Dental abscess

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A tooth abscess (also called dentoalveolar abscess , tooth abscess or root abscess ), is a local collection of associated pus with teeth. The most common type of tooth abscess is a periapical abscess, and the second most common is a periodontal abscess. In a periapical abscess, it is usually a bacterial infection that accumulates in the soft and often dead dental pulp. This can be caused by tooth decay, broken teeth or extensive periodontal disease (or a combination of these factors). Failure of root canals can also cause the same abscess.

Tooth abscess is a type of odontogenic infection, although generally the last term is used in infections that spread outside the area around the causative tooth.

Video Dental abscess

Classification

The main types of tooth abscess are:

• Periapical abscess: The result of a localized chronic infection located at the end, or apex, of the tooth root.
• Periodontal abscess: starts on a periodontal pocket (see: periodontal abscess)
• Gingival abscess: involves only gum tissue, without affecting the tooth or periodontal ligament (see: periodontal abscess)
• Pericoronal abscess: involves soft tissue around the dental crown (see: Pericoronitis)
• Combined periodontic-endodontic abscess: situations in which periapical abscess and periodontal abscess have been combined (see: Combined periodontic-endodontic lesions).

Maps Dental abscess

Signs and symptoms

The pain is continuous and can be described as extreme, growing, sharp, firing, or throbbing. Placing pressure or warmth on the teeth can cause tremendous pain. The area may be sensitive to touch and possibly swelling as well. This swelling may be at the base of the tooth, gums, and/or cheeks, and can sometimes be reduced by applying an ice pack.

Acute abscess may not be painful but still have swelling of the gums. It is important to get anything presented like this checked by the dentist as it can become chronic later.

In some cases, dental abscesses can puncture the bone and begin to flow into surrounding tissues creating localized facial swelling. In some cases, the lymph nodes in the neck will become swollen and tender in response to infection. It may even feel like a migraine because the pain can move from an infected area. The pain usually does not move across the face, only upward or downward because the nerves that serve each side of the face separate.

Severe pain and discomfort on the side of the face where the infected tooth is also quite common, with the tooth itself becoming unbearable to the touch due to the tremendous pain.

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Diagnostic approach

Periodontal abscesses may be difficult to distinguish from periapical abscesses. Indeed, sometimes they can happen together. Because the management of periodontal abscess is different from periapical abscess, this differentiation is important to do.

• If the swelling exceeds the root peak area, it is more likely to be a periapical abscess; if closer to the gingival margin, it is more likely to be a periodontal abscess.
Similarly, in the periodontal abscess the pus is most likely to discharge through the periodontal pocket, whereas the periapical abscess generally flows through the parulis closer to the top of the involved tooth.
• If the tooth has pre-existing periodontal disease, with pockets and loss of alveolar bone height, then the likelihood is a periodontal abscess; whereas if the tooth has a relatively healthy periodontal condition, then the likelihood is a periapical abscess.
• In periodontal abscesses, swelling usually precedes pain, and in a periapical abscess, pain usually precedes swelling.
• The history of toothache with heat and cold sensitivity suggests previous pulpitis, and suggests that periapical abscesses are more likely.
• If the tooth gives normal results in the pulp sensibility test, free from dental caries and has no major restoration; it is more likely to be a periodontal abscess.
• Dental radiography is of little help in the early stages of dental abscess, but then usually the position of the abscess, and therefore an endodontal/periodontal etiologic indication can be determined. If there are sinuses, the gutta percha point is sometimes inserted before the x-ray in the hope that it will lead to the origin of the infection.
• Generally, periodontal abscesses will be softer to the lateral rather than vertical percussion, and the periapical abscess will be softer to the apical percussion.

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Treatment

Successful treatment of dental abscess on the reduction and elimination of offending organisms. This may include treatment with antibiotics and drainage, however, it has become highly recommended that dentists should improve antibiotic prescribing practices, by limiting prescriptions to acute cases suffering from severe signs of the spread of infection, in an attempt to address the development of antibiotic resistant bacterial strains in population. The 2014 Cochrane Review has found insufficient evidence to rule out if patients with acute dental abscesses can benefit from antibiotic prescriptions.

If teeth can be restored, root canal therapy may be performed. Teeth that can not be rejuvenated must be extracted, followed by curettage of all apical soft tissues.

Unless they are symptomatic, teeth treated with root canal therapy should be evaluated at intervals 1 and 2 years after root canal therapy to rule out the possibility of lesional lesions and to ensure appropriate healing.

Abscesses may fail to heal for several reasons:

• Cyst formation
• Inadequate root canal therapy
• Vertical root fracture
• Foreign material in the lesion
• Related periodontal disease
• Penetration of maxillary sinuses

After adequate conventional root canal therapy, abscesses that are not healed or enlarged are often treated with surgery and fill the root tips; and will require a biopsy to evaluate the diagnosis.

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Complications

If left untreated, severe tooth abscesses can become large enough to puncture the bone and extend into the soft tissue that eventually becomes osteomyelitis and cellulitis. From there it follows the least resistance path and can spread both internally and externally. The pathway of infection is affected by things like the location of the infected tooth and the thickness of the bones, muscles and fascia attachments.

External drainage can be initiated as an ulcer that bursts allow drainage of pus from abscesses, intraoral (usually through the gums) or extra. Chronic drainage will allow the epithelial lining to form in this communication to form draining pus (fistula) channels. Sometimes this type of drainage will immediately relieve some of the painful symptoms associated with stress.

Internal drainage is more alarming because increased infection makes space inside the tissues around the infection. Severe complications requiring immediate hospitalization include Ludwig's angina, which is a combination of increased infection and cellulitis that closes the airway space causing shortness of breath in extreme cases. Infections may also spread to tissue spaces to the mediastinum which have significant consequences on vital organs such as the heart. Another complication, usually from the upper teeth, is the risk of septicemia (blood infection) from connecting to a blood vessel, a brain abscess (very rare), or meningitis (also rare).

Depending on the severity of the infection, the sufferer may feel mild illness, or may in extreme cases require hospitalization.

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See also

• Barodontalgia
• Focal infection
• Intraoral sinuses

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References

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External links

• https://toothpainremedies.net/abscess-tooth/abscess dental info from Toothpainremedies.net]

Source of the article : Wikipedia