Dr. Donna S. Bautista, DDS, completed her undergraduate studies at the University of California, San Diego with a bachelor of arts in biochemistry and cell biology. During her time at UC San Diego, she was involved in basic research including studying processes related to DNA transcription in the field of molecular biology. Upon graduation, she went on to attend dental school at the University of California, San Francisco. In addition to her formal dental training, she provided dental care for underserved communities in the Bay Area through clinics and health fairs. She also worked toward mentoring high school students interested in the field of dentistry.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
When a tooth persistently throbs and keeps you up at night with pain, it could be something more worrisome than a simple toothache. An abscessed tooth is an infection within a tooth that has spread to the root tip or around the root. This infection originates from the tooth's inner chamber, which is called the "pulp chamber." Contained within the pulp chamber are blood vessels and nerves, collectively called the "pulp." Prior to the formation of an abscess, the tooth has essentially lost its ability to fight off infection, and bacteria are able to invade the pulp chamber and multiply. As the bacteria multiply, the infection usually spreads from the pulp chamber and exits through the bottom of the root into the bone. The abscess is a collection of pus that is made up of dead white blood cells, tissue debris, and bacteria.
A tooth abscess differs from a gum abscess by the source of the original infection. The tooth abscess (or "periapical abscess") originates from the pulp of the tooth and exits out the tooth's apex at the bottom of the root. A gum abscess (or "periodontal abscess") starts in a gum pocket outside of the tooth next to the root. Treatment will depend on where the infection originates.
What causes an abscessed tooth?
There are many causes for a tooth abscess. A very common cause is when a dental cavity (decay) becomes so large and deep that it reaches the pulp chamber. An inflammatory process takes place within the tooth. Inflammation of the pulp (pulpitis) is usually what is felt as a toothache. Pulpitis is further characterized by tests done by a dentist as reversible or irreversible. Reversible pulpitis means that the pulp is irritated but has an opportunity to recover. Irreversible pulpitis means that it will not recover, and the pulp is dying. Once the pulp is dead (or "necrotic"), an abscess can form as the infection spreads from the tooth to the gum ligament and jawbone below. Often, a tooth that becomes necrotic can still be saved if steps are taken to resolve the infection at an early stage.
Other causes for a tooth to become necrotic and abscess are (1) a blow to a tooth, (2) dental treatment such as a crown or a filling that gets too close to the pulp chamber, or (3) trauma to a tooth from grinding or clenching. In every form of a tooth abscess, the pulp chamber is adversely affected and is unable to recover from the insult or injury. A blow to the tooth can immediately sever the tooth's blood supply. When the blood supply is lost, the nutrient supply is also lost. As a result, the pulp quickly dies. Trauma from grinding or clenching (called "occlusal trauma") is a slower, progressive injury to a tooth.
Any tooth can develop an abscess, but third molars (wisdom teeth) are particularly prone to having a dental abscess because they are difficult to keep clean and can develop decay that can go unnoticed. Wisdom teeth are often removed to avoid this type of complication.
The initial symptoms begin with localized swelling and pain that gets progressively worse over a few days. A tender and sore mass (the abscess) may be felt with a finger and gingival bleeding may occur. Periapical abscesses may be very sensitive to cold and heat.