A dental abscess can be a nuisance to the patient and affect the quality of your life. Anyone suffering from a dental abscess cannot stay long without seeking emergency dental services because of the pain and swelling. You should seek help from a dentist with the right knowledge of dental abscesses. Contact Ganji Dental for an assessment of your tooth problems and learn how we can help you.
Understanding Types of Dental Abscess
A dental or tooth abscess is a pus buildup that forms inside the gum or teeth. It typically comes from a bacterial infection that has accumulated in the soft pulp of the tooth. These bacteria exist in the mouth when a person has stayed for long without brushing, leading to plaque formation. If a person does not regularly brush and floss, the bacteria usually spread inside the gum or soft tissue tissues, eventually causing an abscess.
There are different types of dental abscesses. These types vary according to the location of the condition, and they are as follows:
- Periapical Abscess: This kind of abscess results from a chronic, localized infection located at the apex of the root of a tooth. A periapical abscess is more common in children than adults. Children with poor hygiene have the highest chances of being affected by this condition.
- Periodontal Abscess: This type of abscess starts in the periodontal pocket. A periodontal abscess is more common among adults than children. They originate from the alveolar bone and the periodontium. As a result, a pocket forms between the tooth and the gum tissue.
- Gingival Abscess: This is a type of abscess that involves only the gum tissues without affecting the tooth or periodontal ligament
- Pericoronal Abscess: This type of abscess involves soft tissues surrounding the tooth’s crown
- Combined Periodontic-endodontic Abscess: This abscess involves a combination of periapical and periodontal abscess
Among the above-stated types of a dental abscess, the periapical abscess is the most common, while the periodontal abscess is the second most common type.
Signs and Symptoms of Dental Abscess
A dental abscess is painful. The pain is usually located in the tooth or generalized into the jaw, neck, or face, depending on the abscess's location. Therefore, the affected tooth might:
- Be sensitive to cold or heat in the mouth.
- Feel tender
- Feel loose in the jaw
- Be slightly raised
- Be sensitive to pressure or tapping
You might also experience other symptoms like:
- Bleeding in the gums
- Swelling in the face or gum
- Redness in the affected part or skin
- Generally feeling unwell or malaise
- Swollen lymph glands in the neck
Dental exams can also reveal swelling and redness around the mouth and movable mass in the area. A periodontal abscess might also present a gum boil, which is also referred to as parulis. This is a soft red papule that appears between the gum and the inside of the cheek. This can result from the abscess, and it is a definite sign of an abscess but is not an abscess by itself.
Apart from the symptoms provided above, a severe dental abscess can rarely affect a person in the following ways:
- Cellulitis, which is a bacterial infection of the subcutaneous tissue or skin
- Difficulty speaking
- Difficulty speaking
- Difficulty breathing due to swelling
Generally, a dental abscess can make you feel unwell. You might experience a fever with a body temperature of 38 Degree-Celsius and severe pain that does not respond to over-the-counter painkillers.
If you experience any of the symptoms mentioned above, you should seek emergency dental care from a dentist. An experienced dentist will treat you and prescribe antibiotics to control the infection and pain until you receive proper treatment.
Causes of Dental Abscess
A dental abscess occurs when bacteria invade the dental pulp. The dental pulp is the tooth’s innermost part that consists of the connective tissues, blood vessels, and nerves. The bacteria enter through a crack or chip into the teeth and spread down to the pulp. That's why it causes inflammation and swelling at the root’s tip.
The possibility of suffering from dental abscess depends on several risk factors. These factors include:
- Poor Dental Hygiene — Failing to take care of your teeth properly. This includes failing to brush your teeth twice a day or failing to floss, increasing the risk of dental abscess.
- High Sugar Diet — Frequently drinking or eating sugary foods like sodas and sweet can cause dental cavities, which can lead to a dental abscess
- Dry Mouth — Dry mouth can increase the possibility of tooth decay. It is usually caused by aging or taking certain medications.
- Health Issues — Diseases like diabetes and other autoimmune diseases can be a risk factor for dental abscess. That's why people with these conditions are expected to maintain proper care and regular checkups.
- Inadequate application of fluoride on the teeth or using fluoridated water or toothpaste to rinse your mouth.
Problems That Can Result from Dental Abscess
Ignoring a dental abscess is unwise and potentially life-threatening. A severe dental abscess can lead to the following:
- Infection of the Surrounding Bone — Facial bones, particularly the mandible and the maxilla, are not tolerant of the long-term presence of infection. Therefore, if an infection spreads to these bones, it might have to be surgically removed to avoid further spread. Even in cases where extreme measures are unnecessary, the infection can still weaken the bone structure, making it more difficult for the jaw to support your teeth.
