7th October 2015, Dubai, UAE: Dr. Marwan Al-Obeidi, Clinical Head at Dr. Michael’s Dental Clinics, talks about the causes of tooth abscess, its dangers and treatment.
What is an abscessed tooth and what causes it?
An abscess is a term used to describe the collection of bacteria and their products (pus) around the causing agent which is usually the tooth and its surrounding structures. A presenting dental abscess can be classified broadly into:
a) Periapical abscess: This is by far the most common abscess and usually occurs at the tip of the root of the tooth.
b) Periodontal abscess: Arises as a result of infection in the supporting tissues of the tooth (the gums and bone).
c) Gingival abscess: A localized abscess in the gums around the tooth and only affects the gums.
d) Pericoronal abscess: An infection usually associated with teeth which are not fully erupted, for example wisdom teeth.
e) Combined periodontal and periapical abscess.
There are many reasons why an abscess would occur. The most common would be an untreated dental cavity. Poor oral hygiene and food particles getting stuck in the gums could be the causative factor in a gum abscess. A fractured or cracked tooth could also lead to an abscess as could a very deep filling which is too close to the nerve (owing to the decay being very deep). Occasionally, overheating of the tooth due to a dental procedure may cause rise to a situation where the nerve inside the tooth becomes infected leading to an abscess. A failed root canal treatment may also be a cause for an abscess.
What are the symptoms?
Abscesses can be completely symptom-free for a varying length of time. They can lie dormant not causing any symptoms of discomfort or pain and may even be picked up as a chance finding by a dentist at your regular checkup appointments.
However, when an abscess does cause symptoms they are usually of discomfort especially to biting and eating, and the discomfort is usually deep- seated in nature and occasionally have a throbbing feel to it. Sensitivity to cold and hot may also present and pressure may aggravate the pain. These symptoms can be accompanied by signs of a swelling in the infected area. If the abscess perforates the bone, a small pin size point may appear in the swelling, draining a liquid (which can give some relief to the pain symptoms) and sometimes a facial swelling may appear. The abscess may also drain to other parts of the body causing discomfort especially in the lymph node areas of the neck making it tender and occasionally difficult to swallow.
What are the dangers of untreated tooth abscess?
If left untreated, an abscess may grow and perforate the bone extending to the surrounding structures causing a severe bone infection known as osteomyelitis or into the soft tissues causing cellulitis. This can then follow the path of least resistance spreading into the soft tissues around the area and affecting adjacent structures such as the eyes and in the most severe cases, the brain. An untreated abscess can also drain into the neck compromising the airways and again, in severe cases, can become life threatening. If the abscess drains into the adjacent blood vessels it can lead to septicaemia and can affect vital organs such as the heart.
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