The Dental Abscess

Overview

A dental abscess is an infection of a tooth, gums, or the jaw caused by an accumulation of pus and bacteria.

Dental abscesses originate from

  • Tooth Decay: a cavity that has progressed into the nerve chamber, trapping gas and creating inflammation of the nerve inside the tooth
  • Gum disease: deep pockets harbor bacteria that grow under the gum line, trapping gas and creating inflammation
  • Wisdom teeth: trapped bacteria around wisdom teeth that are not completely erupted, but that have a flap of skin partially covering them (the name of this type of abscess is pericoronitis)
  • Trauma: a blow or some type of trauma to the teeth or jaw, causing the death of the tooth

The first two types of abscesses are the result of poor home tooth care and lack of regular dental visits. Untreated tooth decay or periodontal disease will eventually progress to the point where emergency dental care is necessary.

Pericoronitis (peary- core-on-i-tis) occurs when a patient’s wisdom teeth need to be removed but the patient waits until intense pain manifests to schedule the procedure. The flaps of skin over the wisdom tooth prevent your toothbrush from reaching bacteria, allowing them to multiply and spread into the surrounding spaces in your face and around the tooth.

The last type of dental abscess can occur shortly after the trauma (trauma such as a blow to the face) or years later. A patient can have a perfectly intact tooth (no decay, fracture or gum disease) but experience intense pain and swelling indicating that the tooth is dying. The tooth may become loose and extremely tender to touch.

Symptoms of a Dental Abscess

These types of abscesses create pressure with symptoms of swelling and pain. The infection will take the path of least resistance and can progress into the face or neck. The head and neck have spaces where the gas produced by the bacteria can spread (facial spaces), causing swelling. In some cases, the face or neck can also become inflamed over the top of the swollen area, and the lymph nodes under the chin and in the neck can become swollen and tender. In severe cases, the patient can experience fever, chills, malaise, and a general/overall illness.

 

Treatment of a dental abscess:

An abscess caused by the invasion of decay/bacteria into the nerve chamber of the tooth can be treated by one of two procedures:

  • Root canal therapy: depending on the amount of decay or loss of tooth structure, you may have a strong desire to save the tooth.
  • Extraction of the tooth (see Oral Surgery)

Antibiotics and pain medication are often prescribed for this type of infection (different antibiotics are prescribed for different abscesses).

An abscess caused by bacteria infecting deep pockets, found in periodontal disease, can be more difficult to treat. A regime of antibiotics is necessary along with disinfecting the infected pocket. These pockets, once deep down the side of the tooth, can turn and wrap around the root deep under the gum line, making it difficult to disinfect. The use of dental lasers is a highly useful tool in killing bacteria deep in gum disease pockets. Recurrent periodontal abscesses may best be treated by extraction of the infected tooth.

Sometimes a dental abscess can progress rapidly, or the dental patient waits too long to seek treatment, and the infection spreads into the facial spaces, the floor of the mouth, or the neck. At no time should this swelling be lanced or drained unless the infection has “pointed.” This means that the infection has a white head on it like a pimple waiting to be squeezed. Extreme care should be taken when lancing an abscess in the floor of the mouth to avoid damage to the Lingual artery.