DENTAL ABSCESS

A dental abscess is a localized collection of pus as a result of a bacterial infection associated with the tooth.

Types of dental abscess:

1.      Periapical abscess: Localized collection of the pus at the tip of the root. Usually occurs as a result of untreated dental caries that further approaches the pulp and lead to inflammation of pulp due to bacterial invasion.

2.      Gingival abscess: Localized collection of the pus involving only gum tissue. The abscess is due to the external damage to the gum tissue either due to food lodgement or digging the area with a toothpick.

3.      Periodontal abscess:  Localized collection of the pus involving bone adjacent to the tooth. occurs as a complication of advanced periodontal disease. It occurs when bacteria invade and multiply within the soft tissue of the gingival crevice/periodontal pocket.

4.      Pericoronal abscess: Localized abscess involving the gum tissue surrounding the crown of a partially or fully erupted tooth. It is often associated with lower 3^rd molar.

5.      Combined periodontal/ endodontic abscess: A situation in which a periapical abscess and a periodontal abscess have combined

The most common type of dental abscess is a periapical abscess, and the second most common is a periodontal abscess. 

SIGNS AND SYMPTOMS:

·         Severe toothache

·         Swollen lymph nodes

·         Fever

·         Pain on percussion

·         Unpleasant taste in mouth

·         Sensitivity to hot and cold

·         Swelling or pimple like bump in the affected region.

DIAGNOSTIC APPROACH:

Since the management of a periodontal abscess is different from that of a periapical abscess, this differentiation is important to make.

·         If the swelling is over the area of the root apex, it is more likely to be a periapical abscess; if it is closer to the gingival margin, it is more likely to be a periodontal abscess.

·         In a periodontal abscess pus most likely discharges via the periodontal pocket, whereas a periapical abscess generally drains via a parulis nearer to the apex of the involved tooth.

·         In periodontal abscesses, the swelling usually precedes the pain, and in periapical abscesses, the pain usually precedes the swelling.

·         A history of toothache with sensitivity to hot and cold suggests previous pulpitis,  and indicates that a periapical abscess is more likely.

·         A dental radiograph  is of little help in the early stages of a dental abscess, but later usually the position of the abscess, and hence indication of periodontal etiology can be determined. If there is a sinus, a gutta percha point is sometimes inserted before the x-ray in the hope that it will point to the origin of the infection.

·         Generally, periodontal abscesses will be more tender to lateral percussion than to vertical, and periapical abscesses will be more tender to apical percussion.

TREATMENT:

·         Centers on the reduction and elimination of the offending organisms.

·         Treatment with antibiotics and drainage.

·         If the tooth can be restored, root canal  therapy can be performed.

·          Non-restorable teeth must be extracted,  followed by curettage of all apical soft tissue.

·         Unless they are symptomatic, teeth treated with root canal therapy should be evaluated at 1- and 2-year intervals after the root canal therapy to rule out possible lesional enlargement and to ensure appropriate healing.

·         Following conventional, adequate root canal therapy, abscesses that do not heal or enlarge are often treated with surgery and filling the root tips; and will require a biopsy to evaluate the diagnosis.

                                                                                

                                                                                                  

                                                                               DR. ANJUSHA SHARDA