What is a dental abscess?
An abscess is a collection of pus. Pus is a thick fluid
that usually contains white blood cells, dead tissue and bacteria
(germs). The usual cause of an abscess is an infection with bacteria.
A dental abscess is a localised collection of pus in a tooth, or in nearby structures. They are classified into two main types:
Periapical abscess
This type of abscess
starts in the dental pulp (centre of the tooth). This is the most
common type. This type of abscess usually develops as a complication of
tooth decay (caries). Dental decay is very common and erodes (damages
and breaks down) the protective layers of the tooth (the enamel and
dentine). The damage to the tooth allows bacteria to invade the pulp to
cause an infection.
An infection in the pulp can progress to
form an abscess. Sometimes a periapical abscess develops if the nerve
to the tooth 'dies' for any reason. For example, from injury. The
'dead' tissue inside a tooth is more prone to infection.
Periodontal abscess
This type of abscess
starts in the supporting structures of the teeth such as the
periodontium which is between the tooth and the gum. It most commonly
develops as a complication of gum disease (periodontal disease) which
is infection or inflammation of the tissues that surround the teeth.
Gum disease often causes the gum to become slightly detached from the
tooth. This causes 'pockets' to form which may get filled with bacteria
and progress to form an abscess. A periodontal abscess may also develop
as a complication of injury to the gums or periodontium. A periodontal
abscess is sometimes called a 'gum boil' as the abscess causes a
swelling to develop next to a tooth.
What are the symptoms of a dental abscess?
Symptoms typically include one or more of the following:
- Pain (toothache) which can quickly become worse. It can be severe and throbbing.
- Swelling of the gum which can be tender.
- Swelling of the face. The skin over an abscess may become red and inflamed.
- The affected tooth may become tender to touch, and may even become loose.
- High temperature (fever) and feeling generally unwell.
- In severe cases there may be spasm of the jaw muscles with difficulty swallowing and/or breathing.
What is the treatment of a dental abscess?
Initial treatment
See a dentist as soon as
possible. A dentist will normally drain the pus and this often gives
great relief of symptoms. This is done either by lancing the abscess or
by drilling a small hole in the tooth to let the pus escape. Sometimes,
if the infection is not contained, an antibiotic is prescribed for a
few days after draining the pus to clear any remaining infection.
However, in most cases an antibiotic is probably not needed once the
pus is drained.
If there is a delay in seeing a dentist, a
doctor or nurse may prescribe an antibiotic to help prevent the abscess
from getting worse or spreading. However, an antibiotic will not clear
the pus and cure the abscess. You still need to see a dentist soon. You
may also need painkillers such as paracetamol or ibuprofen until the
abscess is drained and treated. Note: paracetamol and ibuprofen can be
taken together if pain relief with either alone is not enough. Some
people require stronger painkillers prescribed by a doctor.
Further treatment may include the following:
For a periapical abscess
The treatment for
this type of abscess is normally root canal treatment. This treatment
aims to save and restore the damaged or dead inner part of a tooth (the
pulp). Briefly - a dentist will drill into the dead tooth and allow pus
to escape through the tooth, and then remove the dead pulpal tissue. A
root filling is then placed into the tooth to fil the space and prevent
further infection. (Note: even if pain has gone with an initial
emergency drainage of the pus, you are still likely to need root canal
treatment. This is because the infection and abscess will almost
certainly return unless the dead pulp tissue is dealt with.)
If the infection persists despite root canal treatment, the dentist may have to extract (remove) the tooth.
For a periodontal abscess
Once the pus is
drained, a dentist may clean the 'pocket' where the abscess had formed.
Following this a dentist may smooth out the root surfaces of the tooth
to encourage the gum to close back onto the tooth, and for any 'pocket'
to disappear. This helps to prevent a recurrence of infection. If you
develop repeated periodontal abscesses you may be referred to an oral
surgeon who may carry out a procedure to reshape the gum tissue.
What is the outlook (prognosis)?
If treated,
the outlook is good. The pus can usually be drained and the tooth can
be saved if it is not badly broken down. If left untreated, the abscess
may 'burst' onto the skin of the face, or into the mouth. This may
leave a sinus tract (a channel) between a persistent focus of infection
and the skin or mouth which can discharge pus from time to time. Other
complications are uncommon. However, they can be serious, even fatal in
rare situations. They include:
- Osteomyelitis - an infection of the nearby bone.
- Sinusitis - spread of infection to the nearby sinus in the face bone.
- A dental cyst (fluid filled cavity) may develop.
- Cavernous sinus thrombosis - an infection and clotting of a blood vessel in the brain. This is very serious.
- A serious, potentially life-threatening infection of the floor of
the mouth. This could spread to the face, brain or neck (symptoms of
serious infection are listed below).
So, the take home message is - if you have a dental abscess
then you should get it treated. This is not only to relieve pain, but
to prevent possible serious complications. Symptoms that may indicate
that a complication is developing, and where you should seek medical
help urgently, are:
- If you feel very unwell with a high temperature.
- You have any difficulty opening your mouth, swallowing or breathing.
- You have swelling of the floor of your mouth, face or jaw.
- You are in severe pain despite taking painkillers at maximum dose.
- You have a spreading infection of your face.
Complications are more likely to develop in people with
diabetes, and those with a poorly functioning immune system. For
example, people with HIV/AIDS, people taking chemotherapy, people who
have had their spleen removed, people taking steroids and people with
sickle-cell anaemia (not sickle-cell trait).
Can a dental abscess be prevented?
Most
dental abscesses are preventable as most are a complication of tooth
decay or gum disease - both of which can be prevented by good oral
hygiene. Briefly, this means regular tooth brushing and flossing. Other
things that may help include: mouthwashes, tongue cleaning, eating a
healthy diet which includes limiting sugary drinks and foods. If you
smoke, stopping smoking will improve oral hygiene. Have a dental check
up at least once a year. A separate leaflet called 'Oral Hygiene' gives more details.
How do I get to see a dentist?
If you suspect that you have a dental abscess, you should see a dentist as soon as possible. To access emergency dental care:
- See you own dentist if you are registered with one, or
- Go to the Accident and Emergency department of a dental hospital (if available), or
- Go to the local Dental Access Centre (if available), or
- If none of the above are available, go to your nearest general
hospital Accident and Emergency department or your GP; for
severe/urgent problems they may refer you to a hospital oral surgeon.
- If you are not sure where your local services are, then telephone
NHS Direct for advice on 0845 4647. (The phone number for Scotland (NHS
24) is 08454 242424.)
Dental fees
Some people are automatically
exempt from paying NHS dental charges. Also, some people on a low
income can make a claim for help with all or part of the costs. See
leaflet called 'Help With Dental Charges' for details.
Further help and information
British Dental Health Foundation
Helpline: 0845 063 1188 Web: www.dentalhealth.org.uk
A national charity that provides free, impartial advice on all aspects of oral health.
References
Disclaimer: This article is for information only and should not
be used for the diagnosis or treatment of medical conditions. EMIS and
PiP have used all reasonable care in compiling the information but make
no warranty as to its accuracy. Consult a doctor or other health care
professional for diagnosis and treatment of medical conditions.
© EMIS and PiP 2008 Updated: 18 Jun 2008
