WHAT IS A DENTAL ABCESS?
A dental abscess, or
tooth abscess, is an accumulation of pus that
forms inside the teeth or gums. The abscess typically originates from a
bacterial infection, often one that has accumulated in the soft pulp of the
tooth.
Bacteria
exist in plaque, a by-product of food, saliva and bacteria in the mouth which
sticks to the teeth and damages them, as well as the gums. If the plaque is not
removed by regular and proper tooth brushing and flossing the bacteria may
spread within the soft tissue inside the tooth or gums, eventually resulting in
an abscess.
There are 3 types of dental abscess:
1.
Gingival
abscess -
the abscess is only in the gum tissue and does not affect the tooth or the
periodontal ligament.
2.
Periodontal
abscess -
this abscess starts in the supporting bone tissue structures of the teeth.
3.
Periapical
abscess - this abscess commences in the soft pulp of
the tooth.
A
dental abscess usually requires treatment; otherwise it can worsen and result
in the destruction of bone tissue.
Symptoms of a dental abscess
A
symptom is something the patient feels and reports, while a sign is something
other people, including a doctor or nurse, may detect. For example, pain may be
a symptom while a rash may be a sign.
Signs and symptoms of a dental abscess include:
§ Pain in the affected area when biting
§ Touching the affected area may be painful
§ Sensitivity to cold or hot food and liquids
§ A foul taste in the patient's mouth
§ Fever
§ General malaise (the patient feels generally
unwell)
§ Trismus - the patient finds it harder to open
his/her mouth
§ Dysphagia - swallowing difficulties
§ Insomnia.
The
main symptom of a dental abscess is pain. This may be a throbbing pain, and is
often intense. The pain usually starts suddenly, and becomes more intense over
the subsequent hours or days. In some cases the pain may radiate to the ear,
jawbone and neck.
Causes of a dental abscess
A
dental abscess in most cases is a complication of a dental infection. Bacteria,
often bacteria present in plaque, infect and make their way into a tooth.
Periapical abscess
Bacteria
enter the tooth through tiny holes caused by tooth decay (caries) that form in
the tooth enamel (hard outer layer of the tooth). The caries eventually break
down the softer layer of tissue under the enamel, called dentine. If the decay
continues, the hole will eventually penetrate the soft inner pulp of the tooth
- infection of the pulp is called pulpitis.
As
the pulpitis progresses the bacteria make their way to the bone that surrounds
and supports the tooth, called the alveolar bone, and a periapical abscess is
formed.
Periodontal abscess
When bacteria which are present in plaque
infect the gums the patient has periodontitis. The gums become inflamed, which can
make the periodontal ligament (tissue surrounding the root of the tooth)
separate from the base of the tooth. A periodontal pocket, a tiny gap, is
formed when the periodontal ligament separates from the root. The pocket gets
dirty easily and is very hard to keep clean. As bacteria build up in the
periodontal pocket, periodontal abscess is formed.
Patients can develop periodontal abscesses as
a result of a dental procedure which accidentally resulted in periodontal pockets.
Also, the use of antibiotics in untreated periodontitis, which can
mask the symptoms of an abscess, can result in a periodontal abscess. Sometimes
gum damage can lead to periodontal abscesses, even if no periodontitis is
present.
Dental abscess symptoms? What to do
Any
person with symptoms linked to a dental abscess should see a dentist
immediately. Dental abscesses are easily diagnosed by a qualified dentist. In
the UK the National Health Service (NHS) advises people to visit either their
usual registered dentist, a local Dental Access Centre, or the emergency
department of their local general hospital.
People
who have swallowing and/or breathing problems should go straight to the
emergency department of their local hospital.
If
for some reason you cannot get to a dentist immediately you could visit your GP
(general practitioner, primary care physician). A GP cannot treat an abscess,
but he/she may prescribe medication and advise on self-care and pain
management, and is also likely to know the fastest way of getting emergency
treatment, if required.
David Hurst BDS (Lon)
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