Prepared by: David D. Rolf II, D.M.D., M.Sc., Director of Education, Dental1.org
An oral abscess is a bacterial infection with an accumulation of pus or exudate (fluid that drains from an area of infection). Abscesses are often accompanied by acute inflammation with symptoms such as redness, pain, swelling, pus drainage, elevated temperature or fever.
Abscesses can occur
1. Inside a child's (primary) or adult's (permanent) tooth, in the pulp, or “root canal,” resulting from bacterial infection caused by decay, fracture (broken, cracked or chipped tooth) or facial injury.
2. In the periodontal (gum) tissues that surround and support the tooth root.
3. Around an impacted or erupting wisdom tooth (3rd molar)
4. In the oral soft tissues of the mouth
5. In the alveolar bone - the bone that supports the teeth – bone in both the upper jaw (maxilla) and/or lower jaw (mandible) can be affected.
Abscesses must be taken seriously because the bacteria that cause oral infections are very harmful (pathogenic) and can spread to other parts of the head, neck and body. Untreated oral infections can cause more serious illness, significant tissue damage and even death. Recent studies suggest that untreated chronic oral infections like periodontal disease may contribute to cardiovascular disease, pre-term births, and complicate the treatment of diabetes.
Symptoms of an Abscess:
Pain, swelling, redness, itching, and pus drainage at the affected site
Toothache
Lymphadenitis - swollen neck glands
Elevated temperature, feeling sick
Bad taste in mouth/bad breath
A tooth/teeth that feel loose
Pain when chewing on the affected side
Tooth sensitivity: to hot, cold or pressureAction to Take if You Have an Abscess:
1. Contact and see your dentist as soon as possible.
2. In the meantime, here is oral home care that may be helpful:
Take over the counter pain relievers such as acetaminophen, aspirin, or naproxen for pain and fever.
Place an ice pack over the tender/painful/swollen area if possible, for 5-10 minutes per hour.
Use of over the counter topical pain medicine containing Benzocaine may help temporarily relieve pain at the affected area.
Try not to chew on the affected side; keep the infected site clean by brushing and flossing if possible.
If brushing/flossing is not possible, use of a prescription antibacterial mouth rinse (Chlorhexidine) can be beneficial.
Overuse of over-the-counter mouth rinses containing alcohol is not recommended.
Salt water rinsing: 1 tablespoon of salt in an 8 oz glass of warm (not hot) water may offer some relief.
Stay well hydrated - drink plenty of water; avoid drinking too much caffeine and/or alcohol, as this will dehydrate your body. Alcohol can also interfere with the effectiveness of prescription and over the counter medicines, or cause potentially dangerous side effects.
Smoking is not recommended, as smoking only impairs the healing process.
Diagnosis of An Abscess:
Dentists diagnose an abscess by asking about the problems and symptoms you are experiencing, and by taking a "pain history" to help determine the location, duration, type/intensity of your pain, as well as what stimulates/causes the pain and what if anything relieves the pain.Extraoral and Intraoral Examination: The dentist examines the tissues of the head and neck for any abnormality, and then examines the mouth and teeth using techniques such as:
Visual inspection: Looking at the oral soft tissues for signs of inflammation and infection; looking at the teeth for signs of disease or trauma.
Percussion: Tapping on teeth to determine any sensitivity or discomfort.
Palpation: Pushing on the tooth to determine if it is loose, as well as gently pressing on the gum and mouth tissues to determine any tenderness, swelling or exudate (pus drainage).
Pressure: Having you apply chewing pressure on a bite stick.
Hot and cold sensitivity tests on teeth.
Checking your occlusion (bite) for signs of occlusal trauma (excessive and/or damaging forces being placed on teeth).
Periodontal probing: To determine if periodontal disease is present.
Sinus tract exploration: If the dentist observes a pustule (“pimple”) on the surface of the gum tissue near a tooth, this may indicate a pathway where the infection is draining from the tooth – this is called a sinus tract. In order to determine the source of the infection, the dentist may place a flexible probe in the sinus tract and take a radiograph (“X-ray”).
Radiographs (“X-rays”): A panoramic radiograph may be taken to allow the dentist to look at the condition of the upper and lower jaws and all the teeth; radiographs of individual teeth may be taken to examine the condition of teeth, the pulp/root canal and the supporting bone. Conventional radiographs will be shown to you on film; digital radiographs will be shown to you on a computer screen where the images can be enlarged and enhanced to show the problem in more detail.
Treatments Available for Abscesses:
Antibiotics: Usually involves taking an antibiotic pill for 7 to10 days; be sure to notify your dentist of you are allergic to penicillin or any other antibiotics, and to take all the antibiotic pills that have been prescribed until they are gone.
Surgically debride and/or drain the abscess: The infected area is anesthetized (made “numb”) and the infection is debrided (“cleaned out”). In some cases, an incision is made and a surgical tube placed in the wound to allow the infection to drain, known as “Incision and Drainage” or an I & D. The combination of antibiotic therapy and the debridement and/or drainage of the abscess will eliminate the infection and allow for healing of the damaged tissues.
Endodontic therapy (“root canal”): If the nerve and blood supply to the tooth became infected, abscessed and necrotic (the tissue died), the source of the infection must be eliminated. Root canal therapy is done to remove the infectious tissues and repair the damage that was caused by the infection so that the tooth can heal and be saved.
Periodontal therapy: If the abscess was due to periodontal (gum) disease, the infected root surfaces and gum tissues will be thoroughly debrided (cleaned). Depending on the extent of the disease, the periodontal debridement treatment may be non-surgical, known as root planing, or a surgical procedure, usually referred to as osseous surgery.
Combined periodontal/endodontic therapy: In some cases, the source of the infection is located both inside and outside around the tooth. Periodontal and root canal therapy are needed to save the tooth.
Restorative dentistry: If the tooth became abscessed due to severe decay (deep cavity), or a crack, fracture, or other trauma/injury, the damaged tooth needs root canal therapy and a restoration to be saved. Root canal therapy is done first, followed by restoration. Restorative treatment may consist of: A post and core, crown or bridge.
Tooth extraction: In some cases, if the infection has destroyed a large amount of the supporting bone and gum tissue around the tooth, the tooth will be very loose, uncomfortable and not useful for chewing and will need to be removed and replaced. Complications of Abscesses:
If not treated, dental abscesses can develop into serious life threatening infections. Dental abscesses can damage supporting gum tissues and bone around teeth, requiring specialized treatment to repair the damage. Some tissue damage can also cause cosmetic defects that require surgical correction. Despite therapy, abscesses can result in episodes of re-infection, recurrent abscess and tooth loss.
For More Information Related to Oral/Dental Abscess:
American Dental Association: Healthy Mouth, Healthy Body
American Academy of Periodontology: Periodontal (Gum) Disease
American Association of Endodontists: Root Canal Treatment
American Association of Oral & Maxillofacial Surgeons: Wisdom Teeth
American Academy of Pediatric Dentistry: Emergency Dental Care for Children
Contact a Dental School in Your Area
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