – the abscess will be drained and the periodontal pocket cleaned. The surfaces of the root of the tooth will then be smoothed out by scaling and smoothing below the gum line. This helps the tooth heal and prevents further infections from occurring.
Surgery for dental abscesses
Patients with a periapical abscess and a recurring infection may need to have diseased tissue surgically removed.
Patients with a periodontal abscess and a recurring infection may have to have their gum tissue reshaped and the periodontal pocket removed. If the dental abscess recurs, even after surgery, the tooth may be extracted.
Treatment for pain
Antibiotics and painkillers prescribed by the dental surgeon will help in reducing the infection and pain while the patient is waiting for treatment. Painkillers are only there for pain reduction, they cannot replace the visit to a dentist.
Home care measures;
-
Avoid hot and cold foods and drinks
-
Do not floss around the affected area
-
Use a very soft toothbrush.
-
Use saline gargle 3-4 times a day.
Complications of a dental abscess
In the vast majority of cases, complications only occur if the abscess is left untreated. However, complications can occur, even after seemingly effective treatment, but this is very rare. Possible complications include:
Dental cysts – a fluid-filled cavity may develop at the bottom of the root of the tooth if the abscess is not treated. This is called a dental cyst. There is a significant risk that the cyst will become infected. If this happens the patient will need antibiotics, and possibly surgery.
Osteomyelitis – the bacteria in the abscess gets into the bloodstream and infects the bone. The patient will experience an elevated body temperature, severe pain in the affected bone, and possibly nausea. Typically, the affected bone will be near the site of the abscess; however, as it may have spread into the bloodstream any bone in the body may be affected. Treatment involves either oral or intravenous antibiotics.
Cavernous sinus thrombosis – the spread of bacteria causes a blood clot to form at the cavernous sinus – a large vein at the base of the brain. Cavernous sinus thrombosis is treated with antibiotics, and sometimes surgery to drain the sinus. In some cases the condition can be fatal. This is a very rare complication.
Ludwig’s angina – this is an infection of the floor of the mouth when the dental abscess bacteria spread. There is swelling and intense pain under the tongue and in the neck. In severe cases the patient may find it hard to breathe. Ludwig’s angina is a potentially fatal condition. Patients are treated with antibiotics. In severe cases a tracheostomy (procedure to open the airway) is performed if there are breathing problems.
Maxillary sinusitis – the bacteria spread into small spaces behind the cheekbones, called the maxillary sinuses. This is not a serious condition, but can be painful, and the patient may develop a fever and have tender cheeks. Sometimes the condition resolves on its own. Depending on the severity, the doctor may prescribe antibiotics.
The dentist can identify whether the abscess is due to the infection of the tooth or arising from the gums using an x ray and other tests. The treatment is done based on the type of abscess. Patients who identify the presence of an abscess in their oral cavity should immediately visit their dentist without any further delay.
Dr Benley George
Vice Principal, Pushpagiri College of Dental Sciences, Tiruvalla,
