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Tooth Abscess by Rick Alan

En Español (Spanish Version)

Definition

A tooth abscess is a sac of pus (infected material) in a tooth or the gums. There are two types of tooth abscesses:

Abscess of the pulp (blood and nerve supply inside the tooth)
Abscess between the tooth and gum

Abscess Between Tooth and Gum

Causes

A tooth abscess is caused by bacteria. It begins when bacteria invade and infect a tooth. This results in pus build-up. When the pus is unable to drain, an abscess results.

Conditions that allow bacteria to invade a tooth:

Severe tooth decay
Break or crack in a tooth that lets bacteria invade the pulp

Food or other foreign matter that becomes trapped between the tooth and gum may lead to a bacterial infection in the area around the tooth.

Risk Factors

These factors increase your chance of developing a tooth abscess. Tell your dentist if you have any of these risk factors:

Build up of tartar or calculus beneath the gum line
Poor fluoride application to teeth via fluoridated water, toothpaste, or mouthwash
Poor dental hygiene (leading to cavities and periodontal diseases)
Malnutrition, including severe vitamin and mineral deficiencies

Symptoms

If you have any of these symptoms do not assume it is due to a tooth abscess. These symptoms may be caused by other conditions. Tell your dentist if you have any of these:

Throbbing/lingering pain in a tooth or gum area
Pain when biting on a tooth
Spontaneous tooth pain
Redness, tenderness, or swelling of the gums
Fever
Swollen neck glands
Tooth discoloration
Bad breath or foul taste in mouth
Open, draining sore on the gums

If left untreated, complications of tooth abscess include:

Loss of tooth and surrounding tissues or bone
Spread of infection to surrounding tissue or bone

Diagnosis

Your dentist will ask about your symptoms and medical history and perform a detailed exam of your teeth and gums.

Your dentist will test the tooth for pain and sensitivity by:

Lightly tapping on the tooth
Stimulating the tooth nerve with heat or cold
Stimulating the tooth nerve with a low electrical current
Sliding a probe between the tooth and gum to measure gaps or tissue loss

Your dentist will also take an x-ray of the tooth and surrounding bone.

Treatment

Removal of Abscess Via Root Canal

If an abscess results from tooth decay or a break or crack in the tooth:
- The tooth and surrounding tissue is numbed and a hole is drilled through top of the tooth.
- Pus and dead tissue are removed from the center of the tooth.
- The interior of the tooth and the root (nerve) canals are cleaned and filled with a permanent filling.
- A crown is placed on the tooth to protect it.
If an abscess results from infection between the tooth and gum:
- The abscess is drained and thoroughly cleaned.
- The root surface of tooth is cleaned and smoothed.
- In some cases, surgery to reshape the gum is done to prevent recurrence of infection.

Tooth Extraction (Removal)

Removal of the tooth may be required if:
- Tooth decay and/or tooth infection is too extensive for filling or root canal treatment.
- The break or crack in the tooth is too severe to be repaired.
- The infection or loss of tissue/bone between the tooth and gum is severe.
If the tooth is extracted, it will be replaced with a:
- Partial bridge
- Denture
- Tooth implant

Medication

Antibiotics to fight residual infection of the tooth or gums
Nonprescription pain relief drugs ( ibuprofen or acetaminophen ) and warm salt water rinses

Prevention

To help reduce your chance of getting a tooth abscess, take the following steps:

Proper dental hygiene, including:
- Brushing teeth with fluoride toothpaste after meals or at least twice per day
- Daily flossing between teeth and gums
- Regular dental check-ups (every six months)
- Regular professional teeth and gum cleaning (every six months)

RESOURCES:

Academy of General Dentistry http://www.agd.org/consumer/
American Dental Association http://www.ada.org/

CANADIAN RESOURCES:

Canadian Dental Association http://www.cda-adc.ca/
The Canadian Dental Hygienists Association http://www.cdha.ca/

References:

Beers MH, Fletcher AJ. The Merck Manual of Medical Information—Home Edition . New York, NY: Simon and Schuster, Inc.; 2000.
Root canal (endodontic) treatment. American Dental Association website. Available at: http://www.ada.org/public/topics/root_canal.asp#overview . Accessed July 2, 2008.
Tooth abscess. US National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001060.htm . Updated August 8, 2007. Accessed July 2, 2008.

Last reviewed September 2009 by Laura Morris-Olson, DMD

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