Abscessed Tooth

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 bacterial 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 from gum disease. Treatment will depend on where the infection originates.

For the most part, the risk factors for an abscessed tooth are:

• poor oral hygiene and dental care increase the risk of an infected tooth.
• Grinding or clenching teeth (bruxism),
• a high sugar diet,
• other tooth trauma, and
• even the presence of previous dental work can predispose an individual to tooth abscess.

There are many causes of a dental abscess. A very common cause is when a dental cavity (tooth 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

• a blow to a tooth,
• dental treatment such as a crown or a filling that gets too close to the pulp chamber, or
• trauma to a tooth from grinding or clenching. In every form of tooth abscess, the pulp 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.

A tooth that has been previously treated with a root canal procedure can also develop an abscess. This is often due to the lack of adequate seal from bacteria within the tooth or even a fracture of the tooth roots.

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.

1. The tooth turns dark in color compared to the surrounding teeth. The byproducts of the necrotic pulp that leach into the porous tooth layer causes this discoloration. In many cases, there may be no tooth pain present.
2. There is pain with eating or with pressing on the tooth. The abscess that has spread out the root tip causes the supporting structures (gum and bone) to be affected. Sometimes the throbbing or pulsating pain is so severe it can't be relieved with pain medications. This is usually related to the infection spreading and causing more pressure on the surrounding structures of gum and bone.
3. There is swelling on the gum tissue that is filled with pus. The raised swelling looks like a pimple near the affected tooth. An open pimple is called a "draining fistula" and has ruptured to release pus. This is an obvious sign of infection. Other signs of a tooth abscess are a bad taste or bad odor in the mouth.
4. Swelling of the face, jaw or surrounding lymph nodes often signals a growing infection. Jaw pain from the swelling can be present, as well.

It is also important to note that abscessed teeth may not have any symptoms at all. Because the tooth has lost vitality (or the ability to feel stimuli), there may be no pain associated with it. However, the abscess is still present and could be further spreading the dental infection. On occasion, an abscessed tooth is detected during a routine radiographic (X-ray) exam where the patient has not experienced any telltale symptoms of an abscessed tooth.

A primary care provider or pediatrician can assess the signs and symptoms to determine if a dental abscess is present during a check-up. They can then refer the patient to a dental provider for diagnosis and treatment. Diagnosis of a tooth abscess is collectively determined by

• signs and symptoms reported by the patient,
• exam and tests that are performed by the dentist, and
• what is visualized with dental radiographs (X-rays)?

In adults

In adult teeth, the usual treatment for an abscessed tooth begins with properly clearing the infection. Treatment depends on how much the tooth infection has spread.

• The course of action usually involves oral antibiotics such as penicillin.
• The tooth is opened to remove the infected contents within the pulp chamber. If needed, incision and drainage are performed on the soft tissue to provide further exit of pus and pressure of a growing infection.

In some situations, the infection can spread quickly and require immediate attention. If a dentist is unavailable and there is a fever, swelling in the face, or swelling in the jaw, a visit to the emergency room is recommended. An emergency room visit is imperative if there is difficulty with breathing or swallowing.

Once the infection is cleared and the tooth can be restored, a root canal procedure is performed. The "root canal treatment" cleans out the entire inner space of the tooth (pulp chamber and the associated canals) and seals the space with an inert rubber material called gutta-percha. Cleaning and sealing the inner space protects the tooth from further invasive infections. The tooth may need to be extracted if too much tooth structure or bone that surrounds the tooth is lost from tooth decay and infection.

In children

For children's primary teeth (baby teeth), if a tooth has abscessed, there is very little that can be done to save the tooth. The infection has advanced and there is no way to completely remove all of the infection. The appropriate treatment to eliminate the infection would be the extraction of the abscessed tooth.

• Complete removal of the abscessed tooth is also important in avoiding a persistent infection that could risk harming the adult tooth that is developing underneath.
• Oral antibiotics may or may not be needed depending on the extent of the infection.

During pregnancy

During pregnancy, a dental abscess requires immediate attention in order to minimize the further spread of the infection. Any risk of infection while pregnant is a concern as the infection can be more severe in pregnant women or could harm the fetus.

Generally, oral health home remedies are not advised for an abscessed tooth. Home remedies can be used to temporarily alleviate symptoms such as

• warm salt water or baking soda rinses,
• a warm moistened teabag compress over the area and
• taking over-the-counter analgesic medications such as nonsteroidal anti-inflammatory drugs (NSAIDs).

However, the infection will still progress if not properly treated. Furthermore, avoiding treatment can lead to more serious complications. Seeking care and advice from a dental professional is strongly recommended as soon as possible.

The treatment needed usually determines who will treat the abscessed tooth. For the most part, an abscessed tooth can be managed by a general dentist whether it is to clear an infection, perform a root canal procedure or extract the tooth if needed.

• Alternatively, a dental specialist called an endodontist can be consulted to treat the abscess and perform the root canal procedure.
• Another dental specialist, an oral surgeon, can also treat an abscess and extract the tooth if tooth loss is inevitable.
• For children, a pediatric dentist can provide appropriate care for baby teeth to treat an abscessed tooth.

Oral surgeons, as well as emergency room and ENT physicians, would treat more severe cases where the infection from an abscessed tooth has spread beyond the mouth area.

The prognosis depends on the extent of the spread of infection. Usually, when the infection is localized to the tooth, the prognosis is very good if treatment is sought as soon as signs and symptoms are noticed. If the infection affects much of the surrounding jawbone of the tooth and has caused the tooth to become loose, the chances of saving the tooth decrease.

The typical scenario for a dry socket is the occurrence of throbbing pain about two to four days after the tooth is extracted. Dry socket pain is often accompanied by bad breath and a foul taste in the mouth. With this onset of pain, it is obvious that proper healing has been interrupted.

A dry socket is a condition of inflammation of the jawbone (or alveolar bone) after tooth extraction. It is also referred to as "alveolar osteitis" and is one of the many complications that can occur from a tooth extraction. The hallmark of dry socket is noticeable pain that occurs a few days after a tooth is extracted. Pain from a dry socket is often described as a dull, throbbing pain that can range from moderate to unbearable.

Good oral health habits and regular dental visits can play a big role in preventing abscessed teeth. Time is also a big factor in whether a tooth is allowed to reach the point of infection. The longer the tooth sits untreated, the higher chance that infection can occur and spread to become an abscess. Once a decayed, fractured, or sensitive tooth is noticed, taking the preventive steps to fix it early will help prevent bigger problems such as an abscessed tooth.