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Dental abscess
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A dental abscess (also termed a dentoalveolar abscess, tooth Dental abscess
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abscess or root abscess), is a localized collection of pus
Interaction associated with a tooth. The most common type of dental abscess
Help is a periapical abscess, and the second most common is a
About Wikipedia periodontal abscess. In a periapical abscess, usually the origin is a
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bacterial infection that has accumulated in the soft, often dead, pulp
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of the tooth. This can be caused by tooth decay, broken teeth or
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extensive periodontal disease (or combinations of these factors). A
Tools failed root canal treatment may also create a similar abscess.
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A dental abscess is a type of odontogenic infection, although
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commonly the latter term is applied to an infection which has
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Special pages spread outside the local region around the causative tooth.
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Contents
Page information A decayed, broken down tooth, which has undergone
Wikidata item 1 Classification pulpal necrosis. A periapical abscess (i.e. around the
Cite this page 2 Signs and symptoms apex of the tooth root) has then formed and pus is
draining into the mouth via an intraoral sinus (AKA
3 Diagnostic approach
Print/export gumboil).
4 Treatment
Create a book Classification and external resources
5 Complications
Download as PDF Specialty dentistry
Printable version 6 See also
ICD-10 K04.6, K04.7
7 References
In other projects ICD-9-CM 522.5 , 522.7
8 External links
Wikimedia Commons MeSH D010482 D005491, D010482
[edit on Wikidata]
Languages Classification [ edit ]
Afrikaans
The main types of dental abscess are:
‫اﻟﻌﺮﺑﻳﺔ‬
Català Periapical abscess: The result of a chronic, localized infection located at the tip, or apex, of the root of a tooth.[1]
Español
Periodontal abscess: begins in a periodontal pocket (see: periodontal abscess)
‫ﻓﺎرﺳﯽ‬
Gingival abscess: involving only the gum tissue, without affecting either the tooth or the periodontal ligament (see:
Français
Nederlands periodontal abscess)
⽇本語 Pericoronal abscess: involving the soft tissues surrounding the crown of a tooth (see: Pericoronitis)
Русский Combined periodontic-endodontic abscess: a situation in which a periapical abscess and a periodontal abscess have
Svenska combined (see: Combined periodontic-endodontic lesions).
Türkçe
中文
Edit links Signs and symptoms [ edit ]

The pain is continuous and may be described as extreme, growing, sharp,

shooting, or throbbing. Putting pressure or warmth on the tooth may induce
extreme pain. The area may be sensitive to touch and possibly swollen as well.
This swelling may be present at either the base of the tooth, the gum, and/or the
cheek, and sometimes can be reduced by applying ice packs.

An acute abscess may be painless but still have a swelling present on the gum.
It is important to get anything that presents like this checked by a dental
professional as it may become chronic later.

In some cases, a tooth abscess may perforate bone and start draining into the
surrounding tissues creating local facial swelling. In some cases, the lymph
glands in the neck will become swollen and tender in response to the infection.
It may even feel like a migraine as the pain can transfer from the infected area.
The pain does not normally transfer across the face, only upwards or
downwards as the nerves that serve each side of the face are separate.

Severe aching and discomfort on the side of the face where the tooth is infected Abscess originating from a tooth,
is also fairly common, with the tooth itself becoming unbearable to touch due to that has spread to the buccal space.
Above: deformation of the cheek on the
extreme amounts of pain. second day. Below: deformation on the
third day.
Diagnostic approach [ edit ]

A periodontal abscess may be difficult to distinguish from a periapical abscess.

Indeed, sometimes they can occur together.[2] Since the management of a
periodontal abscess is different from that of a periapical abscess, this
differentiation is important to make.

If the swelling is over the area of the root apex, it is more likely to be a
periapical abscess; if it is closer to the gingival margin, it is more likely to be
a periodontal abscess.
Similarly, in a periodontal abscess pus most likely discharges via the
periodontal pocket, whereas a periapical abscess generally drains via a
parulis nearer to the apex of the involved tooth.[2]
If the tooth has pre-existing periodontal disease, with pockets and loss of
alveolar bone height, it is more likely to be a periodontal abscess; whereas if
the tooth has relatively healthy periodontal condition, it is more likely to be a
periapical abscess.
In periodontal abscesses, the swelling usually precedes the pain, and in
periapical abscesses, the pain usually precedes the swelling.[2]
A history of toothache with sensitivity to hot and cold suggests previous Tooth #4, the maxillary right second
pulpitis, and indicates that a periapical abscess is more likely. premolar (upper right 2nd bicuspid),
after extraction. The two single-headed
If the tooth which gives normal results on pulp sensibility testing, is free of
arrows point to the CEJ, which is the
dental caries and has no large restorations; it is more likely to be a line separating the crown (in this case,
periodontal abscess. heavily decayed) and the roots. The
double headed arrow (bottom right)
A dental radiograph is of little help in the early stages of a dental abscess,
shows the extent of the abscess that
but later usually the position of the abscess, and hence indication of surrounds the apex of the palatal root.
endodontal/periodontal etiology can be determined. If there is a sinus, a
gutta percha point is sometimes inserted before the x-ray in the hope that it
will point to the origin of the infection.
Generally, periodontal abscesses will be more tender to lateral percussion than to vertical, and periapical abscesses
will be more tender to apical percussion.[2]

Treatment [ edit ]

Successful treatment of a dental abscess centers on the reduction and elimination of the offending organisms. This can
include treatment with antibiotics[3] and drainage. If the tooth can be restored, root canal therapy can be performed.
Non-restorable teeth must be extracted, followed by curettage of all apical soft tissue.

