An abscess is a collection of pus (bacteria, white blood cells, plasma, and cellular debris) from a bacterial infection that can form in any tissue in the body, including teeth, gums, and even the bone on which the tooth sits.
There are two main types of dental abscess:
- periodontal if it affects the periodontium, i.e., the gum, ligament, or bone,
- periapical if it affects the pulp (it is usually a consequence of caries).
We also recall the gingival abscess, which is the least complicated form of the dental abscess that develops directly in the gum due to infectious processes.
Abscesses are usually quite painful, but require medical attention regardless of this, to avoid annoying and / or dangerous complications. The treatment consists of giving antibiotics for the infection and dental intervention.
Causes
The mouth is normally full of bacteria, but under certain conditions these can form a sticky film on the teeth called plaque. Especially in the absence of correct and regular oral hygiene, the acids produced by plaque bacteria can damage the teeth and gums, even causing the appearance of tooth decay or gum disease. These conditions can thus predispose to the appearance of a dental abscess, i.e. a pocket full of pus produced in response to a bacterial infection.
Risk factors for abscesses
- Poor oral hygiene (plaque can build up more easily on the teeth),
- high consumption of sugary foods and drinks,
- pre-existing tooth problems or unsuccessful surgery, which can act as a gateway for bacteria through damaged parts of the tooth and gums,
- dry mouth (due to medications, age, …),
- weakened immune system (diabetes, heart disease, subjects treated with cortisone or chemotherapy)
- heavy alcohol use,
- smoking and tobacco use.
Symptoms
The main symptoms of an abscess are:
- intense pain affecting the tooth and/or gum;
- it can occur suddenly and generally tends to progressively worsen;
- the pain can also affect the ear, jaw and even the neck on the same side as the affected tooth;
- pain worsens when lying down and can prevent sleep;
- worse at night and becomes unbearable under pressure;
- redness and swelling in the face;
- red, inflamed, and swollen gums;
- excessive sensitivity to cold/heat;
- bad breath and/or an unpleasant taste in the mouth;
- swollen lymph nodes on the affected side;
- migraine.
If the infection spreads, fever and general malaise may also develop. In severe cases it may be difficult to open your mouth fully and it may become difficult to swallow or breathe.
In some cases, the abscess can rupture spontaneously, and this may provide relief from symptoms, but does not eliminate the need for specialist advice; in particular a tooth affected by an abscess that was initially painful, but which subsequently finds relief, could also indicate the death of the tooth itself, a condition to be checked with your dentist.
When to call the doctor
Contact the dentist at the first symptoms of an abscess, without waiting. In case of fever and severe swelling if the dentist cannot be contacted, contact the Emergency Department, especially in the event of difficulty breathing or swallowing (symptoms indicative of a deeper spread of the infection).
Not addressing an abscessed tooth can lead to the need for extraction.
Diagnosis
Generally, a medical examination or observation of the symptoms is sufficient for the diagnosis, but an in-depth instrumental examination (radiography, computed tomography ) may sometimes be required.
