ABSCESS - DENTAL

Overview

An abscess is a localized collection of pus. Dental abscesses can be related to

• infection of the pulp (periapical abscess)
• infection of the gum and tissues surrounding the tooth ( periodontal abscess)
• a combination of both

Dental abscesses, if uncontrolled, can spread to become facial infections.

 

PERIAPICAL ABSCESS

Causes
A periapical abscess is a result of bacteria from plaque invading the pulp of the tooth.

Bacteria enter the pulp through progression of a cavity (decay) or tooth fracture eg. trauma or through the gums and supporting tissues.

The pulpal infection spreads and reaches the bone surrounding the root tip, forming an abscess.
 

Symptoms

You may experience some or all of the following symptoms when you have an abscess

   

• tenderness of your tooth and surrounding area, especially to touch and on biting,
• intense, throbbing pain which disturbs sleep
• sensitivity to food and drink that is very hot or very cold,
• fever
• difficulty in opening your mouth (known as trismus),
• difficulty in swallowing (known as dysphagia),

Prevention

Regular check up with your dentist is the best mode of prevention. Decay can be detected and treated before it becomes a periapical abscess.

When to seek help

If you experience severe toothache you should see a dentist immediately. If you also experience difficulty in breathing or swallowing, you should go to the nearest Accident & Emergency department, if you cannot find a dentist.

Treatment

Your dentist will carry out immediate procedures to reduce pain and limit infection, which may include the following:

• drainage of pus either through a hole drilled into the pulp chamber, or an incision into the abscess or extraction of the involved tooth. This is done usually under local anaesthesia. More severe infections may need hospitalization.
• prescription of antibiotics and painkillers

Once the acute infection has subsided, if the tooth can be conserved, an Endodontist will  offer you the option of saving the tooth with root canal treatment.

 

Complications

Complications can arise when the abscess is left untreated:

• Infection may spread to face and other structures
• Osteomyelitis is an infection to the bone caused by bacteria from the abscess spread through your blood stream.
• Cysts can form around the root tip of a pulpally infected tooth

PERIODONTAL ABSCESS

Overview

A periodontal abscess is a localized collection of pus within the gum, formed by the disintegration of tissue resulting from bacterial infection of the gums, and / or the tooth root(s) and its supporting bone.

 

Causes

Periodontal abscesses differ from periapical abscesses in that the source of infection is the gum and the supporting tissues, and not the pulp. A periodontal abscess is related to:

• pre-existing gum disease (periodontitis)
• bacterial infection from a deep periodontal pocket
• trauma to the gum eg. from food or debris embedded in the gum

Symptoms

Symptoms of a periodontal abscess are very similar to that of a periapical abscess

• Localised gum swelling; red and tender to touch
• Persistent, throbbing pain
• Tooth sensitive to heat and pressure during chewing
• Tooth with increased mobility
• Pus discharge (foul-smelling and foul-tasting fluid) if the abscess ruptures
• Fever

Complications

A persistent infection from a periodontal abscess, can track from the deeper tissues of the gum to gain entry into the pulp. Infection of the pulp can therefore occur, even though the tooth has no evidence of decay. Such an infection is called an endodontic-periodontal lesion to reflect the duality of cause.

 

Prevention of periodontal abscess

Practicing good oral hygiene can help prevent periodontal disease and hence periodontal abscesses. Since periodontal disease is usually “silent” regular dental check-up is important for early detection.

 

When to seek help

If you have a toothache or notice evidence of an abscess on your gum, visit your dentist. Even if the abscess drains and the pain decreases, a visit to the dentist for complete treatment is crucial.

 

Treatment

Successful treatment of a gum abscess focuses on the reduction and elimination of the source of infection. This begins with draining the abscess, which usually relieves pain and removes much of the infection. You may be prescribed antibiotics.

 

The periodontal abscess will not be cured unless the cause is eliminated. A Periodontist will prescribe a range of treatment from deep scaling to root planning and gum surgery to treat the gum disease. If the abscess has also affected the pulp, then the tooth will also need root canal treatment as well.