Abscessed Tooth Causes, Signs, Symptoms, Diagnosis, Treatment, Prevention

Abscessed Tooth Causes, Signs, Symptoms, Diagnosis, Treatment, Prevention

What is an abscessed tooth?

A tooth abscess is a pocket of pus that's caused by a bacterial infection. The abscess can occur at different regions of the tooth for different reasons. A periapical (per-e-AP-ih-kul) abscess occurs at the tip of the root, whereas a periodontal (per-e-o-DON-tul) abscess occurs in the gums next to a tooth root.

Abscessed Tooth Causes, Signs, Symptoms, Diagnosis, Treatment, Prevention

A periapical tooth abscess usually occurs as a result of an untreated dental cavity, injury or prior dental work.

Dentists will treat a tooth abscess by draining it and getting rid of the infection. They may be able to save your tooth with a root canal treatment, but in some instances it may need to be pulled. Leaving a tooth abscess untreated can lead to serious, even life-threatening, complications.

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What causes an abscessed tooth?

There are many causes for a tooth abscess. A very common cause is when a dental cavity (decay) becomes so large and deep that it reaches the pulp chamber. An inflammatory process takes place within the tooth. Inflammation of the pulp (pulpitis) is usually what is felt as a toothache. Pulpitis is further characterized by tests done by a dentist as reversible or irreversible. Reversible pulpitis means that the pulp is irritated, but has an opportunity to recover. Irreversible pulpitis means that it will not recover and the pulp is dying. Once the pulp is dead (or “necrotic”), an abscess can form as the infection spreads from the tooth to the gum ligament and jawbone below. Often, a necrotic tooth can still be saved if steps are taken to resolve the infection at an early stage.

Other causes for a tooth to become necrotic and abscess are: 1) a blow to a tooth, 2) dental treatment such as a crown or a filling that gets too close to the pulp chamber, or 3) trauma to a tooth from grinding or clenching. In every form of a tooth abscess, the pulp chamber is adversely affected and is unable to recover from the insult or injury. A blow to the tooth can cause the blood supply to be severed immediately. When the blood supply is lost, the nutrient supply is also lost. As a result, the pulp quickly dies. Trauma from grinding or clenching (called “occlusal trauma”) is a slower, progressive injury to a tooth.

Any tooth can develop an abscess, but third molars (wisdom teeth) are particularly prone to having a dental abscess because they are difficult to keep clean and can develop decay that can go unnoticed. Wisdom teeth are often removed to avoid this type of complication.

What are the signs and symptoms of an abscessed tooth?

A toothache that is severe and continuous and results in gnawing or throbbing pain or sharp or shooting pain are common symptoms of an abscessed tooth. Other symptoms may include:

  • Fever
  • Pain when chewing
  • Sensitivity of the teeth to hot or cold (mostly hot-sometime relief with cold)
  • Bitter taste in the mouth
  • Foul smell to the breath
  • Swollen neck glands
  • General discomfort, uneasiness, or ill feeling
  • Redness and swelling of the gums
  • Swollen area in the upper or lower jaw
  • An open, draining sore on the side of the gum
  • Loosening of tooth
If the root of the tooth dies as a result of infection, the toothache may stop. However, this doesn’t mean the infection has healed; the infection remains active and continues to spread and destroy tissue. Therefore, if you experience any of the above listed symptoms, it is important to see a dentist even if the pain subsides.

When to see a doctor

See your dentist promptly if you have any signs or symptoms of a tooth abscess. If you have a fever and swelling in your face and you can't reach your dentist, go to an emergency room. Also go to the emergency room if you have trouble breathing or swallowing. These symptoms may indicate that the infection has spread deeper into your jaw and surrounding tissue or even to other areas of your body.

How is an abscessed tooth diagnosed?

Diagnosis is usually achieved based on clinical symptoms or radiographic presentation. An X-ray can reveal bone loss along the ends of the dental roots indicating an infection or abscess. Clinical examination can also confirm the infection and may include pressure tests or simulation of the dental nerve with temperature (sensitivity to warm or cold foods or fluids).

What is the treatment for an abscessed tooth?

Treatment for an abscessed tooth in adult

In adult teeth, the usual treatment for an abscessed tooth begins with properly clearing the infection. Depending on how much the infection has spread, the course of action usually involves oral antibiotics and draining the tooth and surrounding structures of the infection.

In some situations, the infection can spread quickly and require immediate attention. If a dentist is unavailable and there is a fever, swelling in the face, or swelling in the jaw, a visit to the emergency room is recommended. An emergency room visit is advised if there is difficulty with breathing or swallowing.

Once the infection is cleared and the tooth can be restored, a root canal procedure is performed. The "root canal treatment" cleans out the entire inner space of the tooth (pulp chamber and the associated canals) and seals the space with an inert rubber material called gutta percha. Cleaning and sealing the inner space protects the tooth from further invasive infections. If the tooth cannot be restored, the tooth is extracted instead.

Treatment for an abscessed tooth in children

In children's primary teeth, treatment of a dental abscess depends on the extent of infection. If the abscessed primary tooth is in the early stages of infection and is not mobile (moving in the tooth socket), the infection is cleared out within the pulp chamber. The space is then filled with a paste such as zinc oxide eugenol. If the infection is advanced and has caused the tooth to become mobile, the best course of action is to remove the infected tooth. This is also important in avoiding a persistent infection that could risk harming the adult tooth that is developing underneath.

What are the complications of an abscessed tooth?

If the abscess goes untreated, the infection can progress to a cellulitis which can be a serious and produce a life-threatening medical condition such as Ludwig's angina. Signs of a cellulitis or severe infection can include a fever, general malaise, and swollen lymph nodes in the neck or a draining sinus tract. If the abscess causes difficulty swallowing or problems breathing, immediate medical attention should be obtained. Bilateral swelling of the mandible, a condition known as Ludwig's angina, is a serious condition requiring hospitalization and IV antibiotics.

Are home remedies effective for an abscessed tooth?

Generally, home remedies are not advised for an abscessed tooth. Home remedies can be used to alleviate symptoms such as warm water rinses/warm compresses and taking over-the-counter medications for pain relief. However, the infection will still progress if not properly treated. Furthermore, avoiding treatment can lead to more serious complications. Seeking care and advice from a dental professional is strongly recommended as soon as possible.

Can an abscessed tooth be prevented?

Avoiding tooth decay is essential to preventing a tooth abscess. Take good care of your teeth to avoid tooth decay:

  • Use fluoridated drinking water.
  • Brush your teeth at least twice a day with a fluoride toothpaste.
  • Use dental floss or an interdental cleaner to clean between your teeth on a daily basis.
  • Replace your toothbrush every three or four months, or whenever the bristles are frayed.
  • Eat healthy food, limiting sugary items and between-meal snacks.
  • Visit your dentist for regular checkups and professional cleanings.
  • Consider using an antiseptic or a fluoride mouth rinse to add an extra layer of protection against tooth decay.

What is the prognosis for an abscessed tooth?

The prognosis depends on the extent of the spread of infection. Usually, when the infection is localized to the tooth, the prognosis is very good if treatment is sought as soon as signs and symptoms are usually noticed.

When the infection is left untreated for a prolonged period and allowed to spread, the situation can escalate and be more difficult to control. There is the danger that the infection could rapidly spread to the bone of the jaw and other spaces of the head and neck. The swelling in the jaw or neck could even be so great as to affect the airway and become life-threatening. Finally, further complication and spread of the infection throughout the body (sepsis) can occur.