Dental Abscess

Dental abscesses can be painful but they can be treated relatively easily. A dental abscess is formed when the dental pulp in the middle of the tooth dies and the pulp chamber becomes infected. The build-up of pus can raise the tooth up within the socket, making it feel tender when you bite down.

Tooth abscesses can make your jaw ache and feel tender when you chew. If the abscess bursts, the pain may go, but you should still seek treatment.  

The IDA recommends that it's important  you see your dentist to make sure the problem doesn't come back. Your dentist will discuss with you the possibilities of placing a root filling in the tooth to prevent this from happening.

• Periapical Abscess :

Abscess occur when tooth decay is left untreated and reaches the dental pulp . The bacteria then spread into the root of the tooth to form an abscess. Avoiding treatment or putting it off may be one of the reasons for an abscess starting.This is known as Periapical abscess.

• Periodontal abscess

When bacteria which are present in plaque infect the gums the patient has periodontitis. The gums become inflamed, which can make the periodontal ligament (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, 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.

Treatment

1. Treating a periapical abscess - root canal treatment will be used to remove the abscess. A drill is used to bore a hole into the infected 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.
2. 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 (planing) below the gum line. This helps the tooth heal and prevents further infections from occurring.

Surgery for dental abscesses

Patients 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 the dental abscess recurs, even after surgery, the tooth may be extracted (taken out).

What are the 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 conditions resolves on its own. Depending on the severity, the doctor may prescribe antibiotics.

Consult your dentist as soon as you notice a dental abscess.