Tooth abscess refers to localized collection of pus in the alveolar bone at the root apex of the tooth. In case of abscess, the infection extends from the root apex to the periradicular tissue through the apical foramen.
Many reasons for tooth abscess can be there. The most common reason for tooth abscess is Dental caries. Gingival or periodontal problems and tooth trauma can also cause tooth abscess. There can be Gingival, Periodontal, Apical, Pericoronal or Phoenix abscess. Gum or gingival abscess is due to the trauma or infection to the surface of gum tissue and periodontal abscesses is the result of an infection that has moved deeper into the gum area. Periapical abscess refers to a tooth with an infection of pulp. Pericoronal abscess is seen near the incompletely erupted teeth and occurs due to plaque induced inflammation of pericoronal flap that is pericoronitis. Phoenix abscess occurs due to acute exacerbation of chronic lesion.
Periodontal Abscess Originating from a Maxillary Central Incisor
Depending upon the features, the tooth abscess can be classified into two types:
Acute Alveolar Abscess : It is also known as Acute dental abscess, Acute dentoalveolar abscess, cute periapical abscess, Acute radicular abscess or Acute apical abscess.
Acute Alveolar Abscess: The symptoms are acute in case of acute alveolar abscess. That is why it is called so. In case of acute alveolar abscess, there is:
Pain and swelling is present along with systemic manifestations like fever. Chances of dehydration are more in children especially when they are not eating because of pain and inflammation. So they should be given immediate treatment. Osteomyelitis which is the infection of bone may develop as its sequel.
Chronic alveolar Abscess: Due to long standing, low grade infection of the periradicular bone, chronic alveolar abscess develops. Generally no clinical signs and symptoms occur in case of chronic alveolar abscess. Discharge may be there from sinus opening in case of chronic abscess.
In case of acute abscess, minimum of changes are seen in the radiograph as it is confined to medullar bone only due to shorter time period. Whereas in case of chronic, better defined radiographic lesion is seen. Slight thickening of the periodontal space or radiolucent area at apex of tooth is seen. No bone loss is evident.
Dental Abscess Overview
A radiograph should be taken in case of chronic abscessed tooth. It will help the dentist to know whether it would be feasible to save the tooth by the endodontic procedure like root canal therapy or it has to be removed.
Phoenix abscess: It is an acute inflammatory reaction superimposed on an existing chronic lesion such as cyst/granuloma. Exacerbations of chronic lesion are most commonly associated with initiation of root canal therapy in a completely asymptomatic tooth. Phoenix abscess is associated with a non-vital tooth and has symptoms similar to acute infection. Tenderness on percussion is present in case of phoenix abscess.
Regular brushing, flossing along with regular dental check ups can prevent tooth decay and dental abscess. If cavities are restored early, then they would not develop into dental abscess. Tobacco chewing as well as smoking avoidance can also prevent dental abscess.
Outcome of dental abscess
Once the dental abscess has ruptured or been drained, the prognosis is good for resolution. If the condition is improving, the chance of infection getting worse is rare. For reassessment of infection and taking care of tooth, it is mandatory to have proper follow-up care with your dentist.
A dental abscess can be treated very easily with suitable dental treatment. In some cases, when abscess is not treated, complications may occur due to spreading bacterial infection. A severe tooth abscess may cause perforation of the bone and affect the soft tissue becoming cellulitis and osteomyelitis. Osteomyelitis is bone infection and occurs as a result of bacteria present in dental abscess spreading through the bloodstream. Osteomyelitis may cause fever, nausea and severe pain in the affected bone surrounding the dental abscess. Immediate hospitalization is required in cases of cellulitis and ludwig’s angina. Dental cyst may develop at the bottom of root of tooth if dental abscess is left untreated
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