A dental abscess is a collection of pus associated with a tooth that can be localized either below the root apex or around the tooth in the gingival pocket. A dental abscess is usually caused by bacterial infections in a non-vital tooth.
Types of Dental Abscess
Dental abscesses can be classified further into three different categories.
- Periapical abscess
When pus is accumulated below the apex of the root, it is called as a periapical abscess. It is clinically presented as swelling immediately below the tooth or by the presence of sinus tract draining the pus. On radiographs, it is presented as a radiolucent (dark) area below the root tip.
- Periodontal abscess
When pus is accumulated in the gingival pocket around the tooth, it is called a periodontal abscess. It is clinically presented as pus draining through the gingival pocket. On radiographs, there is wider periodontal ligament membrane space around the tooth.
- Gingival Abscess
When an abscess is accumulated only in superficial gingival tissue without affecting the periodontal ligament and associated tooth, it is called a gingival abscess. It is clinically seen as localized swelling in gums. There are usually no radiographic changes in a gingival abscess.
Causes of Dental Abscess
Bacterial infections are the most common cause of dental abscesses. Following are the predisposing factors for dental abscess.
- Poor oral hygiene status with plaque accumulation.
- Acute or chronic periodontal disease.
- Traumatized tooth.
- Foreign body strangulation such bristles of toothbrush or hard tiny food particles.
- Previous treatment failures, such as failed root canal treatment.
Symptoms of Dental Abscess
- Throbbing pain that cannot be localized.
- Severe pain while lying down.
- Pain on percussion. In periodontal abscess, there is pain on horizontal percussion while in periapical abscess, there is pain on vertical percussion.
- Tooth is often slightly extruded.
- There is swelling in the area of the associated tooth or in some chronic cases there may be diffused swelling involving multiple teeth.
- Sinus tract can also be found in gums near the root apex. Gutta-percha is often inserted in the sinus tract to identify the origin of infection by taking a radiograph.
- There can be redness or erythema in the root area of the tooth.
- Patients often complain of bad breath or a foul smell from the mouth.
- Fever and malaise can be associated with a dental abscess.
- Swollen lymph nodes in the neck area can also be found.
- Tooth discoloration can be seen.
Treatment Options
The aim of treatment is drainage of abscess and removal of infection source. Common treatments are as follows:
- Root canal treatment, in which living tissue of the tooth is removed and replaced with synthetic biocompatible material.
- Extract the tooth if it cannot be restored. Extraction should be followed by curettage.
- Incision and drainage of the abscess have opted when conventional treatment fails to respond or for medically compromised patients.
- Antibiotics are preferably not used for dental abscesses but in some patients, antibiotics are indicated such as medically compromised patients, disseminated infections and patients presented with significant cellulitis.
- To relieve the pain, NSAIDs are often prescribed.
- Fistulectomy is required in chronic cases in which the sinus tract persists even after incision and drainage.
Complications
A dental abscess is often self-limited and doesn’t cause complications. But it may cause the following complications if not be treated in time:
- Fistula formation, in which the sinus tract is lined by epithelium.
- Cellulitis
- Osteomyelitis
- Ludwig Angina
- Cavernous sinus thrombosis
- Mediastinitis
- Septicemia
- Prosthetic valve infections
- Sinusitis
- Cystic lesions
How to Prevent?
Following preventive methods may help to reduce the incidence of dental abscess formation.
- Regular visits to registered Dental practitioner
- Good oral hygiene status. Brush your teeth twice a day.
- Use dental floss regularly.
- Sufficient fluoride intake.
- Avoid sticky foodstuffs.
- Reduce consumption of acidic or sugar-containing diet.
- Limit the snacks between meals.
- Regular rinses after eating and drinking a sugar-containing diet.
- Root canal treatment, in which living tissue of the tooth is removed and replaced with synthetic biocompatible material.
