If you have been feeling throbbing pain, an unpleasant taste in your mouth, sharp pain when biting, and swelling in your cheeks, it is recommended that you visit a dental expert immediately if you suspect a periapical abscess. A dental practitioner will examine your teeth, explain the symptoms you are experiencing, and explore the available treatment options to alleviate your pain and enable healing. Here is what you need to know about a periapical abscess.
A Glance at Periapical Abscess
Periapical abscess, also referred to as a tooth abscess or a dental abscess, is a collection of pus that forms in the periapex area of the tooth, or the tip of the tooth root, resulting from an infection that starts from the surface of the tooth, the dentin, and finally the pulp, where nerves and blood vessels are located. After passing through these layers, the infection spreads to the pulp and settles at the periapex. A periapical abscess is not the same as a periodontal abscess. The periapical one forms in the tooth, while the periodontal abscess forms on the gingiva tissue or gums.
Pus formation occurs at the periapex, where the body is trying to combat the infection that has spread to the pulp, using white blood cells. The formation of white blood cells, dead tissue, and germs creates the pus pockets. Depending on the tooth's position, the infection may spread to the surrounding soft tissues, leading to inflammation of the mouth floor, jaw, and cheek. If the problem is not treated early enough, the inflamed tissues can rupture and release pus, spreading the infection into the airway and causing severe, catastrophic symptoms.
So, when you notice signs of an abscess, you must visit the dentist immediately for an emergency procedure to reduce the risk of the bacterial infection spreading to the airway if the pus pocket breaks open. Your dentist will drain the pus through surgery or perform a root canal procedure.
Periapical Abscess Causes
Successful treatment and prevention of a periapical abscess require an understanding of its causes. The common causes include:
Untreated Dental Decay or Cavities that Spread to the Pulp
When you fail to address tooth decay or a cavity, you allow harmful bacteria to spread from the enamel and dentin to the pulp, which houses the living tissues, such as nerves and blood vessels, in the tooth. The toxic bacteria infect these tissues and eventually kill them. When dead tissue, bacteria, and white blood cells from the pulp accumulate around the tip of the tooth root, they form a periapical abscess.
Dental Trauma
Physical trauma to the face or directly to the tooth during a fall or contact sport can hurt the pulp without necessarily causing visible fractures or the tooth to break. Because the injury is barely visible, the nerves and blood vessels at the center of the tooth begin to die, leading to an infection. The body attempts to fight the infection through white blood cells, and the buildup of these cells, the dead tissue, and bacteria in the periapex is what causes a periapical abscess.
Failed Dental Treatments
Restorative treatments such as dental crowns and fillings help restore tooth functionality and appearance and improve your overall oral health. Nevertheless, when these procedures fail, they allow harmful bacteria to seep below the restoration into the pulp. If left untreated, the infection leads to the formation of a periapical abscess. In rare cases, you could develop an abscess because of a root canal treatment failure.
Periodontitis
Also called advanced gum disease, periodontitis is commonly associated with periodontal abscesses. However, in severe cases, the gum infection can also result in periapical abscesses.
Certain people are at a higher risk of developing a periapical abscess than others. Your risk of a periapical abscess is elevated if you have poor oral hygiene. Oral hygiene is the practice of keeping the mouth clean and free of disease through regular brushing and flossing, as well as regular dental visits for examinations. Without proper hygiene, you are at risk of developing various dental complications, which can lead to periapical abscesses.
Additionally, dry mouth syndrome (xerostomia) can increase the risk of tooth abscesses. Saliva washes down bacteria and food particles from the mouth. When you do not have sufficient saliva in the mouth, the food debris and harmful bacteria have more contact with the teeth and gums, which increases the risk of infections.
The risk of a periapical abscess is also higher in patients with high sugar intake. The sugar feeds harmful bacteria in the mouth, allowing them to multiply and spread, leading to infections. When these infections spread to the pulp, they lead to periapical abscesses.
Periapical Abscess Symptoms
The main symptoms of a periapical abscess are distinct from regular or minor tooth discomfort, and they include:
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Pain that becomes severe when chewing or biting down
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Persistent, throbbing toothache that radiates to the jaw and ears
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Swollen lymph nodes in the neck or jaw area
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Fever is the body's attempt to fight the bacterial infection
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Tooth sensitivity to hot and cold substances
The secondary indications of the tooth abscess include:
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Gum boils, which are tiny bumps that resemble a pimple, appear on the gums
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If the abscess ruptures, you experience a sudden rush of foul, salty fluid that alleviates the pain but does not treat the infection.
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Difficulties breathing or swallowing after the pus pockets break open, spreading the infection to the airway and throat.
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General fatigue or unwellness
If you start experiencing breathing difficulties, you should schedule an emergency appointment with your dentist because these symptoms can be life-threatening.
In most cases, periapical abscesses are characterized by throbbing pain. However, some abscesses can be silent, with little or no discomfort. The symptoms start to show in advanced stages. Therefore, you should visit your dentist at least twice annually for an evaluation. These exams can help spot the periapical abscess early. Additionally, you should see a dentist for an assessment if you notice other symptoms of the condition, such as foul breath, swelling, or fever, even if you are not experiencing any pain, because the tooth abscess may be silent.
