HOW TO TREAT DENTAL ABSCESS?

HOW TO TREAT DENTAL ABSCESS

Dental abscess is collection of pus associated with a tooth which can be localized either below the root apex or around the tooth in the gingival pocket. Dental abscess is usually caused by bacterial infections in non-vital tooth.

Types of Dental Abscess

Dental abscesses can be classified further into three different categories.

- Periapical abscess

When pus is accumulated below the apex of the root, it is called as periapical abscess. It is clinically presented as swelling immediately below the tooth or by the presence of sinus tract draining the pus. On radiographs it is presented as radiolucent (dark) area below the root tip.

- Periodontal Abscess

When pus is accumulated in gingival pocket around the tooth, it is called periodontal abscess.  It is clinically presented as pus draining through gingival pocket. On radiographs, there is wider periodontal ligament membrane space around the tooth.

- Gingival Abscess

When abscess is accumulated only in superficial gingival tissue without effecting periodontal ligament and associated tooth,  it is called gingival abscess.  It is clinically seen as localized swelling in gums. There are usually no radiographic changes in gingival abscess.

Causes of Dental Abscess

Bacterial infections are most common cause of the dental abscess. Following are the predisposing factors for dental abscess.

- Poor oral hygiene status with plaque accumulation.

- Acute or chronic periodontal disease.

- Traumatized tooth.

- Foreign body strangulation such bristles of tooth brush or hard tiny food particles.

- Previous treatment failures, such as failed root canal treatment.

Symptoms of Dental Abscess

- Throbbing pain that cannot be localized.

- Severe pain while lying down.

- Pain on percussion. In periodontal abscess there is pain on horizontal percussion while in periapical abscess, there is pain on vertical percussion.

- Tooth is often slightly extruded.

- There is swelling in the area of associated tooth or  in some chronic cases there may be diffused swelling involving multiple teeth.

- Sinus tract can also be found in gums near root apex. Gutta percha is often inserted in sinus tract to identify the origin of infection by taking radiograph.

- There can be redness or erythema in root area of tooth.

- Patients often complain of bad breath or foul smell from mouth.

- Fever and malaise can be associated with dental abscess.

- Swollen lymph nodes in neck area can also be found.

- Tooth discoloration can be seen.

Treatment Options

The aim of treatment is: drainage of abscess and removal of infection source. Common treatments are as following: 

- Root canal treatment, in which living tissue of tooth is removed and replaced with synthetic biocompatible material.

- Extract the tooth if it cannot be restored. Extraction should be followed by curettage.

- Incision and drainage of abscess is opted when conventional treatment fails to respond or for medically compromised patients.

- Antibiotics are preferably not used for dental abscess but in some patients antibiotics are indicated such medically compromised patients,  disseminated infections  and patients presented with significant cellulitis.

- To relieve the pain, NSAIDS are often prescribed.

- Fistulectomy is required in chronic cases in which sinus tract persists even after incision and drainage.

Complications

Dental abscess is often self limited and doesn’t cause complications. But it may cause following complications if not be treated in time:

- Fistula formation,  in which the sinus tract is lined by epithelium.

- Cellulitis

- Osteomyelitis

- Ludwig Angina

- Cavernous sinus thrombosis

- Mediastinitis

- Septicemia

- Prosthetic valve infections

- Sinusitis

- Cystic lesions

How to Prevent?

Following preventive methods may help to reduce the incidence of dental abscess formation.

- Regular visits to registered Dental practitioner

- Good oral hygiene status. Brush your teeth twice a day.

- Use the dental floss regularly.

- Sufficient fluoride intake.

- Avoid sticky foodstuffs.

- Reduce consumption of acidic or sugar-containing diet.

- Limit the snacks between meals. 

- Regular rinses after eating and drinking a sugar-containing diet.