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A dental abscess is an abscess from a tooth with a dead pulp - it can be a periapical, subperiosteal or submucosal abscess, commonly known as "dental abscesses". What is the so-called tooth abscess? What are its symptoms? What is the treatment of dental abscesses?
Tooth abscessisacute purulent inflammation of the tissues around the apex of the tooth root . In medical vocabulary, an abscess (Latinabscessus ) means a pathological cavity surrounded by tissues, filled with purulent contents. It can arise in all areas of the human body, including the head and neck area. Due to the presence of teeth in this anatomical area, they most often become the gateway for microbial invasion.
How is a dental abscess formed?
There is a huge amount of bacteria in the mouth, in 1 ml of saliva there are approximately 108(1 00,000,000) bacterial cells. Under normal conditions, they do not pose a threat, but when one of our protective barriers fails, they become dangerous pathological factors. Dental diseases, injuries, thermal, chemical or physical stimuli can cause the death of the pulp. Under the conditions of the oral cavity (appropriate temperature, high humidity), the dead tissue becomes an ideal place for the development of microorganisms.
The most common dental disease leading to irreversible pulp inflammation followed by pulp necrosis is tooth decay.
Bacteria growing in the dead pulp and the toxins produced by them through the apical opening enter the body. Initially, it causes inflammation of the periapical tissues. If the causal tooth is not treated properly, it may lead to the formation of the so-called dental abscess. The purulent content is a thick cloudy discharge with an unpleasant odor. It consists of dead tissue, bacterial cells and cells of the immune system.
Periapical abscess ,Subperiosteal abscess ,Submucosal abscessare three stages of the same process. This is due to the spread of purulent discharge through subsequent tissues. Initially, an abscess develops only intraosseously, not exceeding the essence of the compacted bone (i.e. the outer layer of the bone). Over time, the size of the abscess increases and covers more tissues. When an abscesspierces the substance of dense bone, the purulent content gets under the periosteum, causing its detachment. This condition is called a subperiosteal abscess. If there is still no treatment, the abscess quickly penetrates the periosteum and gets under the oral mucosa and there it forms a submucosal abscess. The increasing pressure inside the abscess cavity leads to a break in the continuity of the mucosa or skin. The abscess is emptied spontaneously. The opening through which the pus comes out becomes covered with the epithelium and is called a fistula. Despite the patient's feeling of relief, the disease continues and requires treatment. Do not think that this is the end of the problem. The fistula will continue to produce pus, sometimes in large amounts and sometimes in negligible amounts.
Symptoms of dental abscesses
The symptoms may vary slightly depending on the type of abscess. A tooth with a carious cavity, which is the cause of the abscess, may be visible in the mouth (however, this is not a rule).
- Periapical abscessusually begins with a feeling of pain reported by the patient. It is usually distracting, throbbing pain that may radiate towards the ear or temple. Pain symptoms may increase when eating warm food and lying down. Typically, the accompanying symptom is a sensation of "tooth sticking out" or "tooth too high". The tooth itself may be slightly loose. The soreness when biting is clearly marked. The gum in the area of the root apex is painful, red, and may appear swollen. Lymph nodes under the lower jaw and in the neck may be enlarged. The dentist in the office usually performs the percussion test and the tooth vitality test, which gives negative results. The radiological image taken shows a change in the area of the root apex.
- Subperiosteal abscesscauses periosteal detachment. This stage is characterized by the intensification of pain symptoms, the gums remain red and slightly swollen. You can palpate the abscess, it is very painful to touch. The rest of the symptoms remain unchanged.
- Submucosal abscessis formed after an abscess has pierced the periosteum - the pain symptoms, so far very intense, slightly subside. In their place, there is a clear swelling of the mucosa above the abscess that is formed. Palpation can be the so-called "bubbling symptom", related to the displacement of fluids within the abscess. Other symptoms may be similar to those mentioned earlier. Additionally, all three types of abscesses may be accompanied by facial swelling on the side of the affected tooth and trismus. Sometimes they appeargeneral symptoms such as malaise, increased body temperature, etc.
Tooth abscess treatment
If you experience the symptoms described above, see your dentist as soon as possible. Untreated abscesses can lead to he alth-related complications. Periapical, subperiosteal and submucosal abscesses are treated in dental offices. Treatment, regardless of the origin of the abscess, is governed by similar principles. It consists in draining the purulent content and ensuring its free outflow until the lesion heals. Additionally, causal treatment is obligatory. In our case, endodontic treatment of the causative tooth or its extraction.
In intraosseous (periapical) abscesses, the drainage of purulent contents is obtained through the canal system of the tooth causing the ailments. In rare cases, the doctor performs the procedure of incising the mucosa and then reaching the abscess through the dense bone. In the case of subperiosteal and submucosal abscesses, the dentist cuts the abscess to allow the pus to drain freely from all its recesses. The abscess cavity is then rinsed with special preparations. After these steps have been completed, it may be necessary to insert a drain or a rubber filter into the wound to prevent pus drainage from closing and disease recurrence.
In specific clinical situations, the doctor may decide to introduce pharmacological treatment (antibiotics). This is the case, for example, in the event of general symptoms or reduced efficiency of the patient's immune system. Summarizing, the treatment of abscesses is surgical and should not be replaced only with the use of an antibiotic. In any case, it is necessary to treat the causal tooth. Depending on the advancement of the disease process and the destruction of tooth tissues, endodontic treatment or tooth extraction may be indicated.
Preventing the development of "tooth" abscesses consists in maintaining proper oral hygiene. Regular checkups at the dentist's dentist will allow for early treatment of carious lesions and thus preserve the he althy and alive dental pulp, which is a barrier to bacterial invasion.