Dental Abscess

A tooth abscess is a serious condition. It not only causes pain and discomfort but, if not treated in time, can lead to tooth loss. Furthermore, untreated abscesses can lead to complications. We recommend visiting AESTHETE dental clinic. Our doctors have extensive experience in successfully treating this condition.

What is a Tooth Abscess and How Does It Look?

Redness, swelling of the gum combined with pain when pressure is applied to the tooth may indicate a serious dental issue — a tooth abscess.

This is an infectious inflammatory process that develops in the soft tissues surrounding the tooth roots. When pathogenic bacteria affect the mucosa, the body responds by sending blood to the affected area, causing redness. White blood cells, which protect against harmful microorganisms, are carried in the blood. Dead white blood cells and bacteria form pus, which gradually accumulates. As a result, a dense ball, or capsule, filled with pus forms, and externally, this appears as swelling of the gum.

In the case of an abscess, bacteria can enter the tooth through surface defects such as chips, cracks, or cavities caused by tooth decay. This leads to inflammation of the pulp — the soft tissue inside the tooth. An abscess usually develops quickly, often in less than a day. If treatment is not started on time, the consequences can be serious. There is a risk of tooth loss, and in severe cases, the infection may spread to the jawbone.

Causes of Tooth Abscess and Risk Factors

A tooth abscess can occur for various reasons:

• Deep tooth decay. When the hard layers of enamel and dentin are destroyed, bacteria penetrate the pulp. If not treated promptly, the infection can reach the tooth roots and cause inflammation in nearby soft tissues.
• Periodontitis — gum inflammation. This disease is characterized by the formation of pockets between the gums and the teeth, where food particles accumulate and pathogens trigger inflammation and subsequent pus formation.
• Pericoronitis — a pathology that occurs when a wisdom tooth is erupting. A flap of mucous tissue forms over the tooth, where an infection develops, causing inflammation that spreads to the gum and leads to the formation of an abscess.
• Mucosal injuries. Small cuts or scratches from a blow or careless tooth brushing may allow harmful bacteria to enter, leading to an abscess.
• Complications after tooth extraction. In most cases, this occurs when a patient does not follow a dentist's advice, such as touching the extraction site with the tongue, preventing the formation of a protective blood clot, which leads to bacterial penetration into the postoperative wound.
• Dentist's mistakes during root canal treatment. If the root canals are not properly filled, empty spaces can remain where harmful microorganisms multiply, damaging the soft tissues near the tooth roots.

An infection in another part of the body can also lead to an abscess. In this case, bacteria infecting the soft tissues near the tooth root enter the area through the bloodstream.

The likelihood of developing an abscess increases under the following conditions:

• Poor or irregular dental care;
• Age — 50-55% of cases occur in patients under 35 years old, with another 40% occurring in individuals between 35 and 50 years old;
• Immune system disorders;
• Chronic diseases that weaken the body and reduce immune function;
• The use of certain medications, such as antibiotics, hormonal drugs, and cytostatics.

Types of Tooth Abscess

There are several types of abscesses:

• Gum abscess is an infection that occurs on the mucosal surface between the teeth. If treated early, the problem can be resolved relatively easily. Without treatment, the abscess quickly spreads to the roots and surrounding tissues.
• Periodontal abscess occurs within the gum. The pus cannot escape, forming a hard lump. The inflammation gradually spreads, and there is a risk of bone damage.
• Periapical abscess occurs in the root canals, with pus forming at the root tip. A hard lump may form, and a fistula may develop.
• Pericoronitis abscess occurs in the area of the gum above an erupting tooth, usually above a wisdom tooth.

Abscesses can be acute or chronic:

• Acute abscesses develop rapidly with severe symptoms.
• Chronic abscesses develop slowly with intermittent symptoms that may disappear and then reappear during flare-ups.

The severity of the abscess can also be classified into three forms:

• Mild — Only one area is affected, pus is minimal, and the condition progresses slowly.
• Moderate — Two anatomical areas are affected, with noticeable clinical symptoms.
• Severe — The abscess affects more than two teeth, the pus accumulation increases rapidly, and complications arise.

Stages of a Tooth Abscess

The disease progresses through several stages. It is best to treat it at the earliest stages, as this allows for quicker and simpler resolution.

Typically, the abscess develops as follows:

• The gum becomes inflamed, starting with mild redness, gradually increasing.
• A pus-filled ball forms, ranging from 1-5 mm in diameter, which feels firm to the touch.
• In some cases, a pocket forms between the gum and the tooth, accumulating more pus.
• The pus may rupture, creating a fistula that releases pus.

In the acute form, symptoms are pronounced: sharp pain, rapid swelling of the abscess, discomfort when eating, or sensitivity to hot or cold foods and drinks.

