Dental Abscess
An abscess is a pathological cavity filled with pus caused by a bacterial infection. It is an acute purulent infection that develops in the apical part of a tooth. This condition is usually caused by bacteria originating from infected teeth in either the maxilla or the mandible.
There are two types of dental abscesses, periapical abscesses and periodontal abscesses. Periapical abscesses occur at the tip of the tooth root, while periodontal abscesses occur in the gums surrounding the tooth.
Children to adults can experience tooth abscesses. Someone who experiences a tooth abscess must get treatment from a doctor and cannot be treated independently. The infection that causes a tooth abscess must be treated immediately because the infection is at risk of spreading outside the jaw to the neck, head, or other parts of the body.
Symptoms of Tooth Abscess
In most cases, a tooth abscess causes sudden, worsening pain in the teeth and gums. In addition, there are other symptoms, such as:
1. The tooth feels throbbing pain.
2. There is pain in the teeth when chewing.
3. Teeth are sensitive to hot or cold temperatures.
4. Bitter taste in the mouth.
5. Bad breath.
6. Gums are red and swollen.
7. Loosening of teeth.
8. Swollen areas in the upper or lower jaw.
9. Fever.
10. Swollen neck glands.
11. Restless due to holding back pain.
Risk Factors for Dental Abscess
Various factors that can trigger bacterial infections that cause tooth abscesses include:
1. Smoking. Smokers are twice as likely to develop a tooth abscess as non-smokers.
2. Bad teeth cleaning habits. For example, not brushing your teeth before going to bed.
3. Having a dry mouth. A dry mouth can increase the risk of tooth decay. Dry mouth is usually caused by side effects of certain medications or problems related to aging. So bacteria thrive in the mouth with a small amount of saliva.
Causes of Tooth Abscess
The bacteria that play a role in the process of abscess formation are Staphylococcus aureus and Streptococcus mutans . Staphylococcus aureus in this process has an active enzyme called coagulase which functions to deposit fibrin. While Streptococcus mutans has 3 main enzymes that play a role in the spread of tooth infections, namely streptokinase, streptodornase, and hyaluronidase.
There are different types of dental abscesses that are distinguished by their location. The three most common types of dental abscesses are:
1. Periapical abscess, is an abscess located at the tip of the tooth root.
2. Periodontal abscess, is an abscess in the gums next to the tooth root. But it can also spread to the surrounding tissue and bone.
3. Gingival abscess, which is an abscess on the gums.
Meanwhile, some of the causes of tooth abscesses are:
1. Tooth decay
Damage to the hard surface of the tooth is often the main trigger of a tooth abscess. Tooth cavities can form when bacteria break down the sugar in food and drink, which then creates acid. Then, the acid attacks the tooth enamel and forms a cavity. Once the cavity is formed, bacteria can penetrate into every hole in the tooth and spread to the pulp.
2. Gum disease
Gums that are infected or inflamed can also trigger a tooth abscess. As gum disease progresses, bacteria gain access to deeper tissues. Therefore, treat gum disease immediately so that it does not develop a tooth abscess.
3. Injury
Trauma to the tooth can injure the inner pulp or cause the tooth to crack. Unfortunately, the cracked tooth is often not visible. In fact, cracked teeth must be treated immediately because they are susceptible to infection. When a cracked tooth becomes infected, bacteria can enter deeper into the tooth and cause a tooth abscess.
4. Poor oral hygiene
Poor oral hygiene can cause plaque to build up. This plaque buildup can eventually lead to cavities, especially if not treated immediately it can develop into a tooth abscess. Therefore, clean your teeth regularly and thoroughly using a toothbrush and floss.
5. Food consumption
Eating too much sugary and starchy foods can cause bacteria to grow in plaque. Then, the decaying plaque can eventually cause cavities that lead to dental abscesses, if left untreated.
6. Weak immune system
People with weak immune systems are usually more susceptible to tooth abscesses than healthy people. Usually, the immune system is weakened due to certain conditions. Such as diabetes, cancer, or having human immunodeficiency virus (HIV). Someone who is undergoing treatment such as steroids or chemotherapy is also more susceptible to tooth abscesses.