- Tooth Loss — If an abscess is diagnosed and treated early, you can often save the tooth. However, if the abscess persists without treatment, endodontic therapy cannot be possible if the tooth is weakening and having a risk of infection spread. If the situation goes to this extent, you will have to undergo a tooth replacement treatment like a dental implant to restore your teeth’ oral function and avoid compromising your jawbone strength.
- Infection in Sinuses and Soft Tissues — Since the roots of some of your upper teeth extend into the sinus areas, an abscess in one of these teeth can cause a painful sinus infection. The soft tissues and surrounding areas of the mouth are also susceptible to the infection, causing several complications from the facial cellulite to the airway.
- Septicemia — Septicemia is a condition where the entire bloodstream becomes infected. Naturally, the body should respond to infection by increasing the infected area's antibodies by sending extra blood. Septicemia occurs when a pocket of the infection ruptures, spills into the blood, and circulates throughout the body. Septicemia is a life-threatening condition that requires long-term hospitalization and the use of intravenous antibiotics.
- Brain Abscess — A brain abscess is also extremely dangerous and also needs hospitalization. Brain infection can occur in different ways, but the most common way is through septicemia. This condition can be complicated to treat due to the blood-brain barrier.
- Cavernous Sinus Thrombosis(CST) — About 10% of CST patients have an odontogenic focus. This is a spread of dental abscess to the cavernous sinus through the valveless pterygoid venous plexus.
- Ludwig Angina — Ludwig Angina is a rapidly spreading cellulitis of the submental spaces, submandibular, and sublingual. This condition manifests itself as a swelling on the mouth floor with an elevated and posterior displacement of the tongue. The infection can also quickly spread to the entire neck if left untreated.
- Dental Cysts — If you leave a dental abscess untreated, a fluid-filled cavity can develop at the bottom of the root of your tooth. This is referred to as a dental cyst. The cyst can become infected hence the need to treat it with antibiotics. Your dentist can also surgically remove it under local anesthesia.
Testing and Diagnosis of Dental Abscess
If you experience any of the signs and symptoms listed above, you should seek the help of a dentist right away, especially if you experience swelling and feel feverish. Sometimes a dentist might decide to ease the pain based on the extent of your pain, but seeking proper dental attention is the best way to do away with your pain and your condition. Sometimes it might be difficult to distinguish between periapical and periodontal abscess. However, your dentist will use several procedures to differentiate the two. These assessment procedures are as follows:
- If you are experiencing swelling over the root apex area, there is a likelihood that you are suffering from a periapical abscess. If it is closer to the gingival margin, then this is more likely a periodontal abscess.
- Similarly, a periodontal abscess will most likely discharge through the periodontal pocket, whereas the periapical abscess drains through the parulis near the infected tooth.
- If the tooth has a pre-existing periodontal disease, there are chances for a periodontal abscess with the loss of alveolar bone height and pockets. However, if the tooth has a relatively healthy periodontal condition, there are chances that this is a periapical abscess.
- In periodontal abscesses, swelling usually precedes the pain, whereas, in periapical abscesses, the pain usually precedes the swelling.
- A history of sensitivity to cold and cold suggests previous pulpitis and indicates a periapical abscess.
- If the tooth is free from dental caries and does not have extensive restorations, there are chances that it has a periodontal abscess.
- Generally, periodontal abscesses are more tender to lateral percussion than vertical and periapical abscesses will be more tender to apical percussion.
Diagnosis of Tooth Abscess
The dentist will start by asking you about your medical history and the symptoms you are experiencing. He will then perform a thorough examination of your teeth and gum. He or she will then check the infected tooth and determine your pain and sensitivity by:
- Blowing the tooth lightly
- Simulating the dental nerve with cold or heat
- Use slight electric impulses to stimulate the dental nerves
- Place a probe between the gum and tooth and measure the extent of tissue loss and measure its gaps
Apart from the testing methods described above, there are other methods that a dentist can use to diagnose an abscessed tooth. This includes:
- X-rays – An X-ray or other imaging tests like a CT scan can help identify an abscess to be sure whether it is the specific condition or not
- Lab Tests – If the first antibiotic treatment does not work, your dentist can take a sample of the infection and determine what kind of bacteria is causing it. This will help pinpoint a suitable treatment plan in the future.
Treatment of Dental Abscess
Treating a dental abscess focuses on clearing up the infection and relieving your pain. This depends on the symptoms that you are exhibiting and the evaluation of your dental X-ray. Depending on the type and severity of the abscess, your dentist can decide on the following treatment options.
Draining the Dental Abscess
If the abscess is minor and located at the gum's surface, your dentist can drain the pus by making a small incision into your gum. This process starts with positioning your head at your elbow level and with the support of the occiput. The dentist will then try to make your lower occlusal plane roughly parallel to the floor while your mouth is still open.
The dentist will use a more reclined position to make the upper occlusal plane at least 60 to 90 degrees with the upper jaw. He or she will then turn your head to extend your neck to make the abscessed site accessible.
