An abscess tooth is an infection either in the pulp cavity of the tooth or in the gums around the tooth. Technically, a periapical abscess originates in the pulp cavity of the tooth, while a periodontal abscess develops outside the tooth in the gum surrounding it. Since the causes and symptoms are largely the same, we shall refer to either as a dental abscess. Symptoms may vary from none at all (and the abscess is only picked up on a routine checkup) to severe pain preventing one from sleeping.
The pulp cavity of the tooth is the innermost layer below the hard enamel and dentin. It contains the blood and nerve supply of the tooth. Trauma, wear and tear (chronic grinding of the teeth) and infection can allow bacteria to enter the pulp cavity and irritate the nerve, which is what we may feel as pain or sensitivity to heat and cold. Originally, the bacteria will cause a pulpitis, inflammation of the pulp. This is staged by your dentist as reversible (treatable with conservative measures) or irreversible, where the pulp cavity is dying or dead and the solution is a root canal treatment. Pus is the combination of dead tissue, dead white cells (those that attempt to fight the infection) and bacteria. An abscess is an enclosed area of pus.
While all teeth are susceptible to abscesses, the third molars (“wisdom teeth”) seem to become abscessed more commonly, probably because of an increased difficulty of keeping them clean.
What are the signs and symptoms of an abscessed tooth?
As mentioned above, symptoms may vary from none at all to excruciating pain. The tooth may change color (darker). Not uncommonly, reddening or swelling of the gums may occur around the base of the tooth, as well as a throbbing pain. A small pocket of pus might be seen, and this may even rupture, leading to an unpleasant taste and smell in the mouth.
Because infection can kill the nerve conducting sensation to the tooth, there may be no symptoms at all.
How is an abscessed tooth diagnosed?
Usually, the symptoms and signs are obvious (pain, accompanied by redness or swelling around the tooth). Since most abscesses present with pain, the patient usually goes to his/her dental professional who can usually easily diagnose the infection. Dental X-rays will give a more precise location of the abscess and guide the dentist to treatment options. There are no “home remedies” for treating an abscessed tooth.
What is the treatment for an abscessed tooth?
The infection needs to be treated first. Ideally, once the infection is treated, the dentist or endodontist can perform definitive restorative treatment (if possible). Initial treatment, therefore, is with the use of oral antibiotics and draining the tooth and/or gums of the abscess. If the infection is overwhelming, the tooth may need to be extracted, but this is not common.
Once the acute infection is managed, depending on the state of the tooth, a root canal treatment is instituted, where the pulp cavity is carefully cleaned out with small files used to scrape off damaged/dead tissue. An inert rubber material, gutta percha, is inserted into the pulp cavity and the tooth sealed with a composite filling or temporary crown. A second appointment is usually required to fit a permanent crown, which will help seal off access to the pulp cavity and result in many years of good function of that tooth.
In the case of children with milk teeth, if the tooth is still firmly attached, the dentist will attempt (once the infection is treated) to clean out the pulp cavity and fill it, usually with a zinc oxide eugenol paste. Often this is not possible, and tooth will be extracted.
Please contact Southlake Endodontics at 817-488-3636 with any questions.
