If you have ever suffered an abscess an infection of the mouth, face, jaw or throat — you can attest to the fact that it’s one of the most painful dental experiences. Even worse, abscesses actually can be life-threatening if left untreated. Dental abscesses always require professional dental care. They occur when bacteria invade the dental pulp, the soft inner part of the tooth that contains blood vessels, nerves, and tissue. Bacterias enters into root of the tooth through cental decay, chip of the tooth, and crack on the tooth. After bacterial infection, it starts swelling and the formation of pus in the associated region (bacteria, dead tissue, and white blood cells). If unchecked, the bacterial infection spreads from the tooth root to different parts of the body.
Common causes of tooth abscesses are severe, untreated tooth decay, tooth injury, such as broken or chipped teeth, and gum diseases like gingivitis or periodontitis. Two other causes are persistent disease and infection following root canal therapy and infected tooth fillings.
Who is at Risk?
If a person does not receive treatment for a cracked tooth, exposed enamel or a deep cavity runs the risk of developing a tooth abscess. People who have not gone to the dentist for a long time are especially vulnerable because they likely have not received treatment for severe cavities caused by factors such as continued poor oral hygiene maintenance, a high-sugar diet or financial restrictions. People with diabetes, an autoimmune disease or those who are receiving chemotherapy/radiation cancer care treatment (or have another medical condition that weakens their immune system) also are at higher risk of abscesses.
Symptoms of tooth abscess
A tooth abscess normally affects only one tooth, but if the infection remains untreated, other teeth also may become infected. To prevent serious complications that can develop from non-treatment, it is important to see a dentist if you experience any of the following symptoms:
- A toothache (continuous and characterized by gnawing, sharp, shooting or throbbing sensations)
- Bitter taste in the mouth
- Foul breath
- Discomfort ill feeling
- Pain when chewing, especially when biting or closing the mouth tightly
- Tooth sensitivity to hot and cold temperatures
- Red, swollen gums that drain pus
- Swollen lymph nodes in the neck and jaw areas
If the infection damages the tooth nerve, the toothache may stop. However, this doesn’t mean the infection has healed; the infection still continues to spread and destroy tissue. With this advance infection, you may experience nausea, vomiting, and chills. Fever and facial swelling may indicate that the infection has spread deeper into your jaw and surrounding tissue, or even to other areas of your body. If you can’t reach your dentist, go to an emergency room and try to get your treatment done as soon as possible.
Possible Complications of Tooth Abscesses
An abscess may create an eruption or fistula through the skin that leaks and drains pus into the mouth or through the cheek. More severe and serious, the abscess may involve the bone and spread everywhere in the body, infecting surrounding tissue and possibly damaging nerves as it travels. A severe case that has perforated bone and extended into the soft tissue can eventually progress into osteomyelitis (bone infection) and cellulitis (skin infection). When left untreated, an advanced infection can necrose the jaw, leading to loss of the tooth and possible facial disfigurement as a result of compromised, soft facial bones. It can put you at greater risk of systemic (whole body) problems such as diabetic flare-ups, blood infection (septicemia), breathing problems, heart disease and vascular infection. An example of a severe abscess complication needing urgent hospitalization is Ludwig’s angina, a serious form of cellulitis that infects the tissues of the floor of the mouth. In extreme cases, this condition can close the air pathway and cause suffocation. Infection also can spread to the mid-chest area, which has serious consequences on vital organs such as the heart. If the abscess doesn’t drain, it may lead to sepsis, a whole-body infection that can cause limb loss, organ dysfunction, and death. In rare cases, the spread of infection to soft tissue, the jawbone and other areas of the body may result in meningitis, brain abscess, and pneumonia.
A tooth abscess won’t resolve without treatment. Even if the abscess disperses, bursts or drains and the pain stops, you still need professional dental treatment.
Common treatments consist of the following:
Immediate treatment of cavities and traumatized teeth:
Treatment goals include draining the abscess, eradicating and stopping the spread of infection, saving the tooth (whenever possible) and limiting complications.
Antibiotics kill the pathogens responsible for tooth abscesses, supporting the body to repair the tooth and bone. Your dentist normally prescribes antibiotics — most commonly penicillin — after X-rays have been reviewed to confirm that you have an infection. Antibiotics normally are useful in controlling the abscess; most of the symptoms will be relieved within two days, and the abscess typically will heal after five days of antibiotic treatment. If the infection is limited to the abscessed area, antibiotics may not be necessary. However, if the infection has spread to nearby teeth, your jaw or other areas, your dentist likely will prescribe antibiotics to stop the spread of infection. Antibiotics also may be prescribed if you have a weakened immune system.
Warm saline-water rinses :
If an abscess erupts by itself, warm salt-water rinses will comfort, help clean the mouth and promote drainage until you are able to see your dentist. Your dentist also may recommend them during the treatment recovery time to relieve discomfort and encourage healing.
Over-the-counter (OTC) pain medication:
Painkillers such as ibuprofen help alleviate discomfort while the area is healing. However, while these medications will diminish pain, they won’t treat the abscess. You still need to see your dentist for proper follow-up care.
Root canal treatment:
This procedure can help eliminate the infection and save your tooth. This involves removal of the diseased pulp and draining of the abscess. The tooth’s pulp chamber and root canals are filled and sealed, then capped. Root canal surgery also may be recommended to remove any diseased root tissue after the infection has cleared. This option is only recommended when enough tooth structure is left on which to place a permanent restoration.
Extraction of infected tooth:
If the tooth can’t be restored through root canal treatment, it must be extracted. Your dentist will remove the tooth and drain the abscess to eliminate the infection. Your dentist then will follow-up by performing curettage (removing by scraping or scooping) of all infected soft tissue at the tip of the tooth. Tooth extraction and cleaning the affected area will allow the wound to heal.
An abscess that has spread to the floor of the mouth or to the neck may need to be drained in the operating room under anesthesia. Additionally, if an abscess still doesn’t heal, or it enlarges after undergoing conventional root canal treatment, you most likely will need surgery and filling of the root tips, as well as a diagnostic biopsy.
Serious infections of the tooth and jaw, secondary infections of the body and their complications may be life-threatening and require emergency room and/or longer-term hospital care.
Who Treats Tooth Abscesses
If you have an abscess, your general dentist may decide to cut it open and drain the pus or treat it with antibiotics. Unless the abscess ruptures on its own, this generally is the only way to cure the infection. As needed, your dentist typically will prescribe pain relievers, rinses and antibiotics; follow-up care will be scheduled for reassessment. If you require root canal treatment, your general dentist likely will refer you to an endodontist, a specialist in root canals. An oral surgeon is recommended in cases involving removal of non-salvageable, diseased teeth, especially when general anesthesia is required and/or the evaluation and treatment of pathologic conditions, such as severe infections of the oral cavity, jaws and neck; and reconstructive/cosmetic surgery for facial disfigurement and the eating away of jaw areas and facial tissue. Emergency room physicians also may be required in extreme cases. If hospital admittance becomes necessary, a general medical practitioner can treat secondary infections that result from abscesses that have been left untreated too long or from fast-spreading infections.
Cost of Treatment
Because there are so many possible treatment options and factors involved, the cost of treatment is difficult to determine. Variables in the cost equation include procedure(s) required, the type and severity of the tooth abscess, possible complications and secondary conditions resulting from the spread of the abscess or tooth infection, patient’s age and health condition, the type, length and complexity of treatment, the type of dentist(s) needed, location of where treatment is given (such as a dental office, emergency room or hospital operating room) and dental insurance coverage.