What is a Tooth Abscess?

There are 3 common types of dental abscess based on the area of the mouth where they form:

• Periapical abscess - A periapical abscess that forms around the edge of the root (apex) of an infected tooth is the most typical form of tooth abscess. It usually originates from infected pulp tissue due to tooth decay.
• Periodontal abscess - In case of a periodontal abscess, usually referred as gum abscess, the infection is the result of severe gum disease, and it develops in the gingival or bone tissue that surrounds the affected tooth.
• Pericoronal abscess, is a special form of tooth abscess that is related mostly with partially impacted wisdom teeth, and develops when the tissue covering a partially erupted tooth becomes inflamed and infected (pericoronitis).

All types of tooth abscesses are the result of a pre-existing infection in the mouth. The pus formation that characterizes an abscess is a side-effect of the ‘battle’ of the body’s immune system with the bacteria that have caused the infection. Pus is actually a mixture of living and dead white blood cells and bacteria, cell fluids, and liquified dead tissue. The initial infection may be caused by:

• Tooth decay. A periapical tooth abscess develops when tooth decay in a tooth is not treated until it finally reaches and infects the dental pulp. The bacterial infection causes the inflammation and finally the death of the dental pulp tissues. As the bacteria grow and multiply they reach beyond the end of the root canals, infect the surrounding tissues and form a tooth abcess around the root tip. Other conditions such as a tooth injury (crack) or weakened dental restorations may also allow bacteria to reach the centre of the tooth and infect dental pulp, with similar effects in abscess formation as tooth decay.
• Periodontal disease. Severe gum disease causes the gums to pull away from the teeth, creating deep pockets of space between the teeth and gums. Periodontal pockets allow bacteria to enter deep between teeth and the surrounding gums and bone. If the infection is not treated, a periodontal abscess will develop.

Watch this video on how a tooth abscess is formed:

An abscess is typically painful, and it appears as a swollen area that is warm to the touch. The skin surrounding an abscess typically appears pink or red. The main symptoms associated with a tooth abscess are usually:

• a severe, persistent and continuous toothache.
• swelling of the face

Other tooth abscess symptoms include:

• Pain when chewing.
• Sensitivity of the teeth to heat, cold or pressure.
• Visible boil in the gums near a tooth (gum boil)
• Pus drainage in the mouth
• Foul taste in mouth and bad breath (a result of pus drainage)
• Redness and swelling of the gums, jaw or face
• Difficulty fully opening the mouth or swallowing.
• Swollen lymph nodes in the neck.

Although the formation of a tooth abscess is always followed with intense toothache, it may be developing for a long time before the tooth pain starts, revealing its existence.

As more pus is accumulated, the pressure increases and the abscess becomes increasingly more painful. Sometimes the pus finds a way through the tissue to the surface forming a visible bump on the gum overlying the root (gumboil). The boil can then rupture, allowing the pus to drain in the mouth. If such a drainage channel (fistula) is formed, the abscess becomes chronic.

Every time the abscess is drained into the mouth, the pain often decreases significantly, but the infection remains and dental treatment is still necessary. Otherwise the tooth absess will gradually worsen as the infection continues to spread and destroy periodontal tissues.

Severe tooth abcess symptoms such as fever, chills, nausea, vomiting, or diarrhea, mean that the tooth infection has spread to other tissues or organs. The condition may become life-threatening; see your doctor immediately.

The type of treatment for a tooth abscess depends on the severity and extent of the infection. While tooth extraction remains an option, it is not the only one as it was until some decades ago. The dentist will always try to save the tooth with endodontic treatment before deciding a tooth extraction.

The goals of tooth abscess treatment are first to relieve the patient from pain, followed by the elimination of the infection and the restoration of the tooth (if possible). The treatment of dental abscesses is performed by a dentists or endodontist and it requires several dental visits.

Antibiotics

The dentist will prescribe antibiotics for a few days before starting the treatment of the tooth abscess, especially if there is extensive swelling. However, an antibiotic will not clear the pus or eliminate the infection until the pus is drained. Antibiotics use for a few days after draining the pus could also help to clear any remaining infection.

Pain Relief

Pus drainage releases the pressure from the tissues around the tooth abscess, providing a significant relief from the acute pain. Draining the abscess is the first step of the tooth abscess treatment. It can be done either through an opening made through the top of the tooth in case of a periapical abscess or through an incision to the gums in case of a periodontal abscess.

If you can not visit the dentist immediately, you can try the following for temporary pain relief:

• Put an ice pack outside the cheek to relieve pain and reduce facial inflammation.
• Take an over the counter painkiller to help withstand the pain.
• Rinse the mouth with a warm saltwater solution to help clean the mouth, encourage drainage and relieve some of the pain. This is also suggested for several times a day for a few days after treatment of a dental abscess (especially for gum abscesses).

Root canal treatment

Performing a root canal therapy (endodontic treatment) can in most cases clear the infection and preserve the tooth. The procedure involves the removal of bacteria and infected tissues from the pulp chamber and the root canals. The tooth is then sealed and restored with a filling or crown.

Tooth extraction

A tooth extraction becomes necessary when the tooth is badly damaged and it can not be saved with a root canal treatment. Modern dentistry considers tooth extraction only as a last option and not as an alternative of root canal treatment. An extracted tooth due to tooth abscess should be replaced with a dental bridge or a dental implant.

A tooth abscess can cause serious health complications, that in some severe cases may become life threatening. The most common complications of tooth abscesses include:

• Tooth loss
• Spread of infection to soft tissue (facial cellulitis)
• Spread of infection to the jaw bone (osteomyelitis of the mandible or maxilla)
• Sinusitis - spread of infection from the roots of upper molars to the sinus cavities.
• Spread of infection to other areas of the body resulting in Cavernous sinus thrombosis (swelling and blood clotting in the veins behind the eyes), endocarditis, pneumonia, or other disorders
• Dental abscesses that have extended to the floor of the mouth or to the neck (Ludwig's angina) can become life-threatening, blocking the airway and causing difficulty breathing.

Tooth abcess symptoms such as fever, chills, nausea, vomiting, or diarrhea, are indications of severe tooth abscess complications; see your doctor immediately. In the years before WWII and the discovery of penicillin, it was not uncommon for patients to die from complications of tooth infections.