What is a tooth abscess? Should I have it treated? If so, how?

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General Dental Care
BBiomed (dist), DDS (Melb

There are two main types of tooth abscess:

1 periapical

2 periodontal.

A periapical abscess arises at the root tip of the tooth and is generally due to infection of the nerve pulp that runs through the tooth.

A periodontal abscess is an associated swelling or collection of pus in the surrounding gum tissue.

Periapical abscess

What is it?

A periapical abscess usually occurs secondary to decay, but it can also arise due to trauma or past root canal procedures that have failed. When decay becomes advanced and contacts the nerve within the tooth, bacteria from the oral cavity can traverse the root of the tooth and reach the apex (or periapical areas). Here the bacteria interact with the tissues and can induce acute inflammation and the formation of pus, resulting in an abscess at the root of the tooth. 

tooth abscess

Should I have it treated?

Yes, a periapical abscess tends to be quite painful. In addition, this kind of dental abscess can spread through tissue spaces within your head and neck to cause serious infections and swellings.

How to treat it

Periapical abscesses are treated with root canal procedures. These involve removing all decay from the tooth. Small file instruments are then used to clean out the infected nerve from within the root canal of the tooth. Mechanical filing is accompanied by irrigation with solutions that help to chemically remove bacteria and infection. The root canal system is then filled with a biocompatible material and sealed off with a filling or a crown. After the cleaning/filing of the root canal, the tooth abscess is drained.

If the dentist deems your tooth be unrestorable due to heavy decay on its crown, the tooth may need to be extracted.

Periodontal abscess

What is it?

A periodontal abscess is a collection of pus that accumulates in periodontal pockets (gum that surrounds the tooth). These dental abscesses tend to form in patients with a history of periodontitis (gum disease), when the deepened pocket beside the tooth closes over.

Should I have it treated?

Yes, although the pain associated with a periodontal abscess tends to be less than with a periapical abscess, it will probably cause you some discomfort and swelling. Although rare, periodontal abscesses do have the potential to cause systemic signs of infection (fever, lymph node tenderness and facial cellulitis), which is why these abscesses need to be managed.

How to treat it

Treatment requires drainage of the pus. Under local anaesthetic, drainage is usually achieved through the pocket by means of debridement (cleaning of the root surface) or by lancing the swelling to allow external drainage. Irrigation with saline throughout the procedure is recommended. In cases where the periodontal disease is advanced and the tooth is beyond salvage, drainage of the pus can be done by extracting the tooth.

Antibiotics are generally not necessary for a tooth abscess. However, if you show systemic signs of infection or are immuno-compromised, antibiotics can be considered.

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