Dental abscess

Alternative names
Periapical abscess; Tooth abscess; Tooth infection; Abscess - tooth

Definition
A Tooth abscess is a collection of infected material (pus) resulting from bacterial infection of the center (pulp) of a tooth.

Causes, incidence, and risk factors

A Tooth abscess is a complication of Tooth decay. It may also result from trauma to the tooth, such as when a tooth is broken or chipped. Openings in the tooth enamel allow bacteria to infect the center of the tooth (the pulp). Infection may spread out from the root of the tooth and to the bones supporting the tooth.

Infection results in a collection of pus (dead tissue, live and dead bacteria, white blood cells) and swelling of the tissues within the tooth. This causes a painful toothache. If the root of the tooth dies, the toothache may stop, but the infection remains active and continues to spread and destroy tissue.

Symptoms

     
  • Toothache       o Severe, continuous pain       o Gnawing or throbbing pain       o Sharp or shooting pain  
  • Pain when chewing  
  • Sensitivity of the teeth to hot or cold  
  • Bitter taste in the mouth  
  • Foul smell to breath  
  • Possible fever  
  • Swollen glands of the neck  
  • General discomfort, uneasiness, or ill feeling  
  • Swollen area of the upper or lower jaw - a very serious symptom

Signs and tests
The patient will feel pain when the dentist taps the tooth. Biting or closing the mouth tightly also increases the pain. The gums may be swollen and red and may drain thick material.

Treatment

The goals of treatment are elimination of the infection, preservation of the tooth, and prevention of Complications. Antibiotics may be given to fight the infection. Warm salt-water rinses may be soothing. Over-the-counter pain relievers may relieve the toothache and fever. Do not place aspirin directly over the tooth or gums because this increases irritation of the tissues and can result in mouth ulcers.

Root canal surgery may be recommended in an attempt to preserve the tooth. The center of the tooth, including the nerve and vascular tissue (pulp), is removed along with decayed portions of the tooth. The root and surface of the tooth remain in place. The cavity that is created in the core is filled and repaired, and a crown may be placed over the tooth.

Surgical drainage of the abscess or extraction of the affected tooth may be necessary.

Expectations (prognosis)
The infection of Tooth abscess is usually curable with treatment. Preservation of the tooth is possible in many cases.

Complications

     
  • Loss of the tooth  
  • Spread of infection to soft tissue (facial cellulitis, Ludwig’s angina)  
  • Spread of infection to the jaw bone (osteomyelitis of the mandible or maxilla)  
  • Spread of infection to other areas of the body resulting in cerebral abscess, endocarditis, pneumonia, or other disorders

Calling your health care provider
Call your dentist if persistent, throbbing toothache or other symptoms of Tooth abscess occurs.

Prevention
Prompt treatment of dental caries reduces the risk of Tooth abscess. Traumatized teeth should be examined promptly by the dentist.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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