Potential Complications of a Periapical Abscess
If a burst eases your pain, causing you to overlook treatment, or you are afraid of dental clinics or procedures, you should recognize the risk and complications of an untreated periapical abscess. The possible complications include:
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Infection Spread
When you allow the infection to spread without seeking medical attention, the dental abscess can spread to the surrounding soft tissue, causing a jawbone infection, sinusitis (bacterial infection of the sinuses), and a skin infection characterized by severe pain.
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Systemic Infection
In severe cases, the infection could spread to the bloodstream, causing severe blood infection (sepsis) that could damage vital body organs, like the brain or heart, increasing the risk of death.
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Tooth Loss
When the infection spreads to the jawbone, it weakens it with time, destroying the bones that anchor your teeth. As a result, you start losing teeth in the affected jawbone.
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Dental Cyst Growth
If you develop a chronic tooth abscess, you could end up with a cyst that forms on the top of your tooth root, resulting in more jawbone damage and the need for nuanced and expensive dental procedures.
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Ludwig’s Angina
Ludwig’s angina is a bacterial infection of the floor of the mouth. The disease is life-threatening when it spreads to the airway, causing obstruction. You end up developing breathing difficulties, making your case a dental emergency.
A periapical abscess will not go away on its own without treatment. Therefore, when you notice the symptoms, schedule a consultation with your emergency dentist for an evaluation, diagnosis, and treatment to prevent the spread of the infection and life-threatening complications.
Diagnosing a Periapical Abscess
If you visit your dental expert complaining of the symptoms of a periapical abscess, you should expect the following during the consultation:
A Thorough Dental Exam
The dental expert will first ask about your symptoms, dental history, and medical history. The dentist will then examine your teeth and gums to find the symptoms. For tooth sensitivity, the dental expert will gently tap the teeth to identify which are sensitive. Additionally, they will inspect your gingival tissue for swelling, drainage points, or redness.
Perform a Pulp Vitality Test
Before the dentist can decide the best course of action to take, he or she has to assess the vitality of your pulp. A vitality test determines whether the core of your tooth is alive, dead, or swollen. There are two types of tests. The thermal and electric pulp tests. In the thermal test, the dentist will apply cold or hot stimuli to the affected tooth. A tooth will be considered alive if it is sensitive. However, if the tooth has no sensitivity, it is deemed dead.
The other test is the electric pulp test, which utilizes a tiny electrical stimulus to determine the nerve response of the teeth.
Radiographic Evaluation
This is a dental diagnosis that involves dental X-rays and CT scans to detect a tooth abscess. An X-ray of the periapex area of the abscessed tooth reveals the extent to which the infection has spread and whether there is bone damage around the area. An X-ray of the entire mouth, including all the teeth, jaws, sinuses, and the temporomandibular joint, provides the dentist with 2D images of the whole mouth.
Your dentist can order a CT scan, depending on the severity of the abscessed tooth, to determine whether the bacterial infection has spread to the neck, its size, and its location.
If the images from the periapical x-ray show darkness around the periapex, you might be experiencing jawbone loss because of the infection.
Available Treatments for Periapical Abscesses
After the dentist diagnoses you with a tooth abscess, they will administer treatment, contingent on the extent of your infection, your overall health, and the tooth’s condition. The standard treatment options for a periapical abscess are:
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Preliminary Emergency Care
If your swelling is severe, the dentist will surgically drain the pus to alleviate the pain. The procedure entails making an incision to drain the pus. Next, the dentist uses sterile saline to flush the drained area and remove any remaining infection. Based on your situation, the dentist can apply a rubber drain in the cut to allow any remaining infection to drain for a few days.
If the abscess has already burst, you will experience immediate pain relief, but the infection will remain. Worse still, it could even spread to other areas, such as the throat and airway. Therefore, whether the abscess bursts on its own or is surgically drained, the dentist will administer antibiotics as part of emergency care to prevent bacterial spread.
Additionally, the dentist administers antibiotics if the infection has weakened your immune system or if your face has swollen extensively.
The purpose of administering antibiotics is not to heal the abscess but to deter the spread. You must treat the abscessed tooth to stop the infection from returning.
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Tooth Preservation Through Root Canal
Your dentist or endodontist can preserve the abscessed tooth through a root canal. In the process, the dentist:
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Administers local anesthesia to ensure the process is virtually painless
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Drills a small hole in the infected tooth or crown of the tooth to gain access to the pulp
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Removes the infected pulp tissues and pus
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Cleans the pulp chamber
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Shapes the canal to ensure proper filling
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Inserts a gutta-percha in the canal to ensure proper sealing of the tooth to prevent further bacterial growth
In some cases, a crown is placed on the tooth that has undergone the root canal procedure.
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Tooth Removal
If the tooth is severely damaged, the dentist may recommend removing it as a last resort. After extraction, you can replace the missing teeth with implants, dental bridges, or partial dentures.
Find a Seasoned Emergency Dentist Near Me
If you are experiencing periapical abscess symptoms, particularly the life-threatening ones, like high fever, extensive facial swelling, and difficulty breathing, you should schedule an emergency appointment with your dentist immediately. Treating the abscessed tooth immediately could save your life if the infection has spread systemically.
At Lasting Impressions Dental Spa, we will guide you through the diagnosis and treatment process with professionalism and compassion. Call us at 818-751-5100 to arrange a consultation in Encino, CA.
