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Tooth abscess

Tooth abscess

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Encyclopedia
A tooth abscess or root abscess is pus
Pus
Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...

 enclosed in the tissues of the jaw bone at the apex of an infected tooth
Tooth
Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are...

's root(s). Usually the abscess originates from a bacterial infection that has accumulated in the soft, often dead, pulp
Pulp (tooth)
The dental pulp is the part in the center of a tooth made up of living connective tissue and cells called odontoblasts.- Anatomy :Each person can have a total of up to 52 pulp organs, 32 in the permanent and 20 in the primary teeth....

 of the tooth. This can be caused by untreated tooth decay, cracked teeth or extensive periodontal disease
Periodontal disease
Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...

. A failed root canal treatment may also create a similar abscess.

There are three types of dental abscess. A gingival abscess (or gumboil) involves only the gum tissue, without affecting either the tooth or the periodontal ligament. A periapical abscess starts at the apex of the root. A periodontal abscess begins in the pocket of gingiva
Gingiva
The gingiva , or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.-General description:...

 over 3 mm.

Presentation and symptoms


The pain is continuous and may be described as gnawing, sharp, shooting, or throbbing. Putting pressure or warmth on the tooth may induce extreme pain. There may be a swelling present at either the base of the tooth, the gum, and/or the cheek, which can be alleviated by applying ice pack
Ice pack
An ice pack or gel pack is a plastic sac of ice, refrigerant gel or liquid, or, in an emergency, even frozen vegetables. The refrigerant, usually non-toxic, can absorb a considerable amount of heat, since its enthalpy of fusion is high...

s.

An acute abscess may be painless but still have a swelling present on the gum. It is important to get anything that presents like this checked by a dental professional as it may become chronic later.

In some cases, a tooth abscess may perforate bone and start draining into the surrounding tissues creating local facial swelling. In some cases, the lymph glands in the neck will become swollen and tender in response to the infection. It may even feel like a migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...

 as the pain can transfer from the infected area. The pain does not normally transfer across the face, only upwards or downwards as the nerves that serve each side of the face are separate.

Severe aching and discomfort on the side of the face where the tooth is infected is also fairly common, with the tooth itself becoming unbearable to touch.

Treatment



Successful treatment of a dental abscess centers on the reduction and elimination of the offending organisms.
This can include treatment with antibiotics. and drainage. If the tooth can be restored, root canal
Root canal
A root canal is the space within the root of a tooth. It is part of a naturally occurring space within a tooth that consists of the pulp chamber , the main canal, and more intricate anatomical branches that may connect the root canals to each other or to the surface of the root.-Root canal anatomy:...

 therapy can be performed. Non-restorable teeth must be extracted, followed by curettage of all apical soft tissue.

Unless they are symptomatic, teeth treated with root canal therapy should be evaluated at 1- and 2-years intervals to rule out possible lesional enlargement and to ensure appropriate healing.

Abscesses may fail to heal for several reasons:
  • Cyst
    Cyst
    A cyst is a closed sac, having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst could go away on its own or may have to be removed through surgery.- Locations :* Acne...

     formation
  • Inadequate root canal therapy
  • Vertical root fractures
  • Foreign material in the lesion
  • Associated periodontal disease
  • Penetration of the maxillary sinus
    Maxillary sinus
    The pyramid shaped maxillary sinus is the largest of the paranasal sinuses, and drains into the nose. It is present at birth as rudimentary air cells, and develops throughout childhood.-General characteristics:...



Following conventional, adequate root canal therapy, abscesses that do not heal or enlarge are often treated with surgery and filling the root tips; and will require a biopsy to evaluate the diagnosis.

Untreated consequences


If left untreated, a severe tooth abscess may become large enough to perforate bone and extend into the soft tissue eventually becoming osteomyelitis
Osteomyelitis
Osteomyelitis simply means an infection of the bone or bone marrow...

 and cellulitis
Cellulitis
Cellulitis is a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters,...

 respectively. From there it follows the path of least resistance
Path of least resistance
The path of least resistance describes the physical or metaphorical pathway that provides the least resistance to forward motion by a given object or entity, among a set of alternative paths. The concept is often used to describe why an object or entity takes a given path.In physics, the path of...

 and may spread either internally or externally. The path of the infection is influenced by such things as the location of the infected tooth and the thickness of the bone, muscle and fascia attachments.

External drainage may begin as a boil which bursts allowing pus drainage from the abscess, intraorally (usually through the gum) or extra orally. Chronic drainage will allow an epithelial lining to form in this communication to form a pus draining canal (fistula
Fistula
In medicine, a fistula is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.-Locations:Fistulas can develop in various parts of the...

). Sometimes this type of drainage will immediately relieve some of the painful symptoms associated with the pressure.

Internal drainage is of more concern as growing infection makes space within the tissues surrounding the infection. Severe complications requiring immediate hospitalization include Ludwig's angina
Ludwig's angina
Ludwig's angina, otherwise known as angina ludovici, is a serious, potentially life-threatening cellulitis, or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections. It is named after the German physician, Wilhelm Friedrich von Ludwig...

, which is a combination of growing infection and cellulitis
Cellulitis
Cellulitis is a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters,...

 which closes the airway space causing suffocation in extreme cases. Also infection can spread down the tissue spaces to the mediastinum
Mediastinum
The mediastinum is a non-delineated group of structures in the thorax, surrounded by loose connective tissue. It is the central compartment of the thoracic cavity...

 which has significant consequences on the vital organs such as the heart. Another complication, usually from upper teeth, is a risk of septicaemia (infection of the blood) from connecting into blood vessels, brain abscess
Brain abscess
Brain abscess is an abscess caused by inflammation and collection of infected material, coming from local or remote infectious sources, within the brain tissue...

 (extremely rare), or meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...

(also rare).

Depending on the severity of the infection, the sufferer may feel only mildly ill, or may in extreme cases require hospital care. In 2011, a death from an untreated dental abscess was recorded in Cincinnati. Reports indicate that local free dental clinics had too long a waiting list to be effective in this case.

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