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Tooth Abscess

What is a tooth abscess?

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Tooth Abscess explained

Dr. Sarah explains everything you need to know
about tooth abscess treatment at the dentist

Our teeth are amazing structures. They are composed of multiple layers, each with a specific structure and a very specific purpose. While the outer layers are mainly composed of minerals, serving to protect the tooth from both the forces of chewing and biting, as well as the bacteria present in the mouth, the inner layers are softer, and the innermost layer (known as the tooth nerve or pulp) is mainly composed of blood vessels, nerves, and other cells and soft tissues. When that layer is infected with bacteria and left without treatment for a while, these soft contents liquefy and give rise to what is known as a tooth abscess or a dental abscess.

What are the causes of tooth abscess?

The main reason for any abscess is a bacterial infection, and dental abscesses are no different. The process of decay starts when the bacteria produce their acids and toxins when the food remnants are left on the tooth surface without cleaning for more than 2 days. These toxins dissolve the minerals in the outer layers of the tooth, and the bacteria infiltrate even deeper into the tooth structure.

When they reach the innermost layer (the pulp) they begin their process by inflaming the cells and soft tissues there (that’s when you start feeling severe pain due to inflammation of that very sensitive part). Some people have high pain tolerance and are not really bothered by such pain, so they leave the tooth and inflammation untreated. As a result, the bacteria continue to invade the pulp and start to liquefy its contents, basically replacing these contents with dead tissue. Accumulation of that tissue causes the abscess to form.

The bacteria can also reach the pulp through other means, such as through a fracture due to trauma, through the periodontal ligament (such as with a deep pocket), through leakage under a poor filling, and even through the bloodstream from another infection site in the body.

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What are the common tooth abscess symptoms?

  1. Severe pain:

    Pain is a factor in almost every dental disease, but abscess pain is quite different. Not only is the magnitude of pain much higher, the character of the pain is also different. With pulp inflammation (which is the precursor for an abscess) the pain is sharp and lingering, and really unaffected by other stimuli and even resistant to pain killers. Abscess pain is more dull and deep-seated in nature (you feel it right in the bone). It also usually has a throbbing nature (since it is filled with pus) and tends to increase when you lean forward (due to shifting of that liquid pus).

  2. Swelling:

    Swelling is a tell-tale sign of an abscess but doesn’t happen with every case. An abscess has to have existed for a long time before it starts to swell the bone surrounding it, making the swelling visible inside or outside the mouth. When the pus builds up without a way to drain it, it causes expansion of the surrounding bone and you start to notice the swelling. It starts small (a tiny bump in the gums above or below the tooth) and in some cases, it increases in size so much that it starts to appear on the outside. In extreme cases, it can swell so much that it closes the eye or even threatens the airway when it creeps towards your tongue and throat.

  3. Mobility of the tooth:

    Another result of the pus. Usually, the tooth lies within its socket in the bone, all hard structures with little to no mobility. With a periapical abscess, the bone is largely replaced (temporarily) with pus, which is liquid and very mobile. Your tooth may become wobbly in its socket until the problem is fixed.

  4. Foul taste or smell:

    This is one of the late symptoms of a dental abscess. Eventually, the pus has to find a way to drain from the confined space of the abscess. When that happens, and the pus starts to seep into your mouth, you should start to smell or taste it. It is a salty, bitter, yellowish liquid that basically smells like rotten eggs.

  5. Spread of infection:

    Unfortunately, abscesses tend to spread. Not only is that dangerous for the neighbouring teeth and structures, but for other structures in the body as well. If the bacteria reach a blood vessel, they could be carried anywhere in the body, forming new foci of infection. This usually happens in the eyes and in the joints (which is quite painful but easily treated), or if you are unfortunate enough, could happen in very vital structures such as the heart or the brain.

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Are there different types of dental abscesses?

Yes. They are all basically the same and present with similar signs and symptoms, but they differ in their locations. These types include:

  1.   Periapical abscess:

    The most common form. This type of abscess is related to the root of the teeth, meaning an abscess under the tooth. It is a result of the liquefaction of the pulp cells and soft tissues, as we explained before.

  2. Periodontal abscess:

    This typically happens in the space between the tooth and its bony socket, which is known as the periodontal ligament. It is a result of the infection of the cells present in the gums and therefore is also known as a gingival abscess. It is a soft tissue abscess, meaning it doesn’t show on the abscessed tooth X-ray, and is mainly diagnosed through clinical findings as well as the reported signs and symptoms.

    In most cases, this type of abscess is treated like gum inflammation and needs no treatment further than a mouthwash rinse for a few weeks.

  3. Jaw abscess:

    This is a larger type that occurs in the bones of the jaws themselves. It could be a result of a periapical abscess left untreated or be completely unrelated to the teeth. These are more dangerous since they are usually larger in size, and could compromise some vital structures such as the nerve of the lower jaw, or the maxillary sinus.

