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Dental Abscess

dental abscess

An abscess is a collection of pus. Pus is a thick fluid that usually contains white blood cells, dead tissue and bacteria (germs). The usual cause of an abscess is an infection with bacteria. A dental abscess is a localised collection of pus in a tooth, or in nearby structures. They are classified into two main types:

Periapical abscess

This type of abscess starts in the dental pulp (centre of the tooth). This is the most common type. This type of abscess usually develops as a complication of tooth decay (caries).

Periodontal abscess

This type of abscess starts in the supporting structures of the teeth, such as the periodontium which is between the tooth and the gum. It most commonly develops as a complication of gum disease (periodontal disease), which is infection or inflammation of the tissues that surround the teeth. Gum disease often causes the gum to become slightly detached from the tooth. This causes pockets to form which may get filled with bacteria and progress to form an abscess.

Symptoms typically include one or more of the following:

  1. Pain (toothache) which can quickly become worse. It can be severe and throbbing.
  2. Swelling of the gum which can be tender.
  3. Swelling of the face.
  4. The affected tooth may become tender to touch.
  5. High temperature and feeling generally unwell.
  6. In severe cases, there may be spasm of the jaw muscles.

What is the treatment of a dental abscess?

Initial treatment

See a dentist as soon as possible. A dentist will normally drain the pus and this often gives great relief of symptoms. This is done either by lancing the abscess or by drilling a small hole in the tooth to let the pus escape.
If there is a delay, an antibiotic to help prevent the abscess from getting worse or spreading should be used. However, an antibiotic will not clear the pus and cure the abscess. You still need to see a dentist soon. You may also need painkillers such as paracetamol or ibuprofen until the abscess is drained and treated.

Further treatment may include the following:

For a periapical abscess

The treatment for this type of abscess is normally root canal treatment. This treatment aims to save and restore the damaged or dead inner part of a tooth (the pulp). Briefly - a dentist will drill into the dead tooth and allow pus to escape through the tooth, and then remove the dead pulpal tissue. A root filling is then placed into the tooth to fill the space and prevent further infection. (If the infection persists despite root canal treatment, the dentist may have to extract (remove) the tooth.

For a periodontal abscess

Once the pus is drained, a dentist may clean the pocket where the abscess had formed. Following this a dentist may smooth out the root surfaces of the tooth to encourage the gum to close back on to the tooth, and for any pocket to disappear.

What is the outlook?

If treated, the outlook is good. If left untreated, the abscess may burst on to the skin of the face, or into the mouth. This may leave a sinus tract (a channel) between a persistent focus of infection and the skin or mouth, which can discharge pus from time to time. Other complications are uncommon. They include:

  1. Osteomyelitis
  2. Sinusitis
  3. A dental cyst (fluid-filled cavity) which may develop.
  4. Cavernous sinus thrombosis - an infection and clotting of a blood vessel in the brain. This is very serious.
  5. A serious, potentially life-threatening infection of the floor of the mouth. This could spread to the face, brain or neck

Symptoms that may indicate that a complication is developing, and where you should seek medical help urgently, are:

  1. If you feel very unwell with a high temperature.
  2. Having difficulty opening your mouth, swallowing or breathing.
  3. Having swelling of the floor of your mouth, face or jaw.
  4. Being in severe pain despite taking painkillers at maximum dose.
  5. Having a spreading infection of your face.

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