Guide to dental abscesses

One of the most common reasons why people require emergency dental surgery is because an abscess has formed on one of their teeth. An abscess can cause sudden, unexpected and severe throbbing pains in the affected tooth. At the same time, however, the pain can also spread to the jaw, gums and face.

Usually, an abscess requires immediate treatment by your dentist. If it is left untreated, the tooth will ultimately need to be extracted to stop the infection spreading to the other teeth or surrounding gums.

What is an abscess?

Generally speaking, an abscess can occur in various parts of the body, not just the teeth. What many people do not realise is that an abscess is actually a natural aspect of your body’s defensive system. If an infection forms in part of your body, the battle between your immune system and the infection will create a variety of dead cells, which form pus. An abscess is your body’s natural way of keeping the pus in one place, therefore localising the infection and stopping it from spreading to other areas of the body.

Abscesses cause pain because, as the battle between your immune system and the infection continues, they grow. This causes them to create pressure. If an abscess is left untreated, it may burst. While this may relieve the pain initially, it can cause also often cause further complications in the future, as it enables the infection to spread.

What is a dental abscess?

An abscess can form in one of your teeth, therefore if the tooth becomes infected. But how does infection start? Sometimes, if your tooth is cracked, split or fractured through accident or injury, infection can gain access. In the majority of cases, however, infection usually gains access to a tooth through a cavity caused by dental decay.

There are three common types of dental abscess. A gingival dental abscess can form on the gum tissue. This is also sometimes known as a peripheral abscess, as it does not directly affect the bone structure of the tooth.

If plaque has damaged the gum and eroded the teeth, it creates gaps or pockets between the gums and teeth where an abscess can form. This is known as a periodontal abscess.

Finally, a periapical abscess is the name given to an abscess formed by an infection to the pulp of the tooth. This is probably the most serious type of dental abscess. Once the pulp of the tooth is infected, then the tooth is in danger of dying and will ultimately need to be extracted.

What causes a dental abscess?

As we have discussed above, a dental abscess can be caused by injury or trauma to the tooth. However, they are most commonly caused by dental decay, which creates the cavity that allows the tooth or the areas around the tooth to become infected.

Dental decay is caused by the build-up of plaque. Plaque builds up on our teeth on a daily basis. If the plaque is not removed through regular brushing and visits to your dentist, it can react with sugars in certain foodstuffs to form acid. This acid the gradually erodes the tough, outer enamel and dentin of the teeth until the inner pulp is exposed.

A dental abscess can therefore normally be avoided if you maintain a high quality oral hygiene programme. Plaque and bacteria build up on your teeth constantly each day, so regular brushing to remove it is essential. Often, however, plaque will build up in hard to reach places, especially on the molars at the back of the mouth. So it is also important that you floss regularly between your teeth and visit your dentist at least once every six months. Your dentist will be able to give your teeth a thorough check-up and a more thorough clean, removing the plaque from those areas of your teeth that can sometimes be overlooked.

What are the symptoms of a dental abscess?

Often, cavities in our teeth go unnoticed. This is because we will not usually feel any pain until the cavity reaches and exposes the inner pulp of the tooth. The pulp consists of a collection of bloods cells and nerve endings which keep the tooth alive.

Before the cavity reaches the pulp, it needs to get through the outer enamel and dentin. These are tough shields which protect our teeth against damage and decay and cavities that begin to form in the enamel will not usually register any pain.

This is the reason why visiting your dentist regularly is so important. Your dentist will be able to spot and fill small cavities which are not causing any pain yet. This can help to reduce the possibility of more serious problems, such as abscesses, in the future.

If your teeth do decay without treatment and an abscess does form, the pain can arrive suddenly. One of the most common descriptions of the pain caused by an abscess is that it is not localised. The pain spreads across the cheeks, jaw and face. If the infection also spreads, that your gums around the infected tooth can become infected, sore and swollen too. The spread of pain may mean that it can be difficult to locate exactly which tooth is sore – although you may experience some more localised pain if you bite down on the affected tooth. Similarly, if the decay is extensive, the affected tooth may already feel slightly loose.

As with most infections, in the teeth or elsewhere in the body, you may also feel slightly feverish and have a high temperature.

What should you do if you think you have an abscess?

If you are in severe pain and you think you may have a dental abscess, you should visit your dentist immediately. If you ignore an abscess for too long, it can ultimately mean that your tooth will need to be extracted. Sometimes, the infection that begins in your tooth can also spread, causing further complications. So early treatment is essential.

Some people who have a dental abscess find that, after a period of time, the pain starts to ease naturally. If this happens, you might be tempted to think that the worst is over. That is not really the case. Sometimes, an abscess can burst of its own accord, which releases the pressure on the tooth and relieves the pain. However, you should remember that the tooth remains susceptible to infection. So you should still visit your dentist to have the tooth looked after, the decay removed and if possible, the cavity filled.

If the pain in your tooth does not reduce naturally, taking over-the-counter painkillers can help until your dentist is available. It can also help to apply a cold compress to the side of your face, to relieve the throbbing pain in your jaw, cheek and face.

How is an abscess treated?

Treating your abscess will usually depend upon what sort of abscess you have. A gingival, or peripheral, abscess which occurs on the surface of the gum can normally be drained to relieve the pain and pressure. The infection can then be treated using a course of antibiotics.

Similarly, a periodontal abscess will need to be drained immediately to relieve the pressure and reduce the pain. However, once the periodontal abscess has been removed, there is still a space left in the pocket between the gum and tooth where the abscess had initially developed. Therefore, a course of antibiotics will not be enough to ensure that the infection does not return. In these cases, your dentist will need to clean the space where the abscess was, removing any remnants of infection, decay or other debris. Then, by shaping the tooth slightly and smoothing the surfaces, your dentist may be able to encourage the gum to grow back around the roots of the tooth. Once the gum has successfully closed back over the tooth, the gaps where infection can develop will also be closed over.

Treatment for a periapical abscess is more complex once again. This is an abscess caused by an infection inside the pulp of the tooth, so your dentist may need to take an x-ray to identify exactly where the abscess is. Once the abscess is isolated, your dentist will usually need to perform root canal treatment.

You can find out more about root canal treatment in a separate guide on this site. In a nutshell, root canal treatment is designed to save the infected tooth so that it does not need to be extracted. Your dentist will drill into the tooth to clean away the infected pulp, scraping it out through the root of the tooth. The tooth is then technically ‘dead’ as the blood supply and nerves have been removed. Therefore, your dentist will fill the tooth with a neutral matter, which occupies the space where the pulp was and stops infection from re-entering the tooth.

Will a dental abscess return?

With the appropriate treatment, the infection should be cleaned away and the tooth preserved (even if it may now not contain any pulp). Therefore, even if you experience a reduction in pain as the abscess bursts naturally, you must still visit your dentist. Treatment will still certainly be required to stop the infection returning again.

If the infection does return, it can cause numerous complications. Obviously, the tooth may have to be extracted. However, the spread of the infection can also cause problems beyond simply the infected tooth. The infection can spread from the tooth to the skin and cause discolouration, soreness and swelling around the face.

Infection can also spread from the tooth to the jawbone and cause osteomyelitis of the jaw, which can escalate to affect the bone marrow. Osteomyelitis is a debilitating disease which can be very painful. Usually, surgery is required to treat the condition.

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