How to Treat a Dental Abscess

A dental abscess is an infection of the mouth, face, throat, or jaw that begins as a tooth infection or cavity. Generally these infections are caused by poor dental health and can be the result of lack of proper and timely dental care. A Dental abscess may also occur in people with medical conditions such as autoimmune disorders (Sjögren’s syndrome and similar conditions)  or conditions that weaken the immune system (diabetes, following radiation or chemo from cancer). 

A dental abscess can also be triggered by minor trauma in the oral cavity…such as a fractured tooth. Openings in the tooth enamel allow bacteria to infect the nerve tissue (the pulp) in the center of the tooth. Infection may spread out from the root of the tooth and out to the surrounding bones supporting the tooth. A dental abscess occurs when there is an infection to a small area of tissue and the body is able to seal off the infection and keep it from spreading further.

White blood cells (the body’s defense mechanism against certain infections) travel through the walls of the blood vessels in the area of the infection and collect within the damaged tissue. When this happens pus forms (A generally viscous, yellowish-white fluid  formed in infected tissue, consisting of white blood cells, cellular debris, and necrotic tissue). This pus pocket is the dental abscess, which is represented by inflammation, redness, and pain.

The inflamed area can burst, allowing the pus to drain out, but it will come back if the cause of infection is not removed. The bacteria and host cells cause quick destruction of connective tissues around the tooth and into the jawbones as the dental abscess develops. The pain is constant and may be described as gnawing, sharp, shooting, or throbbing.

Putting pressure or something warm on the tooth may induce extreme pain. There may be a swelling present at either the base of the tooth, the gum, and/or the cheek, which can be alleviated by applying an ice pack. A Dental abscess can be acute or chronic. Acute abscess are the most painful. A chronic dental abscess may produce a dull pain with intermittent swelling, but can develop into an acute abscess at any point. Sometimes the infection can progress to the point where swelling threatens to block the airway, causing difficulty breathing. A dental abscess can also make you feel ill, with nausea, vomiting, fevers, chills, and sweats.

In some patients, a dental abscess may penetrate the bone and start draining into the surrounding tissues creating a localized facial swelling. it is also possible for the lymph glands in the neck will become swollen and tender in response to the infection. It may even feel like a headache as the pain can shift from the infected location. Generally, the pain does not travel across the face, only up or down as the nerves that serve each side of the face are separate.

A dentist can determine by a thorough examination, if you have a drainable dental abscess. X-rays of the teeth are usually necessary to show smaller abscesses that may be at the deepest part of the tooth. The objective of any treatment is to remove the infection, save the tooth (if possible), and prevent further complications.

The most frequently seen types of a dental abscess are:

1) Periapical abscess. These are located at the apex of an infected tooth surrounding the roots. This type of dental abscess can occur on any tooth that has severe decay or is broken or chipped.

2) Periodontal abscess. These are located in the periodontal ligament (PDL) surrounding the tooth. This type of dentalabscess will commonly involve the mandibular and maxillary first molars, maxillary incisors, and cuspids, followed by maxillary second molars.

Treatment of a dental abscess can include:

-A Regimen of antibiotics may be given to fight the infection. Along with drainage of the infected area (if it has not already begun to drain). -Endodontic or Root Canal Therapy (RCT) can be performed if the dentist feels the tooth can be saved. Even after the root canal therapy is completed, the dentist may want to see the patient periodically to ensure the area is healing properly.

-Teeth that cannot be restored must be extracted, followed by curettage of all apical soft tissue to remove necrotic infected tissue.. An untreated dental abscess can be life threatening and should not be taken lightly. Timely treatment usually allows the dentist to be able to cure the infection. The tooth can usually be saved in many cases but not all. Prompt treatment of dental cavities reduces the risk of a dental abscess. Teeth that have been subject to trauma should be examined immediately by the dentist.