Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

Types of treatment for a dental abscess

What is a tooth abscess? A dental abscess is a collection of pus that can form in the teeth or in the gums as a result of a bacterial infection. But what exactly is pus? If an infection forms in a part of your body, the battle between your immune system and the infection will create a collection of dead cells, which form pus. An abscess is your body’s natural way of keeping the pus in one place, therefore localizing the infection and stopping it from spreading to other areas of the body.

There are two different types of abscess which may occur in relation to the teeth, namely a periapical abscess and a periodontal abscess.

Periapical abscess: This can present as a very acute, intensely painful infection where the face swells and the patient is in agony and sometimes cannot even open the mouth. This is caused from a rapid influx of pus to the area accompanied with the swelling and inflammation of the surrounding tissues. The site of a periapical abscess is at the apex of a tooth root (this is where the nerve enters the tooth). The soft area at the centre of a tooth (the pulp chamber) is alive and filled with blood vessels and cells, so once infection reaches the tooth pulp it “goes rotten”and ultimately leads to abscess formation. Bacteria enters the pulp of the tooth through a communication between the mouth and the pulp chamber, namely a cavity. This allow bacteria to move into this sensitive area and populate it, leading to infection. A periapical abscess can also occur on a previously root treated tooth. Root canal treatment is unpredictable and a weak area of the tooth. Secondary infection after a root canal treatment is completed is quite common.

The treatment of a periapical abscess in a vital (alive) tooth is root canal therapy. During this procedure your dentist will clean out and remove all of the infected debris and fill it with an inert substance (gutta percha). The treatment of a periapical abscess in a root treated tooth is a little more extreme. Once an infection recurs, the options are increasingly limited. Re-root treatment of the tooth may be attempted (I would recommend only by an endodontist) however this is rarely successful long term. The second option (in some teeth) is a minor surgical procedure called an apicectomy, where the tips of the infected roots are removed and filled by a maxillo facial surgeon. This may prolong the lifespan of the tooth, but infection will likely set in again a few years down the line. My recommended treatment for a periapical abscess on a root treated tooth is extraction of the affected tooth, followed by implant placement.

Periodontal abscess: This is quite different from the previously mentioned periapical abscess. The source of this infection lies within the gingiva (gums). When oral hygiene is poor, a small space develops between the tooth and the gum. This is an ideal space for bacteria to breed and grow in. If oral hygiene is not improved this rapidly develops into a periodontal pocket. If bacteria in the pocket increases and debris and food becomes trapped in the pocket, an abscess will developed. Unfortunately a periodontal abscess is accompanied with underlying bone loss, so the damage becomes permanent. Treatment depends on the extent of the damage. If not too severe and if caught in the early stages, your dentist can debride and clean the area leading to healing. However in more complicated cases a periodontist may be needed to surgically debride and clean the infected area. All patients who have had periodontal problems should be placed on a long term maintenance program to prevent recurrence and maintain the health of their mouths.

Perio-endo lesions: This occurs when a periapical abscess and a periodontal abcess occur in conjunction. Sometimes it is difficult to definitively say which type of abcess occurred first. The treatment consists of root canal therapy combined with periodontal treatment at a periodontist, albeit the prognosis is generally poor and the tooth may not be salvageable.

The use of antibiotics in the treatment of an abscess is common practice. The reason for this is that the pus accumulation in the infected site makes the environment very acidic. The efficacy of the local anesthetics within this acidity is greatly reduced, therefore it is difficult for the dentist to make you numb. In these cases an antibiotic is prescribed first and then the root canal treatment/extraction can be completed far easier after a few days of taking the antibiotic.

A dental abscess is usually a dental emergency and requires immediate attention from a dentist. All the pain killers in the world cannot take away this type of pain. The best cure is prevention (apologies for the cliche!). My advice is regular, 6 monthly dental check ups to prevent these types of painful experiences.