How to Treat Dental Abscess?

How to Treat Dental Abscess?

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.

dental 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.

root canal treatment

- 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.