Dental Abscess : Causes, Symptoms, Diagnosis, Treatment

Dental Abscess : Causes, Symptoms, Diagnosis, Treatment

dental abscess

Everyone who has ever had a pimple has had an dental abscess, even though they’re tiny, they’re still abscesses.
An abscess forms when normal tissue, like the gingiva or gums and teeth, for example, is split apart and that new space is invaded by nearby pathogens like bacteria.
In a healthy mouth, normal or commensal bacteria thrive but don’t cause disease.
However, any cut or break in the mucosa is an invitation for bacteria to dive in and multiply, causing an infection.
When that happens, the immune system typically responds and a battle ensues with the result being pus – a mixture of bacteria, immune cells, and dead tissue.
So, in response to an injury, cells release small chemicals called cytokines, like tumour necrosis factor, interleukin-1, interleukin-6, interleukin-8, and interleukin-17, and these attract nearby immune cells.
It’s kinda like like yelling for help and being heard by the nearby police.
In addition, the cytokines also dilate nearby capillaries and make them leaky – which brings more blood to the site, and allows immune cells that do show up, to easily slip out of the blood and into the tissue.

What is Dental Abscess?

Although herpes is most contagious when there are virus-filled lesions present, it can also spread by asymptomatic shedding which means that herpes viruses can be in saliva even when there are no signs of a cold sore. Typically, when the herpes virus lands on a new host, in other words, a person that’s never had herpes before, it dives into small cracks in the skin or mucosa and binds to epithelial cell receptors, which trigger those cells to internalize the virus. Once inside, the virus starts up the lytic cycle, which is where its DNA gets transcribed and translated by cellular enzymes which help to form viral proteins which are packaged into new herpes viruses which can leave to go off and infect neighbouring epithelial cells. HSV1 and HSV2 also infect nearby sensory neurons and travel up their axon to the neuron’s cell body to start up the latent cycle. The sensory neurons of the face have their cell bodies in the trigeminal nuclei and those around the genitalia are located in the sacral nuclei. So that’s ultimately where the herpes virus settles in—for life! You see, the sensory neurons aren’t destroyed, instead, they become a permanent home for the herpes virus, and from time to time, the herpes virus makes a few viral copies of itself and sends those virus particles back down the axon so they can get released and infect epithelial cells. Since the trigeminal and sacral nuclei serve just one side of the face or body, herpes vesicles and ulcers develop on the ipsilateral or same side as the affected nuclei. This can happen over and over again throughout a person’s lifetime, with classic triggers being things like stress, skin damage, and viral illnesses. Recurrent episodes are usually less severe than the primary infection, and sometimes there are no symptoms at all. When there are symptoms, there might be a characteristic tingling or burning sensation, called a prodrome, one or two days before the blisters appear.
Dental Abscess

Types of Dental Abscesses

here are a few different types of dental abscesses.
The first one is called a periapical abscess, and it’s located at the apical foramen of the tooth.
A periapical abscess begins when bacteria gain entry into the dental pulp of the tooth through an opening caused by dental caries or from trauma.
The inflammation then spreads and causes necrosis or tissue death throughout the entire length of the dental pulp. And if it goes on without treatment – like a root canal, then the infection ultimately reaches the apical foramen of the tooth.
Subsequently, the infection reaches the periapical tissues and at that point, it’s considered apical periodontitis, which is inflammation of the periapical tissues which secure the tooth in its socket.
The infection usually develops into an abscess as the pus coalesces, and it can involve nearby structures like the alveolar bone and adjacent teeth.
Sometimes periapical abscesses become quiescent, meaning that they don’t grow much but the bacteria remain alive within the abscess cavity.
In that situation, it’s called chronic inflammation, and it’s where a periapical granuloma forms
from this walled-off area.
Technically, the term “granuloma” is a misnomer in this case since these lesions
don’t look like normal granulomas under a microscope.
During this stage where there’s a stalemate between the infection and the immune system,
if the infection gains the upper hand, then it’s called an acute apical abscess.
Another type of dental abscess is a periodontal abscess, and that involves both the periodontal structures and the gingiva.
Typically, a periodontal abscess occurs when there’s a pre-existing periodontal pocket, perhaps from a deep plaque collection or from a medical procedure.
Bacteria get into the periodontal pocket, and multiply, leading to an infection and an abscess.
Next, there’s the gingival abscess, which is where the abscess only involves the gingiva next to the bone, called the marginal or interdental gingiva, while sparing the periodontal structures.
This usually occurs when food, plaque, or another foreign object gets stuck in the gingival sulcus, providing a protected place for bacterial growth.
Finally, there’s a pericoronal abscess.
This occurs when a tooth does not erupt completely, leaving a flap of gingival tissue over the top of the crown.
When food or another foreign object gets deeply trapped between the flap of gingival tissue and the top of the tooth, an abscess can form.
Generally speaking, dental abscesses contain a mix of different bacteria.
Some are facultative anaerobes, which means that the bacteria prefer to make energy using oxygen but can also survive without oxygen, like the Streptococcus anginosis group and the viridans group of Streptococci.
Others are obligate anaerobes, which means that the bacteria thrive only in the absence of oxygen, like Fusobacterium and Prevotella groups.

