Dental Abscess

Emergency dentistry is a branch of dentistry that deals with sudden issues with teeth or the mouth that might cause tooth loss or infection. It aims to treat dental problems that need quick attention, like an abscess. An abscess is a pus-filled pocket caused by a bacterial infection in a tooth.

A dental abscess can cause pain and affect your daily life. If you have one, you don’t want to wait long for emergency dental assistance to treat the pain and swelling. An untreated abscess can cause serious issues; for example, the infection can spread to important organs, like the brain, and become life-threatening. At Agoura Hills Advanced Dentistry, our dentists offer emergency dental services to treat dental abscesses. Contact us today to find out how we can assist you.

Understanding Dental Abscess

A dental abscess is a pus buildup inside the gums or teeth, usually from a bacterial infection in the tooth’s soft pulp. These bacteria can thrive when someone doesn’t brush their teeth for a while, leading to plaque. If a person skips brushing and flossing regularly, bacteria can spread in the gums or soft tissues and eventually cause an abscess.

You’re more likely to get an abscess if a tooth’s pulp chamber gets damaged. This chamber holds the tooth’s nerves, blood vessels, and connective tissues. It usually stays sealed to protect these soft tissues. But if decay or injury opens it up, bacteria can enter, leading to infections or abscesses.

There are several types of dental abscesses based on where they occur:

• Periapical Abscess — A periapical abscess happens due to a long-lasting infection at the tip of a tooth’s root. Children get this more often than adults, especially if they don’t keep up with their dental hygiene
• Gingival Abscess — Gingival abscess affects only the gum tissue and doesn’t involve the tooth or the supporting ligament
• Periodontal Abscess — Periodontal abscess starts in the space around the tooth. Adults are more likely to get this type than children. It comes from the bone and tissue supporting the tooth, creating a pocket between the tooth and gums
• Pericoronal Abscess — A pericoronal abscess involves the soft tissues around the crown of a tooth
• Combined Periodontic-endodontic Abscess — This dental abscess is a mix of both periapical and periodontal abscesses

Out of these, the periapical abscess is the most common, followed by the periodontal abscess.

Signs and Symptoms of Dental Abscess

A dental abscess causes a lot of pain. The pain usually originates in the tooth or spreads to the neck, jaw, or face, depending on where the abscess is. You might notice the affected tooth:

• Is sensitive to hot or cold foods or drinks
• Seems loose in the jaw
• Feels tender
• Hurts when you apply pressure or tap it
• Looks slightly raised

You might also have other symptoms like:

• Bleeding gums
• Redness in the affected area or skin
• Swelling in your face or gums
• Swollen lymph nodes in your neck
• Feeling generally unwell
• Fever

During a dental exam, a dentist might find swelling and redness around your mouth or a movable mass in the area. A periodontal abscess can also show a gum boil, known as parulis, a soft red bump between the gum and cheek. This boil can come from the abscess and is a clear sign of one, but it’s not an abscess on its own.

Besides the symptoms mentioned, a severe dental abscess can also lead to:

• Cellulitis, which is a skin infection
• Trouble speaking
• Lockjaw
• Dehydration
• Difficulty breathing from swelling

Overall, a dental abscess can make you feel sick. You might get a fever around 38 degrees Celsius and have severe pain that doesn’t go away with over-the-counter painkillers. You should get emergency dental care if you notice any of these symptoms. A good dentist can help you and give you antibiotics to manage the infection and pain until you get the right treatment.

Causes of Dental Abscess

A dental abscess happens when bacteria enter the dental pulp, the soft part inside your tooth with connective tissues, blood vessels, and nerves. The bacteria usually come in through a crack or chip in your teeth and spread to the pulp, causing inflammation and swelling at the root tip.

