ABSCESSED TOOTH

When you have a toothache, it can make you miserable. It’s usually the first sign of a tooth infection. It’s best to see your dentist right away. The longer you wait, the more time the infection has to spread to other teeth and tissue.

OVERVIEW

What is an abscessed tooth?

A tooth abscess is a pocket of pus from a bacterial infection. Abscesses can occur in different places around a tooth for different reasons and affect the involved tooth, but also the surrounding bone and sometimes adjacent teeth. Three types of tooth infections can cause abscesses:

• Gingival: This infection develops in the gums. It does not usually affect the tooth or supporting structures.
• Periapical: A periapical abscess is an infection that forms at the tip of the root. This occurs because bacteria can spread to the inside of the tooth to the pulp through a fracture or cavity. The pulp is the innermost part of the tooth that contains nerves and blood vessels. When bacteria invades the pulp, they can spread to the tip of the tooth’s root causing the infection to spread to the bone eventually leading to an abscess.
• Periodontal: This infection starts in bone and tissues that support the tooth. A periodontal abscess usually results from periodontitis or gum disease and is more common among adults.

Who gets tooth infections?

You’re more likely to develop tooth infections if you:

• Smoke: Smokers are about twice as likely to get tooth infections as nonsmokers.
• Have dry mouth: Bacteria thrive in a mouth with a low amount of saliva.
• Have poor dental hygiene: Regularly brushing, flossing and getting dental cleanings reduces bacteria.
• Have a weakened immune system: Diseases or medications can lower your immune response, making it harder to fight off germs.

What are the complications of a tooth infection?

Left untreated, a tooth infection can spread to the jawbone, the soft tissues of the face and neck, and beyond. In extremely rare cases, the infection can travel to the heart (endocarditis) and brain (bacterial meningitis).

SYMPTOMS AND CAUSES

What causes a tooth abscess?

Anything that creates an opening for bacteria to get into the tooth or surrounding tissues can lead to a tooth infection. Causes include:

• Severe tooth decay: A cavity, or tooth decay, is the destruction of the hard surfaces of the tooth. This occurs when bacteria break down sugars in food and drink, creating acid that attacks enamel.
• Broken, chipped or cracked teeth: Bacteria can seep into any opening in a tooth and spread to the pulp.
• Gum disease (periodontitis): Gum disease is an infection and inflammation of the tissues around the teeth. As gum disease progresses, the bacteria gain access to deeper tissues.
• Injury to the tooth: Trauma to a tooth can injure the inner pulp even if there’s no visible crack. The injury makes it susceptible to infection.

What are the symptoms of a tooth infection?

If your tooth is infected, your pain may be:

• Gnawing or throbbing.
• Sharp or shooting.
• Continuous or only when chewing.
• Radiating to the jawbone, neck or ear.

Other oral symptoms of infection include:

• Tooth sensitivity to hot or cold temperatures.
• Bitter taste in the mouth.
• Foul-smelling breath.
• Gum redness and swelling.
• Loosening of the tooth.
• Swollen area in the upper or lower jaw.
• Open, draining sore on the side of the gum.

In addition, you may experience more generalized symptoms like:

• Fever.
• Swollen neck glands.
• General discomfort, uneasiness or ill feeling.

DIAGNOSIS AND TESTS

How is an abscessed tooth diagnosed?

In addition to examining the tooth and surrounding tissue for signs of infection, your dentist may:

• Recommend an X-ray. This can help identify sources of dental disease that may have led to the infection. Your dentist can also use X-rays to determine if the infection has spread and may be affecting other areas.
• Recommend a CT scan. If the infection has spread to other areas within the neck, this will help to identify the extent of the infection.
• Tap and press on your teeth. A tooth with an abscess is often sensitive to touch or pressure.
• Thermal tests. These tests will help your dentist determine the health of your pulpal tissues.

MANAGEMENT AND TREATMENT

Will a tooth infection go away on its own?

A tooth infection will not go away on its own. Your toothache may stop if an infection causes the pulp inside your tooth to die. The pain stops because the nerve isn’t functioning anymore, so you may not be able to feel it. However, the bacteria will continue to spread and destroy surrounding tissue. If you have tooth infection symptoms, see your dentist even if you no longer have pain.

How is an abscessed tooth treated?

Goals of treatment are to eliminate the infection and prevent complications. Treatment options include:

• Incision and drainage: Your dentist makes a small incision (cut) in the abscess to drain the pus. Sometimes a small rubber drain is placed to keep the area open for drainage.
• Root canal: This option helps to eliminate the infection and save your tooth. This common procedure removes the tooth’s infected inner pulp, and fills the space with material to prevent another infection. The inner pulp is important when the tooth is growing but once it’s mature, the tooth can survive without the pulp. After the procedure, your tooth should be back to normal, though you may need a crown to protect the root canal. If you care for the restored tooth properly, it can last a lifetime.
• Tooth extraction: Sometimes the tooth cannot be saved, and your dentist may need to pull or extract the tooth allowing pus to drain from the socket.
• Antibiotics: If the infection is limited to the abscessed area, you many not require antibiotics, but sometimes your dentist may recommend them to assist with your dental treatment. It is important to know, that while this medication may help fight off remaining bacteria, it will not get rid of the cause of the infection, which is the affected tooth.

PREVENTION

Can an abscessed tooth be prevented?

You can reduce the risk of developing a tooth abscess by seeing your dentist routinely and getting regular dental exams and cleanings. It’s also important to see your dentist if a tooth becomes loose or chipped. Oral hygiene is very important for dental health. At home, brush teeth twice a day and floss once a day.

How can I relieve the pain of a tooth infection?

Tooth pain is a sign that you should see your dentist. While you wait for your appointment, warm saltwater rinses and over-the-counter pain relievers can ease discomfort.

How do I prepare for an appointment with my dentist for an abscessed tooth?

To help you get ready for your appointment:

• Make a list of your symptoms — include any that may seem unrelated to your tooth or mouth pain. Remember, your dentist can only help you when they know everything going on.
• Make a list of medications, vitamins, herbs or supplements you may be taking with the dosages of each.

You should prepare a list of questions to ask your dentist, including:

• What’s likely causing my symptoms and condition?
• Which tests do you recommend?
• What is the best course of action?
• Are there alternative to the primary

Remember, your dentist wants to help keep you and your teeth healthy. Just like other medical professionals you may see, they’re an important part of the healthcare team. Be sure to see your dentist routinely and don’t put off regular checkups – prevention is key! These visits give your dentist a chance to spot problems early, when they may be easier to treat. If you are experiencing pain, it’s important to see your dentist to get the care you need.

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