Tooth Abscess Symptoms and Management

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Tooth Abscess

A tooth abscess or a periapical abscess is an infective process that involves the periapical region of the tooth. It is also called as a dentoalveolar abscess. This condition is associated with pain and swelling of the tooth. There is acute inflammation of the periodontal tissues (the tissues that attach the tooth to the bone). There is pain in relation to the tooth that is affected. It is caused by:

1. An infection of the root of the tooth as a result of the carious process of the tooth and infection of the pulp.

2. After a traumatic injury to the tooth that results in fracture of the tooth and necrosis of the pulp.

3. It also occur after irritation and inflammation of the pulp tissue due to opening of the dentinal tubules to the outside through extreme wearing of the tooth, mechanical manipulation of the pulp, or application of chemicals.


Symptoms and Features

There is redness and swelling at the periapical portion and gums surrounding the tooth. There is infection and inflammation at the apex of the tooth root, the surrounding periodontal tissue, gum, and alveolar bones. An extreme pain is felt to the tooth (toothache) which is severe when the mouth is closed when the opposing tooth contact each other or biting. It is either a severe and continuous throbbing pain or a sharp shooting type of pain. There will be sensitivity to the tooth to hot or cold foods. There is bitter taste in the mouth and foul smell of the breath. The tooth is slightly extruded from the socket. There is an ill feeling or discomfort and fever associated with this condition. The surrounding lymph nodes or glands of the jaws or neck will be enlarged. Sometimes there will be an opening and draining sinus tract visible on the gums around the tooth. The infection may spread to the surrounding area causing cellulitis, destruction of tissues, and disfigurement of the face.


Diagnosis and Detection of Tooth Abscess

The diagnosis of the periapical infection is done by percussion of the tooth with a dental instrument to test pain. It is carried out by tapping the biting surface of the tooth using a blunt instrument tip. There will be sharp pain elicited by doing this procedure. There is pain on biting with pressure or even on opening and closing of the mouth. There will be enlarged and palpable lymph nodes in relation to the abscessed tooth. There is associated sinus tract and pus drainage from the opening sinus. An x-ray radiograph of the area in suspicion is done and the tooth that is affected is detected using the radiograph.


Management of Tooth Abscess

The principle of treatment is to eliminate the infection, preserve the tooth, and to prevent the complications. For eliminating infection, the abscess must be drained. Drainage is done by opening the abscess, opening the pulp cavity, or extracting the tooth.

1. Opening the abscess involves incision and drainage of the apical portion of the swelling that allows drainage of the pus and reduction of pressure and pain.

2. Opening the pulp cavity of the tooth is done to drain the pus collected inside the tooth through the opening.

3. In severe tooth abscess, the tooth in question may need to be removed paving way for drainage of the pus from the tooth socket.

Antibiotics are given to control infection and to prevent the spread of infection to the adjacent structures and causing serious complications. If the infection is not controlled, it might lead to complications such as osteomyelitis, which is inflammation of the surrounding bone, cellulitis, which is inflammation of the soft tissues, and fistula tract opening to the skin.

The pulp cavity associated with an opened root canal of tooth is treated with a root canal treatment or RCT. The tooth is then prepared for a crown and a ceramic crown placed over it. A missing tooth is replaced with a partial denture placed on the missing area to assist with chewing.

Good oral hygiene measures including proper cleansing of mouth after meals, tooth brushing, and use of warm saline gargle are undertaken. Consult a registered dental practitioner as early as possible when there is suspicion of a periapical tooth abscess.


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