What’s to know about dental abscesses?

February 15, 2018 by Dr. Andrew Smyth  •  Original Post

By Christian Nordqvist

A dental abscess, or tooth abscess, is a buildup of pus that forms inside the teeth or gums.

The abscess typically comes from a bacterial infection, often one that has accumulated in the soft pulp of the tooth.

Bacteria exist in plaque, a by-product of food, saliva, and bacteria in the mouth, which sticks to the teeth and damages them and the gums.

If the plaque is not removed by regular and proper brushing and flossing, the bacteria may spread inside the soft tissue of the tooth or gums. This can eventually result in an abscess.

Fast facts on dental abscesses

Here are some key points about dental abscesses. More detail and supporting information is in the main article.

  • There are three types of dental abscess: Gingival, periodontal and periapical.
  • Symptoms of dental abscesses include pain, a bad taste in the mouth and fever.
  • Dental abscesses are caused by a bacterial infection.
  • Treatment for an abscess may involve root canal surgery.
  • To minimize pain, it is best to avoid cold drinks and food and use a softer toothbrush.

Symptoms
Pain is the main symptom of a dental abscess.

Signs and symptoms of a dental abscess include:

  • pain in the affected area when biting or when touching the affected area
  • sensitivity to cold or hot food and liquids
  • a foul taste in the mouth
  • fever
  • a generally unwell feeling
  • difficulties opening the mouth
  • swallowing difficulties
  • insomnia

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 following hours or days. In some cases, the pain may radiate to the ear, jawbone, and neck.

Types

There are three types of dental abscess:

  • Gingival abscess: The abscess is only in the gum tissue and does not affect the tooth or the periodontal ligament.
  • Periodontal abscess: This abscess starts in the supporting bone tissue structures of the teeth.
  • Periapical abscess: this abscess commences in the soft pulp of the tooth.

The type of abscess will dictate the severity and location of symptoms.

Treatments
Surgery may be necessary for some abscesses.

Any person with symptoms linked to a dental abscess should see a dentist immediately. Dental abscesses are easily diagnosed by a qualified dentist.

People who have swallowing and breathing problems should go straight to the emergency department of their local hospital.

If you cannot get to a dentist immediately, visit a family doctor.

A doctor cannot treat an abscess, but they may prescribe medication and advise on self-care and pain management and are also likely to know the fastest way of getting emergency treatment if required.

Incision: The abscess needs to be cut out and the pus, which contains bacteria, drained away. The doctor will administer a local anesthetic.

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 planing below the gum line. This helps the tooth heal and prevents further infections from occurring.

Surgery

People with a periapical abscess and a recurring infection may need to have diseased tissue surgically removed. This will be done by an oral surgeon.

Those with a periodontal abscess and a recurring infection may have to have their gum tissue reshaped and the periodontal pocket removed. This procedure will be performed by an oral surgeon.

If a dental abscess comes back, even after surgery, the tooth may be taken out.

Pain management

Over the counter (OTC) painkillers may help reduce the pain while an individual is waiting for treatment. It is important to follow the information on the packet carefully. Painkillers are only there for pain reduction and cannot replace a visit to a dentist.

Aspirin, ibuprofen or Tylenol (paracetamol) are effective painkillers. However, some are unsuitable for certain types of patients (read below):

  • Ibuprofen and asthma: If you are asthmatic, do not take ibuprofen.
  • Ibuprofen and stomach ulcers: Do not take ibuprofen if you have, or ever had stomach ulcers.
  • Aspirin and children: Do not give aspirin to children under 16 years of age.
  • Aspirin and pregnancy and breastfeeding: Do not take aspirin if you are pregnant or breastfeeding.

Antibiotics

Antibiotics may be prescribed to prevent the infection from spreading and may be taken together with painkillers. Examples of antibiotics include amoxicillin or metronidazole. In no way should antibiotics be seen as a way of substituting treatment with a dentist, or postponing treatment.

Causes

A dental abscess is, in most cases, a complication of a dental infection. Bacteria, often bacteria present in plaque, infect and make their way into a tooth.

Periapical abscess

Bacteria enter the tooth through tiny holes caused by tooth decay, or caries, that form in the hard outer layer of the tooth. 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 and become infected.

This is known as 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

When bacteria which are present in plaque infect the gums, the patient has periodontitis. The gums become inflamed, which can make the tissue surrounding the root of the tooth 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, a 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. Sometimes gum damage can lead to periodontal abscesses, even if no periodontitis is present.

Complications

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. People with severe Ludwig's angina may require a procedure to open the airway 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. 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.

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