Dental abscesses are a common oral health problem affecting millions of people every year. They present a painful, often debilitating condition that can occur rapidly or over an extended period. Recognizing the initial symptoms mitigates severe pain and discomfort and prevents potential complications, such as the spread of infection or tooth loss.
What is a Dental Abscess?
A dental abscess is a localization of pus associated with a tooth that results from a bacterial infection. The abscess can begin beneath the tooth enamel and dentin or outside the tooth in the gums. The immune system responds to this condition by sending white blood cells, leading to pus accumulation and subsequent swelling or abscess formation.
Types of Dental Abscesses
There are two different types of dental abscesses with similarities and differences. Because the treatment for each one is significantly different, the correct diagnosis is critical to eliminating the infection and restoring your oral health. The two primary types of dental abscesses are discussed below.
1. Periapical Abscess
A periapical abscess is an oral health condition that shouldn't be overlooked due to its potential complications if left untreated. The term 'periapical' refers to the area around the apex (end) of a tooth root, while 'abscess' refers to a localized collection of pus.
Causes
Periapical abscesses can be painful dental conditions resulting from bacterial infection within a tooth's pulp chamber. The dental pulp is the soft tissue, also known as the tooth nerve, located beneath a tooth’s enamel and dentin. These abscesses start when bacteria gain access to the pulp, often through untreated dental issues. Understanding the causes can help in the prevention and early detection of this condition.
The common causes are:
- Tooth decay. Bacteria in the mouth can erode the tooth enamel and dentin, causing cavities that provide an entry point for an infection.
- Cracks or fractures. These can be virtually invisible to the naked eye. Yet they can provide a pathway for oral bacteria through the enamel and dentin of your tooth into the dental pulp.
- Defective dental restorations. Previous dental treatments, such as filling and crowns, can break down over time and lose their tight seal with the tooth. This defect can provide a path for oral bacteria into the tooth’s pulp.
- Gum disease. Severe gum disease can cause a pocket between the tooth, gum, and jawbone. This exposes the root surface of a tooth, which is easily penetrated by oral bacteria.
Symptoms
There is a range of symptoms caused by a periapical abscess, depending on the severity and progression of the infection. Recognizing these symptoms early and seeking early treatment can provide quick relief and minimize more severe symptoms and complications.
Typical symptoms include:
- Sensitivity. Increased sensitivity to hot and cold temperatures is often the initial sign of pulpal inflammation. If not treated, this inflammation can develop into a periapical abscess.
- Pain. Pain from a dental abscess can range from mild to severe. It is not unusual for a dental abscess to cause a throbbing toothache that radiates to the jaw, neck, or ear.
- Swelling. Swelling can range from a small area adjacent to the tooth to swelling of the jaw and face. An oral swelling should be treated immediately as it can become life-threatening.
- Fever. An elevated body temperature is a typical response to infection as your immune system fights the infection.
- Bad taste or bad breath. The presence of pus can lead to a foul taste in the mouth or bad breath.
- Tender lymph nodes in the jaw or neck. This is another sign that your body is fighting an infection.
Treatment
Although a periapical abscess is a serious dental condition, it is usually treatable. Treatment aims to eliminate the infection and preserve the natural tooth. Treatment often includes a combination of one or more of the following steps:
- Root canal therapy. This is an essential step for the long-term preservation of an abscessed tooth. Treatment includes removing the infected dental pulp and cleaning, disinfecting, filling, and sealing the root canal space within the tooth.
- Drainage of the abscess. This can be the most immediate method of providing relief from the abscess when pain and swelling are present. Your dentist makes a small opening into the swelling to allow the pus to drain and then rinses the area with saline.
- Antibiotics. Antibiotics may be prescribed if the infection has spread to other areas or you have a weakened immune system.
- Pain management. Over-the-counter pain relievers can be used to manage pain until the abscess is treated. However, pain relievers do not treat the infection and should not be used as a substitute for proper dental care.
2. Periodontal Abscess
A periodontal abscess is a localized collection of pus within the tissues of the periodontium, the supporting structures of your teeth. Unlike a periapical abscess originating from the pulp inside the tooth, a periodontal abscess is associated with the gums, ligament, and bone surrounding and supporting your teeth. This infection requires immediate attention, as it can lead to severe complications if left untreated.
Causes
A periodontal abscess typically arises due to bacterial infections in the periodontal pocket, the space that can form between the gum and tooth. It's crucial to understand what promotes this infection:
- Gum Disease. The most common cause, periodontitis or severe gum disease, results in deep periodontal pockets that trap bacteria.
- Poor Oral Hygiene. Failure to maintain good oral hygiene can result in plaque build-up, leading to inflamed gums, potentially leading to an abscess.
- Food Impaction. Food trapped between the teeth can result in an infection.
Symptoms
Symptoms of a periodontal abscess can range from mild discomfort to severe pain and may manifest differently depending on the severity of the condition.
- Pain. This is usually constant mild to moderate pain that may increase when eating or applying pressure.
- Swollen Gums. The gums may be red, swollen, and tender to touch around the affected tooth.
- Pus. Pus may ooze from the gums around the affected tooth.
- Bad Breath or Bad Taste. Pus can produce a chronic foul taste or smell.
- Loose Tooth. The affected tooth may feel loose due to the abscess, causing damage to the supporting tissues.
Treatment
Addressing a periodontal abscess involves eliminating the infection, preserving the tooth, and preventing further complications. The choice of treatment often depends on the severity of the abscess.
- Abscess Drainage. The abscess is drained through an opening made in the gum, followed by saline irrigation.
- Scaling and Root Planing. A deep cleaning, which differs from a routine teeth cleaning, removes the cause of periodontal disease from the periodontal pockets and creates smooth root surfaces.
- Antibiotics. These may be prescribed if the infection is severe, has spread, or if the patient has a weakened immune system.
- Surgical Intervention. In severe cases, surgery may be necessary to clean deep periodontal pockets or recontour the gum to reduce pocket depth.
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