Diagnosis of Dental Abscess
To diagnose a tooth abscess, the dentist will ask questions about the patient’s complaints and medical history. For example, such as having experienced an injury, having a certain medical condition, or undergoing certain treatments. After that, the doctor will take the following actions to diagnose a tooth abscess:
Tap the tooth. Teeth with an abscess at the root are generally more sensitive to touch or pressure.
Panoramic X-ray. A panoramic dental X-ray or panoramic radiography is a scanning procedure of the upper and lower jaws to provide a two-dimensional image of the teeth. Your doctor will usually recommend a panoramic X-ray to identify an abscess and to find out if the infection has spread to other areas.
Computed Tomography Scan ( CT scan ). If the infection has spread to other areas in the neck, the doctor will need to do a CT scan to assess the extent of the infection.
Dental Abscess Treatment
The main focus of dental abscess treatment is to eliminate the infection. Here are the treatment options that a dentist can perform:
1. Abscess drainage
The dentist treats the abscess by making a small incision to allow the pus to drain out. Once the abscess has drained, the dentist will clean the area with salt water. Sometimes, the dentist will need to place a small rubber drain to keep the mouth area open for drainage while the swelling goes down.
2. Root canal treatment
This treatment aims to eliminate the infection and save the tooth. The dentist will drill into the tooth, remove the diseased central tissue (pulp) and drain the abscess. After that, the dentist will fill and close the pulp chamber and root canal. The tooth can be covered with a crown to make it stronger, especially if the infected tooth is a back tooth.
3. Tooth extraction
If the affected tooth cannot be saved, the dentist will need to extract the tooth and drain the abscess to eliminate the infection. Before extracting the tooth, the dentist will need to give a local anesthetic through an injection into the nerve around the tooth to be extracted. To reduce the pain from the injection, the doctor can also apply an anesthetic gel to the area to be injected first.
4. Antibiotic drugs
If the infection has spread to nearby teeth, jaw or other areas, your dentist will likely prescribe antibiotics to stop it from spreading further. Your doctor may also recommend antibiotics if you have a weakened immune system.
Prevention of Dental Abscess
Prevention can be done by routinely checking dental health, brushing teeth regularly especially before bed, and immediately treating any cavities or cracks. Here are the right ways to maintain dental health:
1. Brush your teeth at least twice a day with fluoride toothpaste.
2. Use dental floss or an interdental cleaner to clean between your teeth every day.
3. Replace the toothbrush every three or four months, or whenever the bristles fray.
4. Eat healthy foods, limit sweet foods and snacks between meals.
5. Visit your dentist for regular checkups and thorough teeth cleaning.
6. Consider using an antiseptic or fluoride mouthwash to add an extra layer of protection against tooth decay.
Complications of Dental Abscess
In most cases, untreated tooth abscesses can develop into complications. However, complications can still occur even though the tooth abscess has received treatment that seems effective. It’s just that it’s very rare.
Some possible complications are:
1. Dental cyst
A fluid-filled cavity can develop at the base of the tooth root if a tooth abscess is not treated promptly. This condition is called a dental cyst. There is concern that the cyst may become infected. If this happens, the patient may need antibiotics or even surgery.
2. Osteomyelitis
Bacteria in the abscess can enter the bloodstream and infect the bone. The sufferer will experience an increase in body temperature, pain in the affected bone, and accompanied by a start. Usually, the affected bone will be close to the location of the abscess.
However, because it may have spread to the bloodstream, any bone in the body may be affected, requiring oral or intravenous antibiotic treatment.
3. Cavernous sinus thrombosis
In addition, the spread of bacteria can cause blood clots to form in the cavernous sinus, a large vein in the brain. In some cases, this condition can be fatal. However, cavernous sinus thrombosis is a very rare complication.
4. Ludwig’s angina
This complication occurs due to infection in the floor of the mouth when the bacteria of the tooth abscess spread. This condition is accompanied by swelling and pain under the tongue and neck. In severe cases, sufferers may find it difficult to breathe. Ludwig’s angina is a potentially fatal complication.
5. Maxillary sinusitis
The bacteria spread into the small spaces behind the cheekbones, called the maxillary sinuses. This complication may not be serious, but it can be painful. The sufferer may have a fever and the cheeks may feel tender.
When to See a Doctor?
If you have a cavity or pain in your tooth, immediately check your teeth to the dentist. Proper handling can minimize the negative effects of a tooth abscess so that treatment can be done faster.