Abscessed Tooth: Symptoms, Causes, Diagnosis, and Treatment
Toothache is one of the most common oral conditions. Although relatively straightforward to diagnose, access and treat, some toothaches can be a lot more serious, especially if it is a result of a dental abscess. If not treated in good time, an abscessed tooth can, in severe cases, become a life-threatening condition. Therefore, it is essential that this condition receives immediate medical attention from a certified dentist.
What is a tooth abscess?
An abscess is an oral infection that occurs around or in the root of a tooth. It occurs when the pulp of the tooth becomes necrotic (dies) and gives rise to an infection. It can also occur in patients with severe gum inflammation (gingivitis or periodontitis).
Signs and symptoms of an abscessed tooth
The first sign of an abscessed tooth is an ache in the area around the affected tooth. You may also experience;
- Bad breath
- Feeling unwell
- Swelling of the gums
- Pain when chewing
- Swallowing difficulty
- Red or swollen gums
- Loose or discoloured teeth
- Bad or foul taste in your mouth
- Tooth sensitivity to hot or cold foods
- Pain that worsens when you lie down
- A throbbing that radiates to your jaw, neck or ear
- Swelling in your cheeks, face, and your neck, or jaw lymph nodes
- In case of an abscess rupture, you may get a bad tasting and smelling discharge in your mouth and an open draining sore.
What causes an abscessed tooth?
According to the National Institute of Health, poor dental hygiene, dental caries, and dental trauma are the most common causes of a dental abscess (1).
Although the tooth has a hard outer layer, the inner part is filled with a soft pulp that contains blood vessels, nerves, and connective tissues. Oral bacteria can break down the protective enamel of the tooth and, as decay progresses, enter the pulp area. These bacteria can cause an infection to the pulp, which can result in an abscess. Other causes of an abscessed tooth include;
- An untreated cavity or tooth decay
- A cracked or broken tooth or filling
- Gum infection or periodontal disease
- Chronic tooth infections that are not treated
How is a dental abscess diagnosed?
The diagnosis of a tooth abscess is determined by examining the tooth and the surrounding area. The dentist may also need to;
- Tap on the tooth to check its sensitivity to touch or pressure
- Conduct an x-ray to determine whether the infection has spread
- Refer you to hospital if they suspect the infection has spread to your neck and other areas.
What is the treatment for an abscessed tooth?
The treatment for an abscessed tooth focuses on relieving pain by clearing up the infection. Depending on the symptoms your abscess is displaying, the dentist might need to perform an x-ray first. This will help them see how far the infection has spread, which is crucial to determining the best treatment method.
Here are the treatment options of an abscess depending on the type and severity;
Draining the abscess
If the abscess is only in your tooth and has not spread to other areas in your gum, the dentist will make a small cut in the abscess. Here is where they will drain the pus and clean the area with a saline solution.
A root canal
For a root canal treatment, the dentist will have to drill into the affected tooth to drain out the abscess and remove the infected pulp. After cleaning the area, they will fill and seal the pulp chamber, which holds the root canal and pulp. The dentist may also need to cap your tooth to strengthen it.
If the tooth is too damaged to be saved, the dentist may need to remove it for the abscess to heal completely.
If the dentist determines that the infection has spread beyond the abscessed area, or that you have a weakened immune system, they might prescribe an oral antibiotic to clear the infection.
Removal of a foreign object
If your abscess is due to a foreign object lodged in your gum, the dentist will work to remove it before cleaning the area with a saline solution.
What are the risk factors for an abscessed tooth?
- Poor oral hygiene and dental care: Not taking proper care of your oral health increases your risk of developing an abscess.
- High sugar diet: Frequently eating and drinking foods high in sugar such as sodas and sweets
- Dry mouth: Dry mouth increases the number of bacteria in your mouth and your caries risk, which puts you at a higher risk for a tooth abscess
Once you realise that you have an abscessed tooth, you need to be treated by a dentist as soon as possible. Even if the abscess has already burst, a dentist will need to examine the area and to determine the cause and explain any further treatment required. While most infections occur if the abscessed tooth is left untreated, sometimes, complications can arise even after effective treatment. However, this is very rare. Some of these complications include;
If the abscess is not adequately treated or the problem ignored, a cavity filled with fluid (cyst) may develop at the base of the root of the affected tooth. If the cyst becomes infected, you might require antibiotics or even surgery.
This complication occurs when the bacteria causing the abscess spreads into the bloodstream, infecting the bone. In such a case, you will experience high temperatures, possible nausea, and severe pain in the affected bone. This condition is extremely rare in developed countries.
This condition occurs when the abscess spreads to the floor of the mouth. This can cause swelling and intense pain under the tongue and around the neck area. In severe cases, this condition can cause difficulty in breathing. You should go to hospital as soon as you can if you notice any of these symptoms as a doctor will need to protect the airway. This is usually a severe complication of an abscess in a lower tooth.
Cavernous sinus thrombosis
Contrary to Ludwig’s angina, this is usually a severe complication of an abscess in an upper tooth. It is the formation of a blood clot in the cavernous sinus as a result of spreading infection and can be life-threatening if left untreated. As with Ludwig’s angina you would need to be hospitalised for intravenous antibiotic treatment and possible surgical drainage of the abscess. Symptoms include severe headache, fatigue, swelling or irritation in the eye/s, and limited ability to move the eyes.
Both Ludwig’s angina and cavernous sinus thrombosis can occur from spreading infection in the head and neck region not only as a result of a dental abscess.
Can you prevent an abscessed tooth?
The best way to prevent yourself from getting an abscessed tooth is by getting rid of any bacteria or infection in your mouth. Here are a few tips for keeping your teeth and gums healthy;
- Keep up with regular dental checkups and professional cleaning
- Always book a dentist appointment as soon as you realize you have a cracked or loose tooth
- Brush your teeth twice a day for at least 2 minutes with a fluoride toothpaste
- Floss daily and preferably after your last meal before bed to clean hard to reach spots between your teeth and gums
- Limit your sugary foods and drink intake. Sweets and sodas cause cavities, which can lead to an abscess.
When to see your dentist
If the following symptoms accompany an abscessed tooth, it is crucial that you receive immediate emergency treatment:
- Facial swelling
- Rapid heart rate
- High fever
- Difficulty swallowing
These are all signs of a severe infection, calling for immediate treatment.
What is the prognosis for an abscessed tooth?
The prognosis for a minor abscessed tooth after it ruptures or gets drained is good. If your symptoms start improving, there is a high chance that the infection is going away. Larger abscesses, however, call for immediate medical care and may require drainage and antibiotics. After that, proper follow-up and care is crucial for the reassessment of the infection and taking care of the problem area.
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