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Abscessed Tooth

Abscessed Tooth

A tooth abscess or root abscess is pus enclosed in the tissues of the jaw bone at the tip of an infected tooth. Usually the abscess originates from a bacterial infection that has accumulated in the soft pulp of the tooth. This is usually but not always associated with what is commonly described as a dull throbbing excruciating ache.

A tooth abscess typically originates from dead pulp tissue, usually caused by untreated tooth decay, cracked teeth or extensive periodontal disease. A failed root canal treatment may also create a similar abscess.

There are two types of dental abscess. A periapical abscess starts in the dental pulp and is most common. A periodontal abscess begins in the supporting bone and tissue structures of the teeth.

Presentation and Symptoms
Common symptoms of an acute tooth abscess is a toothache or a persistent, throbbing pain at the site of the infection.[1] Putting pressure or warmth on the tooth can induce extreme pain.

In some cases, a tooth abscess may perforate bone and start draining into the surrounding tissues creating local facial swelling. The lymph glands in the neck in some cases will become swollen and tender in response to the infection.

Treatment
One treatment for an abscessed tooth is to extract it, thereby removing the source of infection. However, in select cases a root filling or root canal therapy may be able save the tooth by cleaning the source of infection in the pulp chamber and root canal system. For more information see Root canal therapy

Untreated Consequences

An untreated severe tooth abscess may become large enough to perforate bone and extend into the soft tissue. From there it follows the path of least resistance. Largely dependent on the location of the infected tooth; the thickness of bone, muscle and fascia attachments, the infection then spreads either internally or externally.

External drainage may begin as a boil which bursts allowing pus drainage from the abscess, intraorally (usually through the gum) or extra orally. Chronic drainage will allow an epithelial lining to form in this communication to form a pus draining canal (fistula). Sometimes this type of drainage will immediately relieve some of the painful symptoms associated with the pressure.

Internal drainage is of more concern as growing infection makes space within the tissues surrounding the infection. Severe complications requiring immediate hospitalisation include Ludwig's angina, which is a combination of growing infection and cellulitis which closes the airway space causing suffocation in extreme cases. Also infection can spread down the tissue spaces to the mediastinum which has significant consequences on the vital organs such as the heart. Another complication, usually from upper teeth, is a risk of septicaemia (infection of the blood), from connecting into blood vessels.

Depending on the severity of the infection, the sufferer may feel only mildly ill, or may in extreme cases require hospital care.

References

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