Tooth abscess

Definition

A tooth abscess is a collection of infected material (pus) due to a bacterial infection in the center of a tooth.

Alternative Names

Periapical abscess; Dental abscess; Tooth infection; Abscess - tooth

Causes

A tooth abscess is a complication of tooth decay. It may also result from trauma to the tooth, such as when a tooth is broken or chipped. Openings in the tooth enamel allow bacteria to infect the center of the tooth (the pulp). Infection may spread out from the root of the tooth and to the bones supporting the tooth.

Infection results in a collection of pus (dead tissue, live and dead bacteria, white blood cells) and swelling of the tissues within the tooth. This causes a painful toothache. If the pulp of the tooth dies, the toothache may stop, unless an abscess develops. This is especially true if the infection remains active and continues to spread and destroy tissue.

Symptoms

The main symptom is a severe toothache. The pain is continuous and may be described as gnawing, sharp, shooting, or throbbing.

Other symptoms may include:

• Bitter taste in the mouth
• Breath odor
• General discomfort, uneasiness, or ill feeling
• Fever
• Pain when chewing
• Sensitivity of the teeth to hot or cold
• Swelling of the gum over the infected tooth, that may look like a pimple
• Swollen glands of the neck
• Swollen area of the upper or lower jaw -- a very serious symptom

Exams and Tests

The dentist will closely look at your teeth, mouth, and gums. You may have pain when the dentist taps the tooth. Biting or closing the mouth tightly also increases the pain. The gums may be swollen and red and may drain thick material.

Dental x-rays and other tests can help your dentist determine which tooth or teeth is causing the problem.

Treatment

The goals of treatment are to cure the infection, save the tooth, and prevent complications.

Antibiotics may be given to fight the infection. Warm salt-water rinses may be soothing. Over-the-counter pain relievers may relieve the toothache and fever.

Do NOT place aspirin directly over the tooth or gums, because this increases irritation of the tissues and can result in mouth ulcers.

A root canal may be recommended in an attempt to save the tooth.

If there is a severe infection, the tooth may be removed or surgery may be needed to drain the abscess. Some people may need to be admitted to the hospital.

Outlook (Prognosis)

Untreated abscesses may get worse and can lead to life-threatening complications.

Prompt treatment usually cures the infection. The tooth can usually be saved in many cases.

Possible Complications

• Loss of the tooth
• Blood infection (sepsis)
• Spread of infection to soft tissue (facial cellulitis, Ludwig's angina)
• Spread of infection to the jaw bone (osteomyelitis of the jaw)
• Spread of infection to other areas of the body resulting in brain abscess, endocarditis, pneumonia, or other complications

When to Contact a Medical Professional

Call your dentist if you have a persistent, throbbing toothache.

Prevention

Prompt treatment of dental caries reduces the risk of tooth abscess. Traumatized teeth should be examined promptly by the dentist.

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