When we mention the word ‘abscess’, most patients think of a painful, purulent collection.
Tooth abscess is an increasingly common pathology among patients of all ages, particularly affecting people who only go to the dentist when they feel pain.
Tooth abscess can be localized at the root tip and occurs when the nerve is affected or it can be localized periodontally, materialized by a swelling in the gum, quite close to the dental crown.
Causes
Most often, abscesses that occur in relation to the root tip may have the following causes:
Deep decay that has not been treated in time and progresses with nerve damage.
Cavities occur due to acid attack and increased bacterial gradient. Initially, they evolve in the enamel, and over time attack dentin and progressively, untreated, reach the pulp chamber.
Incomplete or overflowing root canals – Root canal or endodontic treatments must be carried out up to a certain milestone to be sure that the entire root canal space has been prepared and obturated.
Otherwise, bacteria can continue to proliferate and produce abscesses. On the other hand, an endodontic treatment carried out with root canal over-filling may cause pain and abscess through the body’s reaction to the presence of a foreign body.
Dental abscess can be quite painful and, if not properly treated, can spread to other tissues in the head and neck, causing complex problems.
Treatment
Treatment of abscesses is carried out according to the degree of tissue involvement, as follows:
Endodontic treatment is the treatment of choice. This is the root canal treatment, where the canals of the tooth in question are thoroughly cleaned, after which, depending on the clinical situation, the tooth is left open or filled with biocompatible materials.
Root canal filling is the final step in the completion of endodontic treatment, and is intended to seal off the contaminated oral environment, thus preventing bacteria from entering the root space. If, after clinical examination, the clinician finds that the causative tooth is too badly damaged to be saved, this may indicate tooth extraction.
If the purulent collection migrates and externalizes to the gingival tissues, the doctor may double the drainage of the canals by making an incision in the soft tissues. This maneuver helps to decrease the swelling and speed healing.
If the abscess extends to the other spaces of the facial mass, the swelling may take different forms and, depending on the causative tooth, have particular localizations. In severe situations, when too much time is waited, the abscess extends to the integument, represents a maxillo-facial emergency and the indicated treatment is incision made in the skin and the application of drainage tubes.
Through these drainage tubes, communication with the infected spaces will be kept open and lavage with mild antiseptic solutions will be practiced until the symptoms subside.
After incision of an abscess, the causative factor should always be suppressed. Whether it is conservative, endodontic or radical treatment involving extraction, the causative factor must always be treated, otherwise there is a risk of recurrence.
