Dr. Marwan Al-Obeidi, Clinical Head at Dr. Michael’s Dental Clinics, Dubai, talks about the causes of tooth abscess, its dangers and treatment.
7th October 2015, Dubai, UAE: Dr. Marwan Al-Obeidi, Clinical Head at Dr. Michael’s Dental Clinics, Dubai, 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:
- Periapical abscess: This is by far the most common abscess and usually occurs at the tip of the root of the tooth.
- Periodontal abscess: Arises as a result of infection in the supporting tissues of the tooth (the gums and bone).
- Gingival abscess: A localized abscess in the gums around the tooth and only affects the gums.
- Pericoronal abscess: An infection usually associated with teeth which are not fully erupted, for example wisdom teeth.
- Combined periodontal and periapical abscess.
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What are the symptoms?
How is it diagnosed?
- A tenderness to tapping test. This usually gives a good indication as to which tooth is causing the pain and whether the pain is of a gum origin or a tooth origin.
- Probing the gums around the tooth to see if the gums are affected.
- Vitality testing. This is a test to see if the nerve inside the tooth is healthy or not. This can either be done with a cold test or an electric tester.
- An x-ray (radiograph) needs to be taken. This is to confirm the size of the abscess and occasionally can be used in adjunction with the above tests to make the diagnosis. It is also useful to see the underlying cause of the abscess if this is not obvious clinically.
How is it treated?
- The most common abscesses, the periapical abscesses are treated in the following manner: If the tooth is restorable then root canal treatment would be the first line of action followed by a restoration of the tooth (a crown is the preferred choice in most cases). Occasionally, further treatment may also be necessary and a regular follow-up of the root canal treatment is necessary to ensure adequate healing. If the tooth is deemed unrestorable, an extraction of the offending tooth would be necessary.
- For gingival and periodontal abscesses, a deep debridement of the tissues surrounding the tooth is necessary. This is in adjunction with antiseptic and antibacterial medication. Again, a follow up is usually necessary.
- For pericoronal abscesses, either a debridement of the area in adjunction with some surgery (usually LASER) to expose the tooth to the oral environment or if the impaction is deep then extraction of the offending tooth would be necessary.
- For combined periodontal and periapical abscesses, a combined treatment of root canal therapy as well as localized debridement of the area would be indicated.
What are the dangers of untreated tooth abscess?
How can it be prevented?
Avoiding tooth decay and gum infections is key to preventing an abscess. Maintaining the highest standards of oral hygiene is the first line of defense against bacteria which cause tooth decay and gum disease so brushing twice a day with an electric tooth brush and using fluoride tooth paste is the easiest way to avoid an abscess. Flossing is just as important as it cleans the part of the tooth your toothbrush will not reach. Using an antiseptic mouthwash (and fluoridated mouthwash) will also help prevent cavities and keep your teeth strong and disease-free.