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.

Gingival Abscess

Periodontal Abscess Originating from a Maxillary Central Incisor


Classification of Abscessed Tooth

Depending upon the features, the tooth abscess can be classified into two types:

  1. Acute dental abscess/ Acute alveolar abscess
  2. Chronic dental abscess/ Chronic alveolar abscess

Reasons of Alveolar Abscess

  1. Extension of pulpal infection can lead to alveolar abscess
  2. Traumatic injury to the tooth- traumatic injury to the tooth causes necrosis of the pulp and can further lead to alveolar abscess
  3. Perforation of apical foramen due to faulty root canal technique with bacterial invasion in periapical region can lead to periapical abscess
  4. It may develop from acute periapical periodontitis or from a periapical granuloma


Acute Alveolar Abscess :  It is also known as Acute dental abscess, Acute dentoalveolar abscess, cute periapical abscess, Acute radicular abscess or Acute apical abscess.

Clinical features of acute alveolar 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:

  1. Severe throbbing pain is present
  2. Tooth is tender on percussion
  3. Swelling is present and it becomes more pronounced as the infection progresses
  4. Tooth becomes mobile and gets extruded from the socket.

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.


General symptoms of alveolar abscess

  1. Irritability, pale & loss of sleep
  2. Slight rise in body temperature.
  3. Chills, malaise & headache
  4. Lymphadenopathy

Radiographic changes

 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


Acute Alveolar Abscess Treatment

  1. By using antibiotic therapy, the acute symptoms can be treated.
  2. Drainage should be established for relief of symptoms more efficiently. Drainage of pus is must if swelling is fluctuant. If the swelling is not fluctuant, moist heat in the form of hot saline mouth rinse should be applied until the swelling becomes fluctuant.
  3. Drainage can be established through the tooth’s pulp chamber or the associated gingiva. It can also be established by tooth extraction.
  4. Pain occurs during the preparation of access cavity during root canal treatment.
  5. Warm saline rinses help in localizing the infection
  6. Fluids intake should be more and the patient should take rest.

Treatment of chronic abscessed tooth

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.


Prevention of dental 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.


Complications of dental abscess

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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Comments

  • Linda Riling

    Linda Riling 02 - July - 2014, at 16:13 PM

  • THIS INFORMATION REALLY MADE ME UNDERSTAND WHAT I JUST WENT THROUGH A FEW MONTHS AGO.WAS REALLY SICK FOR 6 WEEKS,WENT TO ER,URGENT CARE AND WASNT HELPED.SOMEONE SUGGESTED TMJ SO WENT TO DENTIST AND WAS TOLD I HAD A LIFE THREATENING TOOTH .INFECTION.END UP LOSING MY TOOTH AND THANK GOD NOT MY LIFE.WAS TOLD IT WAS SLOWING GROWING INFECTION AND I HAD NO TOOTH OR MOUTH PAIN.BUT HAD SEVERE JAW AND EAR PAIN,WAS JUST REALLY SICK.SO PLEASE GO TO THE DENTIST FOR REG.CHECK UP.I HADNT ,DIDNT HAVE THE MONEY BUT AFTER THIS I WILL GET REG.CHECK UPS.SAVE MONEY OR WHATEVER I HAVE TO AND GO.

  • ahmed hani

    ahmed hani 11 - November - 2013, at 04:41 AM

  • Nice information

  • Katie

    Katie 10 - November - 2013, at 22:41 PM

  • Thank you for the detailed description. I'm beginning to heal from a phoenix abscess and will be having root canal treatment tomorrow. I really appreciate understanding this condition and possible dangers, etc. better.

  • jane

    jane 29 - September - 2011, at 09:14 AM

  • it's useful to know about tooth disease and prevention

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