Tooth Abscess

What is a tooth abscess?

A tooth abscess is a collection of pus around an infected tooth. There are 2 types of dental abscess:

• a pus-filled sac at the root of a tooth
• a pus-filled sac between the gum and a tooth.

How does it occur?

An abscess at the root is usually caused by severe tooth decay or injury. When decay reaches the inside or pulp of a tooth, which contains the nerves and blood supply, the pulp dies. The infection in the pulp spreads from the tip of the root to the surrounding bone.

An abscess at the root can also be caused by injury to a tooth, such as a severe blow to the tooth or jaw.

An abscess between a tooth and gum usually forms when bacteria and food become trapped in an area that is hard to clean.

Sometimes the cause of an abscess is not known.

What are the symptoms?

Possible symptoms of an abscess are:

• sensitivity to heat and cold
• a lingering ache
• pain or throbbing with or without biting or chewing
• redness and swelling of the gums
• discolored tooth
• tender glands in the neck
• swollen face
• a bad taste
• an open, draining sore on the side of the gum
• relief obtained only from ice water.

How is it diagnosed?

The dentist will examine your teeth and usually order X-rays to check for any disease.

The dentist may use ice or an electric tester to check the health of a tooth. A battery-powered electric tester uses a small amount of electrical current to stimulate the nerve. A normal tooth will feel sensitive to the ice or the electrical stimulation but will feel relief when the dentist removes the ice or current. A tooth with an irritated nerve will feel some sensation even when the dentist removes the ice or current. A dead tooth will not feel any sensation at all.

Your dentist may slide a probe gently down the side of the tooth to check for pocketing. If you have an abscess, this procedure may release some of the pressure from built-up infection, but the pocket will have to be fully cleaned out to remove pus and debris.

How is it treated?

Abscess at the Root of a Tooth:

Root canal therapy is the usual treatment for an abscess at the root of a tooth. A general dentist or an endodontist (a specialist in this therapy) may perform a root canal.

If the infection persists after a root canal, additional treatment is necessary. Your dentist may refer you to a specialist (an oral surgeon) who may surgically remove diseased tissue.

When a root canal or surgery is not possible, the dentist may have to pull the tooth. You may then need to wear an implant, a bridge, or a removable partial denture to replace the lost tooth.

Abscess Between the Gum and a Tooth:

Dentists usually treat this kind of abscess by first draining the infection, then thoroughly cleaning the area. The dentist then smoothes out the root surfaces of the tooth to promote healing and to help keep the infection from recurring. Before doing this procedure, your dentist may inject an anesthetic to numb the gum and tooth.

Your dentist may recommend a follow-up X-ray of the tooth in 6 months to see how well the bone is healing and if the infection has cleared up.

Your dentist may recommend gum surgery to help heal an abscess between the gum and a tooth. This surgery, often performed by a periodontist, involves surgically reshaping the gum tissue to make a shallow area that is easier to keep clean and free from infection.

If you have an area that tends to trap food every time you eat, a filling may be placed to close off the opening.

How long will the effects last?

The effects of an abscessed root last as long as it is left untreated. An infection that spreads from the tip of the root builds up pressure and destroys the surrounding bone. This destruction continues until the pressure is released by root canal therapy, or until the infection destroys enough bone so that it can drain out near the tooth, creating a gumboil on the tissue. The body continues to fight the buildup of pus and bacteria.

An abscess between the gum and tooth will generally heal soon after the abscess has been drained and the root surfaces cleaned. However, the abscess may recur if the area is not kept clean. Your dentist or dental hygienist may recommend the use of cleaning aids to make it easier to take care of these areas.

How can I take care of myself?

Follow your dentist's instructions and take the full course of any antibiotics prescribed. In addition, you can:

• Rinse your mouth 3 to 4 times a day with warm saltwater.
• Chew on the side that does not have the affected tooth or tissue.
• Keep your mouth as free from bacteria as possible by brushing at least twice a day and flossing daily.
• Drink plenty of fluids.
• Take ibuprofen, acetaminophen, or another pain-relief medicine prescribed by your dentist or healthcare provider.
• Follow any special instructions given to you by your dentist.
• Keep any follow-up appointments with your dentist.
• Do not take any antibiotics that have not been prescribed for you by your dentist or healthcare provider.

How can I help prevent a dental abscess?

The best way to prevent an abscess is to brush your teeth at least 2 times a day and see your dentist twice a year. At your appointments, your dentist and dental hygienist will:

• Examine your teeth and mouth.
• Remove any plaque and tartar that have built up on your teeth.
• X-ray your teeth once a year to check for decay and to evaluate the health of your jawbone and gums.
• Teach you how to care for your teeth and maintain good oral health.
• Alert you to any problem areas.
• Recommend any needed treatments.