Unless they are symptomatic, teeth treated with root canal therapy should be evaluated at 1- and 2-year intervals after
the root canal therapy to rule out possible lesional enlargement and to ensure appropriate healing.

Abscesses may fail to heal for several reasons:

Cyst formation
Inadequate root canal therapy
Vertical root fractures
Foreign material in the lesion
Associated periodontal disease
Penetration of the maxillary sinus

Following conventional, adequate root canal therapy, abscesses that do not heal or enlarge are often treated with
surgery and filling the root tips; and will require a biopsy to evaluate the diagnosis.[4]

Complications [ edit ]

If left untreated, a severe tooth abscess may become large enough to perforate
bone and extend into the soft tissue eventually becoming osteomyelitis and
cellulitis respectively. From there it follows the path of least resistance and may
spread either internally or externally. The path of the infection is influenced by
such things as the location of the infected tooth and the thickness of the bone,
muscle and fascia attachments.

External drainage may begin as a boil which bursts allowing pus drainage from
the abscess, intraorally (usually through the gum) or extraorally. Chronic
drainage will allow an epithelial lining to form in this communication to form a
pus draining canal (fistula). Sometimes this type of drainage will immediately
relieve some of the painful symptoms associated with the pressure.

Internal drainage is of more concern as growing infection makes space within A dental infection resulting in an
the tissues surrounding the infection. Severe complications requiring immediate abscess and inflammation of the
maxillary sinus
hospitalization include Ludwig's angina, which is a combination of growing
infection and cellulitis which closes the airway space causing suffocation in
extreme cases. Also infection can spread down the tissue spaces to the
mediastinum which has significant consequences on the vital organs such as
the heart. Another complication, usually from upper teeth, is a risk of
septicaemia (infection of the blood) from connecting into blood vessels, brain
abscess (extremely rare), or meningitis (also rare).

Depending on the severity of the infection, the sufferer may feel only mildly ill, or
may in extreme cases require hospital care.

See also [ edit ]

Barodontalgia
CT scan showing a large tooth
Focal infection abscess (right in the image) with
Intraoral dental sinus significant inflammation of fatty tissue
under the skin

References [ edit ]

1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Dentistry portal
Louis: Mosby. ISBN 1-4160-2999-0.
2. ^ a b c d Kathleen FM Fan; Judith Jones (2009). OSCEs for dentistry (2nd, new and updated ed.). 2nd: PasTest Ltd. p. 68.
ISBN 978-1-905635-50-4.
3. ^ "Archived copy" . Archived from the original on 27 December 2011. Retrieved 1 March 2012.
4. ^ Neville, Brad W. (1995). Oral and Maxillofacial Pathology (1st ed.). Saunders. pp. 104–5. ISBN 978-1-4160-3435-3.

External links [ edit ]

https://toothpainremedies.net/abscess-tooth/ Tooth abscess info from Wikimedia Commons has

Toothpainremedies.net] media related to Tooth
abscess.

V·T·E Acquired tooth disease (K02–K05, 521–525)

Caries (tooth decay) · Attrition · Abrasion · Erosion · Hypercementosis · tooth resorption
Hard tissues
(External resorption, Internal resorption, Root resorption)
External resorption · Internal resorption · Irreversible pulpitis · Reversible pulpitis ·
Pulpal
Pulp necrosis · Pink tooth of Mummery
Acute apical periodontitis · Chronic apical periodontitis ·
Pulp/periapical (Endodontal)
Periapical Combined periodontic-endodontic lesions · Fistula · Periapical abscess ·
Phoenix abscess · Vertical root fracture
Ungrouped Pulpitis · Radicular cyst · Periapical abscess

Gingiva/periodontal
Gingivitis · Periodontitis (Chronic periodontitis) · Periodontal disease
(Periodontal)

Bone cyst Dentigerous cyst · Calcifying odontogenic cyst · Glandular odontogenic cyst

Other Cracked tooth syndrome

Chronic periodontitis · Localized aggressive periodontitis ·

Generalized aggressive periodontitis ·
Diagnoses Periodontitis as a manifestation of systemic disease ·
Necrotizing periodontal diseases · Abscesses of the periodontium ·
Combined periodontic-endodontic lesions
To be grouped A. actinomycetemcomitans · Capnocytophaga sp. · F. nucleatum ·
Pathogenesis
from periodontology P. gingivalis · P. intermedia · T. forsythia · T. denticola
Calculus · Edentulism · Fremitus · Furcation defect ·
Gingival enlargement · Gingival pocket · Gingivitis ·
Pathologic entities Horizontal bony defect · Linear gingival erythema · Occlusal trauma ·
Periodontal pocket · Periodontal disease · Periodontitis · Plaque ·
Recession · Vertical bony defect

Categories: Acquired tooth disorders Infectious diseases

This page was last edited on 6 March 2018, at 19:03.

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