Whether you get a dental abscess can depend on several risk factors, like:

• Poor Dental Hygiene — Not taking care of your teeth properly, like not brushing twice a day or skipping flossing, increases your risk of getting a dental abscess
• Dry Mouth — A dry mouth can make tooth decay more likely, often due to aging or certain medications
• Health Issues Conditions like diabetes and other autoimmune diseases can raise your risk for dental abscesses, so it’s important for people with these issues to take good care of their teeth and have regular checkups.
• High Sugar Diet — Eating or drinking a lot of sugary stuff, like sodas and sweets, can lead to cavities and eventually a dental abscess
• Not Enough Fluoride — Not using fluoride properly on your teeth or not rinsing with fluoridated water or toothpaste can also be a factor

Issues that can Arise from a Dental Abscess

Ignoring a dental abscess is risky and can be life-threatening. A serious dental abscess can cause the following issues:

• Infection of the Surrounding Bone — Facial bones, especially the jaw, can’t handle long-term infections. If the infection spreads to these bones, doctors might need to surgically remove them to prevent further issues. Even if surgery isn’t needed, the infection can still weaken the bone, making it harder for your jaw to support your teeth
• Infection in Sinuses and Soft Tissues — The roots of some upper teeth go into the sinuses, so an abscess in one of these teeth can lead to a painful sinus infection. The soft tissues around your mouth can also get infected, leading to complications like facial swelling or airway issues
• Tooth Loss — If you catch and treat an abscess early, you can usually save the tooth. But if you leave it untreated, the tooth might weaken and become too risky for treatment. In that case, you’ll need a tooth replacement, like a dental implant, to keep your mouth functioning well and protect your jawbone.
• Brain Abscess — A brain abscess is very dangerous and also requires hospitalization. Brain infections can happen in various ways, but septicemia is the most common. Treating this condition can be tricky because of the blood-brain barrier
• Septicemia — Septicemia happens when the whole bloodstream gets infected. Normally, the body fights infection by sending more blood and antibodies to the area. But septicemia occurs when an infection bursts and spills into the bloodstream, spreading throughout the body. This serious condition needs long-term hospital care and intravenous antibiotics
• Ludwig Angina — Ludwig Angina is a fast-moving infection in the spaces under your chin and jaw. It shows up as swelling on the floor of your mouth, pushing your tongue up and back. If you don’t treat it, the infection can quickly spread to your neck
• Cavernous Sinus Thrombosis (CST) — A CST happens when a dental abscess spreads to the cavernous sinus through a network of veins that don’t have valves
• Dental Cysts — If you don’t treat a dental abscess, it can turn into a fluid-filled cavity at the root of your tooth, known as a dental cyst. This cyst can get infected, so treating it with antibiotics is important. Your dentist can also remove it surgically with local anesthesia

Testing and Diagnosing Dental Abscess

You should immediately see a dentist if you notice any of the symptoms mentioned, especially swelling and fever. Sometimes, a dentist might help relieve your pain based on its severity, but getting proper dental care is the best way to handle your pain and condition. It can be tricky to tell the difference between a periapical and periodontal abscess, but your dentist will use various methods to figure it out. Here’s how they do it:

• If you have swelling near the root of your tooth, you might have a periapical abscess. If the swelling is closer to your gums, it’s likely a periodontal abscess
• A periodontal abscess usually drains through the gum pocket, while a periapical abscess drains through a bump near the infected tooth
• If the tooth has gum disease, there’s a higher chance of a periodontal abscess, which can cause bone loss and pockets. If the tooth’s gums are generally healthy, it’s more likely a periapical abscess
• If you feel sensitivity to cold, it may indicate previous pulpitis, suggesting a periapical abscess
• With periodontal abscesses, swelling often comes before the pain, while with periapical abscesses, pain usually comes first
• If the tooth isn’t decayed and doesn’t have major restorations, it might be a periodontal abscess
• In general, you’ll feel more tenderness in periodontal abscesses when tapping sideways, while periapical abscesses will hurt more when tapped on the top

To make a diagnosis, the dentist will first ask about your medical history and the symptoms you’re having. Then, they will examine your teeth and gums closely. They’ll check the infected tooth and assess your pain and sensitivity by:

• Blowing air on the tooth gently
• Using slight electric impulses to stimulate the dental nerves
• Testing the dental nerve with cold or heat
• Placing a probe between the gum and tooth to check for tissue loss and gaps

Apart from these methods, dentists can use other ways to diagnose an abscessed tooth, such as:

• Lab Tests — If the first antibiotic doesn’t work, your dentist can take a sample of the infection to determine which bacteria are causing it. These help create a better treatment plan
• X-rays — An X-ray or a CT scan can help confirm if it’s an abscess

Treatment of Dental Abscess

Treating a dental abscess aims to clear the infection and relieve your pain. The treatment depends on your symptoms and the evaluation of your dental X-ray. Based on the type and severity of the abscess, your dentist might suggest:

Draining the Dental Abscess

If the abscess is small and on the gum’s surface, your dentist can drain the pus by making a small cut in your gum. They’ll position your head at elbow level with some support. The dentist will adjust your lower jaw to be parallel to the floor while keeping your mouth open.

