A dental abscess is defined as a bacterial infection where a pocket of pus is formed within the tooth, in the gums, or in the bone where the tooth is present. It is a very painful condition and is considered an emergency.

Types of dental abscesses

1. Periapical abscess

2. Periodontal abscess

3. Pericoronal abscess

4. Gingival abscess

5. Endo-periodontal abscess

Causes of dental abscess

The causes of dental abscesses vary according to their types.

Periapical abscess

Dental caries and fractures are the most common causes of periapical abscesses. Bacteria invade through the carious lesion as the disease progresses. It spreads from enamel to dentin to the pulp. When the infection reaches the pulp, it causes inflammation of the pulp called pulpitis. If not treated at this point, pulpitis can lead to a periapical abscess.

Periodontal abscess

Advanced periodontal disease is the main cause of periodontal abscess. It begins with dental plaque or calculus, which occurs due to poor oral hygiene. When the bacteria invade the gingiva or periodontium, an inflammatory response is commenced by our immune system, which results in a localized pus-filled abscess on the periodontium.

Gingival abscess

It is also known as a gum abscess and occurs due to the impingement of a sharp object or tooth bristle. They do not involve teeth and are present only in the affected part of the gingiva or gums.

Pericoronal abscess

A pericoronal abscess is found in the gums surrounding a partially or fully erupted tooth. It is commonly associated with the partially erupted third molar or wisdom tooth. It is caused when the overlying gums around the tooth become inflamed due to the collection of food and debris.

Perio-endo lesion

When the abscess is of both pulpal and periodontal origin, it leads to a perio-endo lesion, which can lead to an abscess. Dentists often find it difficult to diagnose whether it is pulpal or periodontal in origin.

Microbial flora

Streptococcus and Staphylococcus have been found to be frequently associated with dental abscesses. Various sample analyses reveal that species belonging to Fusobacterium, Clostridium, Prevotella, and Treponema are also found in dental abscesses.

Signs and symptoms

• Pain

• Swollen gums

• Redness in the area of the abscess

• Mobile tooth

• Difficulty in mouth opening

• Difficulty in swallowing

• A bitter taste in the mouth

• Bad breath

• Swollen lymph nodes

• Fever

How is a dental abscess diagnosed?

An oral examination is the first step in the diagnosis process. The diagnostic instrument is tapped on the infected tooth and the vestibule near the tooth. If tenderness is present on both, an abscess is suspected.

For a detailed examination, your dentist will recommend an x-ray of that particular tooth, known as an intraoral periapical radiograph (IOPAR), to determine the extent of the infection. If the infection has spread to other regions, an orthopantomogram (OPG) is advised.

In severe cases, the infection can spread to the neck or other areas. In that case, computed tomography (CT) is recommended.

What is the treatment for dental abscesses?

A dental abscess is considered a medical emergency and should be treated as soon as possible. But the patient may not feel pain once the pulp dies because the pulp is part of the tooth that houses nerves and blood vessels. However, even if the tooth dies, infection may continue to spread to the surrounding areas, which may lead to severe complications. Hence, treatment of dental abscesses is mandatory.

Medications: Antibiotics and analgesics (painkillers) are prescribed by dentists to reduce the severity of infection.

Incision and drainage: This is a very mandatory process in the management of an abscess. A dentist will make a cut or incision in the abscess to drain the pus.

Root Canal Treatment (RCT): RCT can save your tooth by removing the infection. In RCT, the infected pulp of the tooth is removed from the root canal and replaced with a medicament called gutta-percha. A person who has undergone root canal treatment won’t feel any pain or sensitivity in that particular tooth, and the tooth may not be as strong as before. So, in order to protect the root canal-treated tooth, a crown is also placed above it.

Tooth extraction is the final option for the management of dental abscesses. If the tooth cannot be saved by any treatments, then dentists will suggest that you undergo extraction. Your dentist will allow the pus to drain while extracting. After the extraction, the dentist will prescribe medications to eliminate the infection completely.

Complications of Dental Abscess

If left untreated, dental abscesses can lead to severe complications and, rarely, life-threatening conditions as well. Osteomyelitis and cellulitis are common complications.

• Osteomyelitis

• Cellulitis

• sinus

• fistula

• endocarditis

• brain abscess

• meningitis