Dental Abscess Health Article

Definition

A dental abscess is a localized collection of pus in a cavity formed by the disintegration of tissues from a bacterial infection.

Description

Dental abscesses occur when a small area of tissue becomes infected and the body is able to "wall off" the infection and keep it from spreading. White blood cells, the body's defense against some types of infection, migrate through the walls of the blood vessels in the area of the infection and collect within the damaged tissue. During this process pus forms, which is an accumulation of fluid, living and dead white blood cells, dead (necrotic) tissue and bacteria, or any other foreign invaders or materials; popcorn hulls, calculus, etc. This pus pocket is the abscess, characterized by swelling, redness, and pain.

The swollen area can rupture, allowing the pus to drain, but it will return if the cause of infection is not removed. As an abscess develops, the bacteria and host cells cause rapid destruction of connective tissues around the tooth and into the jawbone. Abscesses can be acute or chronic, with the acute abscess being the most painful. A chronic abscess may produce a dull pain with intermittent swelling, but can develop into an acute abscess at any time.

The most common types of dental abscesses are:

• Periapical abscess: located at the apex of an infected tooth surrounding the roots.
• Periodontal abscess: located in the periodontal ligament (PDL) surrounding the tooth.

Studies by the American Academy of Periodontology (AAP) find that periapical abscesses can occur on any tooth that has severe decay or is broken or chipped, but periodontal abscesses commonly involve the mandibular and maxillary first molars, maxillary incisors, and cuspids, followed by maxillary second molars.

Causes and symptoms

Periapical abscesses usually result from dental caries that allow bacteria to infect the center area of the tooth (pulp). But they can also occur after a traumatic injury to the tooth resulting in necrosis (death) of the pulp. This infection may spread out from the root of the tooth to the bones supporting the tooth, causing an abscess. This type of abscess is extremely painful and very sensitive to cold and hot, and to the touch. Acute inflammation of the apex commonly occurs with the tooth seeming to be slightly extruded from its socket. The patient may also have a fever and redness of the cheeks and gum tissue. The abscess itself may feel hot and hard to the touch. The bigger the abscess gets, the more painful it becomes.

A periodontal abscess occurs where pre-existing periodontitis is present. This infection occurs in the walls of the periodontal pocket as a result of bacterial invasion into the periodontal tissue. While abscesses usually spontaneously occur in patients with untreated periodontitis, they are more common in periodontitis patients with a systemic disease, in which there is a reduced ability to combat infections, such as individuals with diabetes or HIV, or patients on chemotherapy.

Periodontal abscesses are generally not sensitive to heat, and the pain is not as severe as with a periapical abscess, but the discomfort level is constant. They appear red, edematous (swollen), shiny, and very sensitive to the touch.

Other symptoms of a dental abcess include:

• earache
• general ill feeling
• bad breath or foul taste in mouth
• fever
• continuous or throbbing pain

Diagnosis

When a patient has swelling and pain it is necessary to locate the exact region causing the pain. X rays greatly aid in locating the tooth or teeth in question. Hot and cold tests may be performed by touching the teeth with ice or heated instruments. This helps to pinpoint the exact location of the pain and to determine the type of abscess. Percussion tests may also be done by tapping the teeth in question lightly with the small end of an explorer. After diagnosis, the general dentist may choose to treat the abscess, but may also refer the patient to an endodontist or periodontist. The entire treatment may take a number of visits to complete depending on the severity of the abscess.

The cost for treatment of a periapical abscess is normally covered under dental insurance at 80%. The cost is usually a few hundred dollars or more if the patient is referred to an endodontist because of the specialty field. The insurance then only covers a certain amount of the usual and customary charge (UCR), commonly about 50%. A patient has to consider whether to have a general dentist treat the abscess, or whether to pay the extra cost to have a specialist perform the treatment. Usually having a specialist treatment the abscess is worth the extra cost in the long run.

For a periodontal abscess, a dental hygienist may perform the necessary scaling and root planing required to treat this condition. The cost for periodontal abscess treatment is commonly covered by dental insurance at 80%. Even when treated by a periodontist, insurance normally covers the treatment at 80% because a periodontal abscess is considered part of the periodontal disease for which the patient is already being seen by the specialist.