Dental Abscess

Symptoms of Dental Abscesses

Symptoms of dental abscesses mainly include local pain and swelling, as well as generalized symptoms like fever and malaise.
Dental abscesses can cause affected teeth to loosen and they can sometimes create a fistula to the surface, where the tissue overlying the abscess breaks down, allowing it to drain out by itself.
This can either be within the mouth or out through another surface like the cheek.
The abscesses can also erode into nearby structures such as the nasal sinuses – causing sinusitis, the floor of the mouth, or even into the neck.
Diagnosing a dental abscess is usually done by feeling for areas of tenderness and fluctuance,
and imaging studies like x-rays or a CT scan can be done to determine the exact location and size.
Generally speaking, infections are treated with antibiotics, but for antibiotics to work, they need to first reach the bacteria, and that’s usually done through the bloodstream.
Since abscesses do not have blood vessels inside of them, the antibiotics can only diffuse into an abscess and that’s not very effective especially when dealing with a large abscess; you could imagine it getting to bacteria close to the edges, but there’s no way it’s getting to the bacteria in the middle.
That’s why the most important treatment for an abscess is incision and drainage – in other words, cutting it open and removing the pus.
This is typically followed by frequent saltwater rinses, pain-relieving medications, and regular check-ups.
For periapical abscess, a root canal treatment or extraction has to be performed on the offending tooth to get rid of the infection that cannot be reached by an incision and drainage or antibiotic treatment.
Sometimes, antibiotics are used even after drainage to make sure that no additional bacteria are lingering around.

as a quick recap:
Dental abscesses are a mix of immune cells, pathogens such as bacteria like viridans group Streptococcus, and dead tissue.
Common types include periapical, periodontal, gingival, and pericoronal abscesses.
Because there’s no blood supply to the middle of an abscess to deliver antibiotics, it usually needs to be cut open so that the pus can drain out.
For periapical abscess, a root canal treatment or extraction has to be performed on the offending tooth.

mix of immune cells

Common Causes of Dental Abscesses

An abscess is a painful infection that arises when bacteria gain access to the pulp tissues of a tooth by way of a crack, leaking dental restoration like a crown or large filling, or even the lateral canal which may naturally occur and be exposed to the oral cavity by gum recession.
Many different species of bacteria are found in the mouth, and the ones that decay teeth may be different from those that produce abscesses. A decayed tooth simply creates favourable conditions for bacteria to multiply. The body responds to foreign invaders like bacteria by increasing blood flow to the tooth to deliver specialized cells that can fight the infection. The increased blood flow to the tooth, known as “hyperemia” produces intense pressure inside, because teeth are rigid and cannot swell. Pressure on the nerves inside leads to a severe toothache.
Eventually, the toot’s fresh blood supply is cut off by the high pressure inside of it, and the tissue inside dies. The tooth may stop hurting, but the problem has simply changed location.
The infection then spreads into the jaw bone, where fluid accumulation causes throbbing, swelling, and sometimes numbness. An abscess is a true dental emergency and is usually treated by some combination of antibiotic therapy, endodontic treatment (root canal) or removal of the tooth.

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