They will also lean you back to make your upper jaw about 60 to 90 degrees to the upper jaw and turn your head to make the abscess site easier to reach.

The dentist will wear a face shield, gloves, or safety glasses. Then, they will pull back the soft tissues to see the abscess. After getting everything ready, they will move on to the next steps.

Administer Anesthesia

The local anesthesia for draining a dental abscess might not work well because of the low pH. So, your dentist will use more solutions than usual but will be careful not to exceed the maximum dose.

Keep in mind, injecting local anesthesia can spread the infection. That’s why your dentist will likely choose a dental nerve block, procedural sedation, or other types of anesthesia. If needed, they might inject local anesthesia into the healthy tissue next to the abscess to help with the nerve block.

Incision and Draining the Abscess

The dentist will check the abscess to see how far it spreads and find the best spot for drainage. They will then make a one to two-centimeter incision in the abscess, avoiding fragile or dead tissue.

Your dentist will use gauze or suction to get rid of the pus. Then, they insert a hemostat into the abscess space until clumps break up. The dentist should do this in different directions to create a larger opening. Once they finish draining, they won’t close the abscess area while the jaw is open to avoid damaging important structures, and they will remove the hemostat.

Next, the dentist will rinse the area with sterile saline using a large syringe with a catheter attached. They should apply enough pressure until all the fluid flows back, and then suction it out.

Root Canal Therapy

If your tooth is infected, your dentist might suggest a root canal to treat your dental abscess. This procedure can save your tooth from decay. The dentist removes the nerve and pulp, then cleans and seals the tooth.

Taking out the nerve doesn’t harm the tooth’s health or function. It just helps you with sensitivity. So, losing it won’t change how your tooth works.

Getting a root canal usually takes one or more visits to the dentist. If your dentist can’t do it, they’ll refer you to an endodontist, who specializes in treating issues with the tooth’s pulp.

First, your dentist will take an X-ray to check the shape of the root canal and look for signs of infection. Then, they’ll numb the area with local anesthesia. While anesthesia isn’t always necessary, your dentist might use it to help you feel more comfortable.

Next, the dentist will dry the area using a rubber sheet around the infected tooth. They’ll drill a hole in the tooth and remove the pulp, bacteria, and debris. They’ll use various root canal files to clean the insides, flushing away the debris with sodium hypochlorite or water.

After cleaning, the dentist will seal the tooth. They might wait up to a week to do this, especially if the infection is serious and needs medication. If the tooth looks clean, they might seal it the same day. If they wait, they’ll fill the outside hole to keep things clean until your next visit.

At your next appointment, the dentist will fill the inside of the tooth with a rubber compound called gutta-percha and seal the outside access hole with a filling.

Tooth Extraction

Your dentist will numb the area around the tooth with a local anesthetic. Sometimes, they might use a stronger general anesthetic to put you to sleep during the procedure.

Next, the dentist will use forceps to wiggle your tooth until it falls out. They will then give you a gauze pad to bite down on until the bleeding stops. Sometimes, your dentist will use a few stitches to close up the gum where the tooth has been removed

Prescribe Antibiotics

Your dentist can treat a dental abscess with antibiotics. However, they will only prescribe antibiotics if you have a serious infection and a weak immune system.

The type of antibiotics you need depends on the bacteria causing the infection, so your dentist will pick the ones that can effectively eliminate it.

Common antibiotics for tooth infections are from the penicillin group, like amoxicillin and penicillin. They may also prescribe metronidazole for specific infections, but penicillin is usually better for infections with different types of bacteria.

Even though penicillin is often used for tooth infections, many people are allergic to it. Tell your dentist about past allergic reactions to avoid bad side effects.

Find an Emergency Dentist Near Me

If you have a lot of pain and swelling in your mouth, make an appointment with an emergency dentist. You might already have a tooth abscess. You should get this treated quickly to prevent any further issues. An emergency dentist can answer your questions and determine the best treatment. At Agoura Hills Advanced Dentistry, we’re proud to offer great emergency dental care in Agoura, CA. If you want to make an appointment or have any dental questions, just give us a call at 818-878-7300.