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What is the main tooth abscess treatment?

The main treatment of an abscess is drainage of the pus inside the cavity. Tooth abscess drainage can happen in 2 main ways:

  1. Through the tooth:

    This method mainly works with small periapical abscesses (abscess under tooth). The nerve of the tooth is accessed with a dental turbine, and after all the decay is removed, the root canals are cleaned with specialized dental files. The empty canals are thoroughly cleaned, forming a pipeline for the pus to exit through. It can take a while, but it is the safest and least invasive method. After all the pus drains, the root canal treatment is completed and the tooth is sealed and covered by a crown.

  2. Through an incision:

    This invasive surgical approach is needed when the pus is related to the undersurface of the tooth, such as with a large gingival or periodontal abscess, and with abscesses inside the bone. The enlarged surface is cut with a lancet, and the pus is allowed to drain via that cut. In some cases, that is enough to drain the whole thing, but in other cases, the opening will have to be maintained for a few days just to make sure none of the pus is left behind.

Antibiotics are also a part of the treatment in some cases, when fever is involved or when the main structure is compromised. 

A tooth abscess is quite a serious condition brought about mainly by the neglect of very obvious signs and symptoms. In most cases, it can be avoided easily if you head to the dentist as soon as you start to feel any problem in your mouth, and when it does happen, it needs immediate intervention since it can cause quite a bit of problem if left untreated.

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Have you woken up in pain?  Swelling on the side of your face and throbbing around the area?  Perhaps you have noticed a reddish lump on the gum surface under a tooth.  These are all signs you may have a tooth abscess and are in need of urgent care by your local general dentist.  Fortunately, we have some of the best dentists in town available to book an emergency consultation with day or night!  

Simply login to AirSmile either online at www.airsmile.com or download the free app on Google Play or Apple Store.  Once there, select from the booking options that best match your needs and find a suitable time with one of our dentist members.

Don’t let a tooth abscess ruin your day and the long term health of your mouth – book today!

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Get even more savvy with our FAQ'S

Understanding your condition is the key to making the right choices for you

WE'RE DENTAL.. BUT HELPFUL.. BUT CLEVER..

A dental abscess is an infection brought about by bacteria invading the soft tissue either inside the tooth (namely the pulp of the tooth) or outside the tooth (namely the periodontal ligament. The bacteria liquefy these soft tissues turning them to pus, and when it builds up in its cavity, that’s when a dental abscess is formed.

No, it needs immediate treatment to drain the pus and eliminate the bacteria. That being said, it usually fluctuates between acute and chronic phases. The acute phase is usually the one with the symptoms, while the chronic is usually symptom-free, but that doesn’t mean the problem doesn’t need treatment, as the chronic can turn to acute at any time.

An acute tooth abscess is definitely an emergency. It is often accompanied by severe pain, as well as swelling that could compromise the airway and some very important structures.

Symptoms of a dental abscess are usually widespread and poorly localized (meaning it is very difficult for you to pinpoint which tooth is the diseased one). However, the swelling is a very obvious sign, and when the swelling enlarges, it means the abscess is enlarging and spreading.

Another aspect to consider is also the body spread of the abscess. When the bacteria and pus gain access to the bloodstream, they can spread the infection to other structures such as the eyes and joints, and more dangerous places such as the heart and the brain.

Drainage of a tooth abscess can be done either through the root canal system (which works with periapical abscess or the abscess under tooth), or through an incision which works with larger abscesses and the ones related to the gums or inside the bone.

Ice and cold compresses are generally better for swellings, but neither heat nor cold does any effect on the abscess itself.

In the early stages, there is no specific look for an abscess. On examination, you might find a decayed or fractured tooth, or a tiny swelling in the gums around that tooth. When it progresses to the later stages, the swelling could enlarge so much that it becomes visible outside the mouth.

No, an abscess can never be cured without intervention from a dentist. The symptoms could subside and the acute phase could change to a chronic phase, but the disease itself will remain present until a dentist drains the pus, eliminates the cause of the problem and repairs the tooth involved.

It really depends on how much you can withstand the signs and symptoms of pain and swelling.

If you start to feel any of the common symptoms of a tooth abscess (pain that is dull and deep-seated and usually increases when you lean forward, swelling that is either small on the gums surrounding the tooth, or large enough to be visible from the outside, and a foul taste and smell when the pus drains into your mouth) then you should head to a dentist immediately.



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Tooth Abscess

An abscess is an area of infection that is formed due to the death and liquefaction of cells and soft tissues in a specific area. When that happens related to a tooth or its surrounding structures, it is known as a dental abscess. It is basically a sack filled with pus that resulted from the liquefaction of the pulp cells.

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