What are the Symptoms of a Dental Abscess?
A dental abscess is simply an area in the oral cavity, usually, but not always, associated with a tooth. The abscess creates a pocket of pus. This often has symptoms of fever, warmth, redness, pain, and swelling and sometimes feels like a bladder filled with fluid. All the symptoms may not be present at the same time. This abscess may grow into a fluid-filled cyst. The fluid may feel to be either very firm or more liquid.
What Causes a Dental Abscess?
A dental abscess is the result of infection being initiated by various causes to a tooth resulting in a bacterial infection. If not treated, the infection will never disappear on its own. The treatment for an abscessed tooth is extraction or root canal (endodontic treatment). A periodontal abscess, commonly called a gum abscess as opposed to a tooth abscess, requires either extraction or treatment of the infected gums and or bone. Both types of abscesses, gum, and tooth, can form quite rapidly.A dental abscess or tooth abscess usually results from decay, splitting a tooth, moving a tooth too rapid by orthodontics, trauma, splitting or fracturing the tooth, or traumatic occlusion (bite). The infection destroys the vitality of the tooth by involving the pulp and nerves of the tooth and building up internal pressure. This pressure combined with infection results in pus forming at the tip (apex) of the tooth. If left untreated it will tunnel through the bone and gums forming a fistula. This fistula then allows the pus to drain from inside the tooth, down the root, out the tip, and into the mouth, thus creating a draining fistula.
The fistula can readily be seen in the mouth, but its source is verified via x-ray, either convention x-ray or 3-D x-ray. Sometimes a soft gutta percha point is inserted into the vistulous tract which is then easily seen on x-ray. This confirms the abscess and the need for a root canal or removal of the offending tooth.
Pain & Other Symptoms
The majority of patients feel an increase in pressure, but not acute pain. Others, in fact, do feel acute pain and throbbing and seek immediate care. Other than the obvious pain, the patient may also have a fever, experience the aforementioned throbbing, have swollen and sore lymph nodes, tenderness to the tooth, bad taste and bad breath. And, as mentioned in the first paragraph, will not abate on its own. Treatment is mandatory.
If Not Treated
Left untreated, and in some cases, a dental cyst (encapsulated pus which slowly grows) will form. Sepsis, or infection in the bloodstream, severe swelling in the neck and facial region, infection in the jaw bone, brain abscess, infection of the heart, and other anomalies. In other words, a simple abscessed tooth if not treated may easily become life-threatening.
Most infected teeth become quite tender to percussion or chewing and is a strong indicator of a problem. This is due to a build-up of internal pressure or mobility of the tooth. And there may be associated swelling. This condition sometimes will lead to severe headaches. And as was previously mentioned, the lymph nodes of the neck often become enlarged and painful.
If the infection has a quick onset, immediate treatment by antibiotics is required and then further treatment is necessary. The doctor may use a scalpel to drain the infection from the abscess if it is excessive. Or he may simply perform a root canal to remove any infected pulp tissue, blood vessels, or nerves. This is in lieu of an extraction which may be required. On a fairly rare occasion, the root tip is also removed (apicoectomy) and the fistulous tract is curettage so that a perfect seal is made at the root tip during root canal therapy, and the infected tissue is cleaned. All this treatment does not sound good to the novice. Nonetheless, the end result is termination of the swelling and discomfort, as well as maintaining the tooth. Plus, it is a fairly simple procedure.
There is immediate relief when the pus drains, but the infection is still present…the pressure is just relieved. If this occurs, you still need to have the dentist perform the proper necessary procedure to avoid problems in the future. Antibiotics will relieve the symptoms caused by the infection but will not permanently cure the infection.
Dental Abscess vs Follicular Cyst
Do not confuse any of the above with a follicular cyst which often forms around an unerupted wisdom tooth. This is usually self-limited and may be alleviated by performing an operculectomy or even removing the wisdom tooth or the opposing tooth but only if it also is a wisdom tooth. The fluid within this type cyst is usually sterile and antibiotics will not aid in this case.
An infected tooth sometimes, but rarely, drains outside the mouth. This creates a subcutaneous (just below the skin) which might be called a boil. An ingrown hair follicle may also create a boil. Do not drain this boil or squeeze it as you may spread infection. Warm, moist compresses may be used to create drainage. You should immediately use antimicrobial soap and see your dentist as soon as possible.
Other than trauma or a split tooth, the patient can easily prevent both a dental abscess and a gum abscess with excellent and proper daily brushing and flossing. Of course, this should always be followed up with two visits to your dentist per year. But should you have any unusual symptoms, see your dentist immediately.
Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Association of Implant Dentists