Definition
A collection of infected material (pus)
resulting from bacterial infection of the center (pulp) of a
tooth.
Alternative names
Periapical abscess; Dental
abscess; Tooth infection; Abscess - tooth
Causes, incidence, and risk factors
Tooth abscess
is a complication of dental
caries. It may also result from trauma to the tooth (such
as when a tooth is broken or chipped). Openings in the tooth
enamel allow bacteria to infect the center of the tooth (the
pulp). Infection may spread out from the root of the tooth and
to the bones supporting the tooth.
Infection results in
a collection of pus (dead tissue, live and dead bacteria,
white blood cells) and swelling of the tissues within the
tooth. This causes a painful toothache.
If the root of the tooth dies, the toothache may stop, but the
infection remains active and continues to spread and destroy
tissue.
Prevention
Prompt treatment of dental
caries reduces the risk of tooth abscess. Traumatized
teeth should be examined promptly by the dentist.
Symptoms
- toothache
- severe, continuous
- gnawing or throbbing pain
- sharp or shooting pain
- pain when chewing
- sensitivity of the teeth to hot or cold
- bitter taste in the mouth
- foul
smell to breath
- possible fever
- swollen
glands of the neck
- general discomfort, uneasiness, or ill feeling (malaise)
- swollen area of the upper or lower jaw (very
serious)
Signs and tests
Examination of the teeth by the
dentist reveals pain when the tooth is tapped. Biting or
closing the mouth tightly also increases pain. The gingiva
(gums) may be swollen and red and may drain thick, purulent
material.
Treatment
The goals of treatment are elimination of
the infection, preservation of the tooth, and prevention of
complications.
Antibiotics may be given to fight the
infection. Warm salt-water rinses may be soothing.
Over-the-counter analgesics
may relieve the toothache
and fever.
Do not place aspirin directly over the tooth or gums because
this increases irritation of the tissues and can result in mouth
ulcers.
Root canal surgery may be recommended in an
attempt to preserve the tooth. The center of the tooth,
including the nerve and vascular tissue (pulp), is removed
along with decayed portions of the tooth. The root and surface
of the tooth remain in place. The cavity that is created in
the core is filled and repaired, and a crown may be placed
over the tooth.
Excision (surgical drainage) of the
abscess or extraction of the affected tooth may be necessary.
Prognosis
The infection of tooth abscess is
usually curable with treatment. Preservation of the tooth is
possible in many cases.
Complications
- loss of the tooth
- spread of infection to soft tissue (facial cellulitis, Ludwig's
angina)
- spread of infection to the jaw bone (osteomyelitis
of the mandible or maxilla)
- spread of infection to other areas of the body resulting
in cerebral
abscess, endocarditis, pneumonia,
or other disorders
Calling your health care provider
Call your
dentist if persistent, throbbing toothache
or other symptoms of tooth abscess occurs. |
