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DENTOALVEOLA R ABSCESS

Pruthvish IV BDS Patel

Contents

Definition Etiology Pathogenesis Clinical Features Radiological features Histopathology Diagnosis Treatment Complications Prevention of complications References

An ABSCESS (Latin: abscessus) is a collection of pus (dead neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e.g. splinters, bullet wounds, or injecting needles). PERIAPICAL ABSCESS or DENTOALVEOLAR ABSCESS is defined as a localized, acute or chronic suppurative infection in the periapical region of a tooth.

Etiology

Extension of pulpal infection into periapical tissue Fracture of tooth with pulpal exposure Accidental perforation of apical foramen during treatment procedure Extension of periodontal infection into periapical tissues Anachorectic infection spread to the pulp via blood vessels

Pathogenesis

The primary abscess always appears suddenly, involving with the root tip of the tooth and the dead pulp. There is direct and rapid entry of viable bacteria, causing acute periodontitis and results in an extremely painful toothache. Sometimes, the inflammation may push the tooth slightly out of the tooth socket and brings even more pain when chewing.

The secondary abscess may be acute or chronic, depending upon the number and the aggressiveness of the pathogen, the immune system of the patient, and the type and timing of the treatment provided. Mostly various strains of staphylococci and streptococci along with some other microorganisms such as Bacteroides, Peptococcus, Peptostreptococcus, Actinomycetes, Eubacterium, and Fusobacterium etc can be found.

Clinical features

The affected tooth is nonvital and may be mobile Severe pain in the affected tooth Localized swelling and erythematous change in overlying mucosa Pain aggravates on percussion or on mastication Fever and occasional presence of lymphadenitis Patient may feel his/her tooth longer than the other normal teeth. Application of heat intensifies the pain while cold stimuli gives a temporary relief The tooth never responds to electrical pulp tests.

Contd
Pus discharging sinus may develop on alveolar mucosa over affected root-apex and on skin over the jaw-bone. At the intraoral opening of the sinus tract, theres often a mass of subsequently inflammed granulation tissue known as Parulis or Gum Boil. If the host defence is stronger or virulence is low, chronic stage of the abscess sets in if left untreated, which at most times remains asymptomatic.

Radiographic Features
Radiographic changes are usually minimal and limited to only slight thickening of periodontal ligament space in apical region of the involved tooth. In chronic cases, small radiolucent area at the root apex with poorly defined margins can be seen.

HistoPathological Features

A zone of liquefactive necrosis made up of proteinaceous exudates, necrotic tissue and viable or dead neutrophils. Inflammatory changes can also be seen in adjacent periodontal ligament fibres and adjoining bone marrow. Chronic lesion is characterized by presence of chronic inflammatory cells

Areas of bone destruction with fibrosis and bone regeneration. Pus discharging cavity is lined by squamous epithelial lining.

Diagnosis

History of any infection or painful condition regarding the affected tooth. A physical examination of the mouth for the evidence indicating a dental abscess, such as a boil in the gums near a tooth, or redness and swelling of gum tissue. Pulp vitality tests with hot, cold and electrical stimulus. Radiograph to confirm the disease progression.

Treatment

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Extraction was the only treatment in the past. The present procedure of tooth abscess treatment may include:

Draining the abscess: This usually relieves pain and removes much of the infection. If it is a periapical abscess around the tooth root, draining requires an opening made through the tooth during a procedure known as root canal treatment. If the tooth is too damaged for a root canal treatment, extraction is done followed by drainage of the abscess.

Complications

abscess if detected promptly is usually curable with proper treatment. In some cases, when the tooth infection causes little or no pain, people ignore it and wait for it to go away. If the pus is not drained and the infection is left untreated, serious complications may develop. Abscessed tooth complications may include: Spread of infection to soft tissue (facial cellulitis, Ludwig's angina ) Spread of infection to the jaw bone (osteomyelitis of the mandible or maxilla Spread of infection to other areas of the body resulting in sinusitis, cavernous sinus thrombosis or endocarditis

Dental abscesses that have extended to the floor of the mouth or to the neck can become life-threatening, blocking the airway and causing difficulty in breathing Dental Cyst Loss of the tooth

Preventing the complications

This includes preventing infection from spreading to other areas of the body, as well as reducing pain and swelling. Medication.
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Antibiotic. Painkillers

Follow-up x-rays: X-rays are recommended six months after treatment of an abscess to confirm that bone and tissue have appropriately regenerated in the treated area. If not, additional periodontal, endodontic or surgical treatment may be needed.

REFERENCES:

http://www.encarta.msn.com http://www.wrongdiagnosis.com http://www.elsevierhealth.com http://www.doctorspiller.com

Oral and Maxillofacial PathologyBrad W. Neville The Textbook of Oral PathologyShaffer