If the abscess transitions into a chronic form, even after the pus drains through the fistula, the pain may diminish or disappear, and the swelling may reduce. However, the condition doesn't resolve and can flare up again. Acute and chronic forms may alternate.

Symptoms

In chronic cases, the first sign of a new abscess may be an exacerbation of the underlying disease, such as periodontitis. Tissues around the tooth become inflamed, and there is pain when biting down.

The main symptom is pain, especially when chewing or applying pressure on the tooth. It can become constant and pulsating. There may also be discomfort when the tooth contacts hot or cold food.

Other signs of an abscess include:

• Pain in the gum when pressure is applied;
• Swelling of the gum, sometimes forming a hard lump;
• Bleeding and pus discharge from the gum;
• Foul smell from the mouth;
• Thickened saliva;
• Coating on the tongue;
• Loosening of the teeth.

As the inflammation progresses, body temperature may rise to 40°C (104°F), along with sweating, headaches, and swollen lymph nodes in the affected area.

If these symptoms occur, it's crucial to visit a dentist as soon as possible. Some of these signs could indicate other diseases, so it's important to have a differential diagnosis and begin appropriate treatment.

Complications

If an abscess is not treated promptly, the patient's health may deteriorate. Possible complications include:

• Phlegmon — profuse pus discharge when the abscess bursts. Unlike an abscess, it lacks clear boundaries and can affect a large area of soft tissue.
• Phlebitis or thrombophlebitis. Bacteria from the infected area enter the bloodstream, causing inflammation of blood vessel walls. This can lead to fever and weakness.
• Osteomyelitis — infection of the jawbone. Pathogens destroy the bone, deforming the jaw and causing facial asymmetry.
• Sinusitis — infection of the maxillary sinuses, which are located near the roots of the upper teeth. An abscess in this area can spread to the sinus mucosa.
• Sepsis — blood infection. Harmful bacteria enter the bloodstream, which can disrupt the entire body's functioning. Sepsis is characterized by high fever, chills, rapid heartbeat, difficulty breathing, and confusion. In severe cases, it can lead to death.
• Meningitis — a brain infection caused by bacteria spreading from the abscess. It can lead to death if untreated.

Diagnosis

Diagnosing a tooth abscess is straightforward due to the clear symptoms. However, a differential diagnosis is essential to rule out other conditions with similar symptoms. The dentist may use the following methods:

• Patient history — listening to complaints and asking clarifying questions;
• Examination — redness, swelling, and lumps in the gums are usually visible to the naked eye;
• X-rays — to assess the state of the dental system, locate the pathology, and determine the size of the abscess and the extent of tissue damage;
• CT scan — for more complex cases where the diagnosis needs further clarification.

Treatment

The treatment of a tooth abscess is systemic, considering the patient's overall health and any chronic conditions that may affect the course of the disease.

The ability to save the tooth depends on the severity of the abscess. Therefore, the earlier you seek treatment, the higher the chance of saving the tooth.

Surgical intervention is usually required, as conservative methods alone cannot fully resolve the problem.

The goals of treatment are:

• To remove the abscess;
• To address the underlying cause of the abscess.

The surgery to remove the abscess generally involves:

• Local anesthesia to numb the area;
• Making an incision in the gum;
• Draining the pus;
• Removing affected tissues.

Post-surgery, medication is needed to fully resolve the inflammation and suppress the growth of harmful bacteria. Patients should follow the doctor's prescribed course of antibiotics and anti-inflammatory drugs.

The dentist will also evaluate the condition of the tooth. Depending on the situation, the dentist may:

• Clean and fill the root canals;
• Decide whether tooth extraction is necessary if the roots are severely damaged.

Prognosis and Prevention

The prognosis depends on the stage of the abscess. In the early stages, the abscess can be successfully treated and completely resolved. If the condition is severe or complicated, treatment may be more difficult. It is best not to wait too long before seeking help.

To prevent tooth abscesses:

• Treat infections promptly;
• Manage chronic conditions;
• Brush teeth at least twice a day;
• Visit the dentist for a preventive check-up and professional cleaning twice a year.

The AESTHETE Dental Clinic is located in Dubai (UAE), on Bluewaters Island. With extensive experience and impeccable professionalism, we can successfully treat tooth abscesses. Book an appointment with us today!

FAQs

What should you do before seeing a dentist?

Under no circumstances should you attempt to open the abscess yourself. Over-the-counter painkillers can be taken, but do not exceed the recommended dosage. Saltwater or soda rinses, or chamomile or calendula infusions, can help reduce inflammation. Sleeping with your head elevated on a wedge pillow may help alleviate pain.