Under healthy conditions, the body is able to fight off disturbing factors. When this balance is disrupted, either by depressed immunity or by other factors, bacteria colonize the crevices around the tooth.
Dental abscess is a bacterial infection.
Dental infections and inflammations are emergencies for which patients seek the earliest possible attention from their dentist.
Dental caries, in its initial stage, is confined to the enamel. As it progresses, it spreads to the dentine, where it is easier for it to penetrate dental structures
If the caries process is not stopped, the inflammation may spread to the pulp chamber.
Once the nerve is affected and the pulp chamber is opened, the nutrition of the tooth will not be optimal, pain will increase in intensity and the treatment of choice is pulp removal.
The pain in this case may be relieved by taking painkillers but will not disappear.
After some time, if in this case too no intervention is made because the patient does not go to the doctor, the pulp of the tooth will undergo a process of necrosis, decay and the pain will disappear.
Although the dental pain disappears when the pulp is dead, the infection spreads to deeper structures, from the pulp chamber to the root canals.
Once it reaches the dental apices, the inflammation moves on to the periodontium, i.e., the supporting structures of the tooth.
Associated manifestations
For a period of time, the alveolar bone will limit the spread of inflammation.
Later, through evolution, the dental abscess will perforate the bone cortices and will extend towards the area of weakest resistance. At this point the inflammation takes the form of an abscess, confined to the oral mucosa. The formation of the abscess also coincides with a reduction in pain intensity, but other phenomena occur, such as:
A yellowish-white, soft-to-the-touch formation with a prominent tip appears at the mucosa where the abscess is discharged. It contains pus, which is externalized as a result of bacteria that have degraded the dental tissues through the development of caries.
The mucosa around the purulent formation is red, shiny, loose, showing signs of inflammation.
The pain manifests itself more in the form of discomfort when chewing, when in contact with hot food or when the patient lies down.
Fetid halitosis – is a sign that is felt by the patient and the entourage and is due to fermentative processes.
Due to severe inflammation of the adjacent mucous membranes, the mobility of the tooth involved may increase.
Also, by extending the inflammatory process to the surrounding areas, the patient may develop fever, chills and altered general condition.
How do we recognize a dental abscess?
A dental abscess is generally manifested by a throbbing pain, which does not subside when taking anti-inflammatory medication and persists at night.
In some cases, we may notice congested gums with a softer consistency on palpation due to inflammation.
The pain may also radiate to the surrounding teeth and the patient cannot locate the origin of the pain. In the affected area, the temperature of the skin and mucous membranes increases and is accompanied by swollen glands. The dentist will analyze the dento-parodontal status and will be able to indicate the tooth responsible for generating the infectious process based on the identification of the favoring factors.
Causes of dental abscesses
Caries – the lack of substance generated by carious lesions allows bacteria to advance into the dental pulp, infecting it.
Dental trauma – generates dental infection based on the same principle of loss of dental hard substance.
Dental abrasion is the wear of one or more teeth caused by mechanical processes (friction), most commonly by repeated chewing or insertion of hard objects between the teeth.
A common cause is inappropriate brushing, which leads to the dislocation of enamel prisms and the appearance of cuneiform lesions preceding periodontitis or dental abscess.
Dental abscess means wear of teeth caused by mechanical processes, parafunctional forces. These forces occur when the occlusal relationships between teeth are abnormal
Malocclusions with various etiologies, from loss of masticatory units to maladaptive prosthetic work.
The breakdown of these abnormal forces causes microcracks and microfractures in the tooth enamel, and in the long-term areas of wear appear on the tooth surface.
Dental erosion is caused by chemical processes occurring in the hard dental tissues (enamel and dentin).
The chemical process of destroying enamel prisms is basically the same as for dental caries. However, the source of acid is not the result of the metabolism of bacteria in the oral cavity, but can be an external or internal source, such as gastric acid in the case of bulimia, for example.
Tooth eruption – particularly the eruption of wisdom molars; the gum cap remaining over the crown of incompletely erupted teeth causes bacterial deposition at this level.
Subgingival tartar – compromises the gum-tooth seal responsible for protecting the underlying structures.
Periodontitis – untreated, unmonitored periodontitis is a veritable gateway for bacteria.
Factors contributing to tooth abscesses
If the factors mentioned above were triggers of purulent processes, the following factors can only influence the development of dental abscesses in the absence of dento-periodontal health. These are:
Stress
Diabetes – it should be noted that in diabetes the body’s natural defense processes are slowed down.
Recent upper respiratory tract infections – through communication with the oral cavity.
Types of abscesses by location
Gingival abscess – occurs as a result of gum injury
Periodontal abscess – is located in the ligamentous tissues that hold the tooth in the socket. The detachment of these from the tooth leads to the formation of periodontal pockets, a fertile environment for bacterial growth.
Peri coronal abscess – at the time of tooth eruption, in the tissues surrounding the crown.
Complications of dental abscess
Complications of abscess can occur in the form of bone destruction in the tooth concerned or it can migrate, in the case of teeth on the upper arch, into the maxillary sinus. In severe cases, when the infection is ignored, it can spread via the bloodstream to other organs. In the heart, it can cause bacterial endocarditis. If the infectious invasion becomes widespread, there is a risk of sepsis
Treatment
Treatment of abscesses is emergency and involves a complex approach. In the first phase, the abscess is incised downhill to encourage the pus to flow. Local washing with antiseptic substances is also carried out when the abscess is incised.
Drainage of the tooth that caused the abscess should also be performed during the first session to clean the bacterial focus.
Definitive treatment of the tooth causing the abscess will be carried out when the acute symptoms have subsided. This consists of endodontic treatment, which involves the removal of bacterial debris and altered dentin from the root walls.
In other cases, depending on the size of the carious lesion and the destruction it has caused, the prognosis of the tooth is reserved and it can no longer be maintained on the arch, the indication being extraction.
Dental abscesses can be a complication of untreated dental caries, so prevention of this type of pathology is aimed at early presentation to the dentist to eradicate bacterial outbreaks.
In all cases where there is gingival fistulation, incision and drainage is indicated, followed by antibiotic treatment. To prevent recurrence, treat the lesions that led to the abscess and treat the tooth endodontically to prevent further bacterial seeding.
Conclusions
It is important to maintain rigorous oral hygiene as well as keeping appointments for check-ups at the dentist’s office.
This pathology is disturbing because of the severe pain it causes, the risks to which the whole body is subjected and the halitosis it generates.
Dental abscesses are therefore a pathology that can be entirely prevented by a good collaboration with the dentist.