The dentist will then wear gloves, a face shield, or safety glasses. He will then retract the soft tissues to reveal the abscess. Once the dentist has completed the preparation process, he or she will proceed to the following procedures.
The local anesthesia used in draining dental abscess can be ineffective due to the low PH environment. Therefore, your dentist will use more solution than usual but should be careful not to exceed the maximum allowed dose.
Please note, local anesthesia injection puts you at risk of spreading the infection. Therefore, your dentist should prefer a dental nerve block, procedural sedation, or other forms of anesthesia. Local infiltrations might be placed in the uninfected tissue adjacent to the abscess if needed to supplement a nerve block.
Incision and Draining the Abscess
The dentist will frisk the abscess to check its extent and confirm where the maximum dependent drainage is obtainable. He will then make a one to two centimeters incision inside the abscess but not in the friable or necrotic tissue.
Ensure that the dentist uses gauze squares or suction to remove the exuding pus. He or she will then insert a hemostat to a full depth of the abscess space until the jaw breaks up the loculation. At this point, the dentist should do this in several directions to open up a large space. As soon as the dentist finishes the draining process, they should not close the abscess area while the jaw is opened to avoid crushing vital structure and take out the hemostat.
The dentist will then rinse the space using sterile saline with a large syringe with an attached catheter. Your dentist should apply force until all the fluid flows back and suction it up.
Root Canal Therapy
Your dentist can decide to treat your dental abscess using a root canal if it is severely infected. A root canal can save your tooth if it is severely infected to f decaying. During this procedure, the dentist will remove the tooth's nerve and pulp, then clean and seal it.
Please note that removing a tooth's nerve does not affect the tooth’s health and function after removal. It only provides a sensory function – giving sensation to hot or cold. Therefore, its absence cannot affect how your tooth works.
Root canal therapy requires one or more office visits to a dentist. If your dentist cannot perform the root canal therapy, he or she can refer to you to an endodontist. An endodontist is a dentist specialized in the causes, diagnosis, prevention, and treatment of disease and injuries of the teeth' dental pulp.
In the first step, your dentist will take an X-ray to observe the root canal's shape and check whether there are any infection signs. Your dentist or endodontist will then numb the area using local anesthesia. The use of anesthesia is not entirely necessary, but your dentist can decide to use it to make you relaxed and feel at ease.
Next, the dentist will keep the treatment area away from saliva using a rubber sheet around the infected tooth.
They will then drill a hole inside the tooth and remove the pulp and the bacteria and other debris. The dentist will complete this process using several root canal files. Different files with increasing diameter are placed inside the hole and worked down to the tooth's full length to scrape and scrub the root canal’s sides. Debris formed from this process will be flushed out using sodium hypochlorite or water.
After cleaning the tooth, it will be sealed. Your dentist can wait up to a week before sealing the tooth, especially if it is severely infected and might require medication to clear it up. He or she might choose to close it on the same day if it is clean. If it has to wait for a few days, your dentist will fill the exterior hole to keep the contaminants out between the appointments.
During the next appointment, the dentist will fill the tooth's interior using a rubber compound known as gutta-percha and place it into the root canal. The exterior access hole is filled using a filling.
Your dentist will inject a local anesthetic to numb the area around the tooth to be extracted. In some instances, your dentist can use a strong general anesthetic to prevent your body and make you sleep through the procedure.
The dentist will then use forceps to rock your tooth until it loosens from the jawbone. Once the tooth has been removed, the blood will clot inside the socket. The dentist will give you a gauze pad into the socket and bite down until you stop bleeding. Sometimes the dentist might place a few stitches to close down the gum at the site of extraction.
A dental abscess can be treated using antibiotics. However, not all dental abscesses are treated using antibiotics. Your dentist can only decide on antibiotics if you are severely infected and have a weakened immune system.
The kind of antibiotics that you need depends on the type of bacteria causing the infection. Therefore, your dentist will choose antibiotics that will successfully eliminate the infection.
Antibiotics of the penicillin class like amoxicillin and penicillin are common in treating tooth infections. You may also be prescribed antibiotics called metronidazole to treat particular types of infection. However, penicillin is more suitable if you have a variety of bacteria species infection.
Please note, although penicillin antibiotics are commonly used for tooth infection, many people are allergic to this class of antibiotics. Therefore, make sure that you tell your dentist about any allergic reactions to your past medication to avoid harmful side effects.
Find a Dental Abscess Dentist Near Me
It is recommended that you contact an emergency dentist if you notice tooth abscess symptoms. Your dentist will answer your questions and determine the best treatment for your tooth abscess. At Ganji Dental, we pride ourselves on providing quality dental care to patients in Hawthorne, CA. Whether you want to set up an appointment or ask dental-related questions, feel free to call us today at 310-643-8045, and schedule an appointment.