Abscess is due to a bacterial infection which leads to pus accumulation in the soft pulp of the tooth. Abscesses have their origin from dead pulp tissue, due to untreated tooth decay, cracked teeth or extensive periodontal disease. A failed root canal treatment or RCT can also cause abscess.

Types of dental abscess

• Gingival abscess involves only the gum tissue and does not affects tooth and periodontal ligament
• Periapical abscess involves the dental pulp
• Periodontal abscess involves the supporting bone and tissue structures of the teeth

Signs and Symptoms

• Severe toothache
• Pain is continuous and is of gnawing, sharp, shooting, or throbbing nature
• Pressure or warmth worsens pain
• Swelling at the base of tooth, gum and cheek.
• Chronic abscess is usually painless but swelling may be present on the gum
• Perforated tooth abscess drains in surrounding tissues leading to localized swelling
• Palpable lymph nodes in the neck due to the infection
• Patient may have migraine like headache due to referred pain
• Pain will not transfer across the mouth as the two sides are innervated by different nerves

Treatment and Medications

• Topical application of oil of cloves containing Eugenol can effectively control pain
• Surgical elimination of the abscess
• Root canal therapy or RCT can be performed to restore tooth
• Tooth which is not restorable needs to be removed
• Curettage of all apical soft tissues is advised

Complications

• Cyst formation
• Inadequate root canal therapy
• Vertical root fractures
• Foreign material in the lesion
• Associated periodontal disease
• Penetration of the maxillary sinus