Abscessed Tooth

Medical Author : Donna S. Bautista, DDS

Medical Editor : William C. Shiel Jr., MD, FACP, FACR

What are the signs and symptoms of an abscessed tooth?

  1. The tooth turns dark in color compared to surrounding teeth. The by-products of the necrotic pulp that leach into the porous tooth layer cause this discoloration.
  2. There is pain with eating or with pressing on the tooth. The abscess that has spread out the root tip causes the supporting structures (gum and bone) to be affected. Sometimes the throbbing or pulsating pain is so severe it can't be relieved with pain medications. This is usually related to the infection spreading and causing more pressure on the surrounding structures of gum and bone.
  3. There is swelling and/or a pimple on the gum that is filled with pus. This pimple is called a "draining fistula" and oftentimes can rupture to release pus. This is an obvious sign of infection. Other signs of a tooth abscess are a bad taste or bad odor in the mouth.

It is also important to note that an abscessed tooth may not have any symptoms at all. Because the tooth has lost vitality (or the ability to feel stimuli), there may be no pain associated with it. However, the abscess is still present and could be further spreading the infection. On occasion, an abscessed tooth is discovered during a routine radiographic (X-ray) exam where the patient has not experienced any symptoms of an abscessed tooth.

How is an abscessed tooth diagnosed?

Diagnosis of a tooth abscess is collectively determined by: 1) signs and symptoms reported by the patient, 2) exam and tests that are performed by the dentist, and 3) what is visualized with dental radiographs (X-rays).

What is the treatment for an abscessed tooth?

In adult teeth, the usual treatment for an abscessed tooth begins with properly clearing the infection. Depending on how much the infection has spread, the course of action usually involves oral antibiotics and draining the tooth and surrounding structures of the infection.

In some situations, the infection can spread quickly and require immediate attention. If a dentist is unavailable and there is a fever, swelling in the face, or swelling in the jaw, a visit to the emergency room is recommended. An emergency room visit is advised if there is difficulty with breathing or swallowing.

Once the infection is cleared and the tooth can be restored, a root canal procedure is performed. The "root canal treatment" cleans out the entire inner space of the tooth (pulp chamber and the associated canals) and seals the space with an inert rubber material called gutta percha. Cleaning and sealing the inner space protects the tooth from further invasive infections. If the tooth cannot be restored, the tooth is extracted instead.

In children's primary teeth, treatment of a dental abscess depends on the extent of infection. If the abscessed primary tooth is in the early stages of infection and is not mobile (moving in the tooth socket), the infection is cleared out within the pulp chamber. The space is then filled with a paste such as zinc oxide eugenol. If the infection is advanced and has caused the tooth to become mobile, the best course of action is to remove the infected tooth. This is also important in avoiding a persistent infection that could risk harming the adult tooth that is developing underneath.

What is the prognosis for an abscessed tooth?

The prognosis depends on the extent of the spread of infection. Usually, when the infection is localized to the tooth, the prognosis is very good if treatment is sought as soon as signs and symptoms are usually noticed.

When the infection is left untreated for a prolonged period and allowed to spread, the situation can escalate and be more difficult to control. There is the danger that the infection could rapidly spread to the bone of the jaw and other spaces of the head and neck. The swelling in the jaw or neck could even be so great as to affect the airway and become life-threatening. Finally, further complication and spread of the infection throughout the body (sepsis) can occur.

Are home remedies effective for an abscessed tooth?

Generally, home remedies are not advised for an abscessed tooth. Home remedies can be used to alleviate symptoms such as warm water rinses/warm compresses and taking over-the-counter medications for pain relief. However, the infection will still progress if not properly treated. Furthermore, avoiding treatment can lead to more serious complications. Seeking care and advice from a dental professional is strongly recommended as soon as possible.

Can an abscessed tooth be prevented?

Good home care habits and regular dental visits can play a big role in avoiding an abscessed tooth. Time is also a big factor in whether a tooth is allowed to reach the point of infection. The longer the tooth sits with a problem, the higher chance that infection can occur and spread to become an abscess. Once a decayed, fractured, or sensitive tooth is noticed, taking the preventive steps to fix it early will help prevent bigger problems such as an abscessed tooth.

Medically reviewed by Kenneth Rotskoff, MD, DDS; Board Certified Dentistry, Oral/Maxillofacial Surgery

REFERENCE:

Burns, Richard C. and Stephen Cohen (Eds.). Pathways of the Pulp. 2nd ed. St. Louis, MO: The C.V. Mosby Company, 1980.

 

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