Tooth abscess: root, gum, wisdom tooth and deciduous tooth

Teeth are a subject of concern and care for every person, from infancy to the end of life. Their eruption in childhood is accompanied by swelling and inflammation of the gums, pain, they require daily care, and emerging problems require timely intervention, which many people fear, postponing a visit to the dentist. But there is one disease that does not tolerate delay and will drive anyone, even the most cowardly, to the doctor. This is a tooth abscess - an inflammatory process accompanied by the accumulation of pus in the root part.

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Causes tooth abscess

The cause of a tooth abscess is the penetration of bacteria into the tooth pulp through the damaged enamel layer. This is caused by:

• dental diseases (pulpitis, caries, periodontitis, cysts, etc.);
• tooth damage due to chipping or fracture;
• infectious diseases (flu, sore throat);
• violation of the integrity of tissues in the mouth;
• facial abscesses;
• the introduction of pathogenic microorganisms during various doctor’s manipulations (unsuccessful root canal filling, working with non-sterile instruments).

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Risk factors

Risk factors for tooth abscess include poor oral hygiene. Another negative aspect of enamel damage is the development of caries due to excessive consumption of sweets. People who avoid dental checkups and diabetics are also at risk.

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Pathogenesis

The pathogenesis of a tooth abscess is the penetration of infection through damage to the dental coating or soft tissues around the tooth into the outer or inner part of its alveolar process. The proliferation of bacteria leads to the accumulation of pus in the soft pulp of the tooth, most often already dead at this point. If the pus is not allowed to escape, the abscess involves areas beyond the tooth - the jawbone, periodontal tissues, adjacent teeth.

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Symptoms tooth abscess

Symptoms of a tooth abscess result in the following state of the body:

• pulsating, "jerking" toothache;
• pain when pressing, including biting, chewing;
• redness and swelling of the gums, the appearance of a lump;
• swelling of the cheek;
• enlarged lymph nodes in the neck;
• reaction to hot or cold food;
• bad breath;
• high temperature, chills, fever;
• general malaise;
• the appearance of an open purulent wound.

The first sign of an abscess is the appearance of a dull throbbing pain that is impossible to ignore. Over time, it only gets worse, the gum around the aching tooth begins to swell and turn red. A sleepless night is possible. Over time, swelling appears on the face. You shouldn't hope that this will go away on its own; a dentist's intervention is necessary.

Stages

There are two stages of a tooth abscess: acute and chronic. All the signs of the acute stage are described above. In some cases, it can stop without the dentist's intervention, i.e. the abscess opens on its own, the pus comes out into the oral cavity and relief occurs. But in this case, a transition to a chronic form is possible, which will lead to further complications and the formation of a fistula.

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Forms

There are several types of abscesses, depending on the location of the purulent focus, namely:

• gingival or flux, does not spread to the tooth;
• periodontal, concentrated closer to the root of the tooth in the periodontal pocket;
• periapical, develops in the tooth itself, which has dead pulp.

Purulent tooth abscess

The acute stage is also called a purulent abscess of the tooth. It is not always characterized by shooting pains, it can proceed painlessly, but swelling near the tooth will definitely appear. Swelling of the cheek, enlargement of the lymph nodes, and headache are also possible. Over time, acute increasing pulsating pain will appear, the gum swelling will increase even to the size of a walnut. The general condition will worsen, the body temperature will rise.

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Chronic tooth abscess

A chronic tooth abscess is characterized by moderate pain when pressing on it, but this does not affect the general condition of the body. Often, with a purulent abscess, a spontaneous breakthrough of the abscess occurs, the symptoms disappear. However, the infection does not go away, but becomes chronic and continues its destructive effect. Recurrence of exacerbations is inevitable.

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Abscess after tooth extraction

Often there is a need to remove a diseased tooth. Anesthesia eliminates pain during the operation, but a bleeding and painful hole remains. Until the wound heals, you have to endure, follow certain rules of hygiene and eating (excluding hard, rough, hot food). Symptoms such as prolonged bleeding, increasing pain, the appearance of purulent plaque, bad breath should be a reason to immediately contact a dentist. The healing process is the replacement of a blood clot with granulation tissue, from which bone is formed. If it does not form and an infection gets into the open wound, an abscess occurs after tooth extraction. Another reason may be the non-sterility of the instrument used by the surgeon.

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Tooth root abscess

A tooth root abscess is also called periapical. The most common cause of its occurrence is deep caries against the background of poor oral hygiene. Pathogenic microbes enter the bloodstream, causing an inflammatory process. The danger of such an abscess is that the roots of the tooth are located in close proximity to blood vessels, through which the infection quickly spreads throughout the body. Symptoms of a tooth root abscess do not take long to appear: boring pain that intensifies at night, a jump in temperature, general weakness, swelling of the gum tissue, swelling of the facial jaw.

Wisdom tooth abscess

Often due to the peculiarities of its location and the difficulty of removal. It is embedded in soft tissues that are well supplied with blood. If it is necessary to break the tooth into fragments for removal, the traumatic area increases. After removal, a high temperature is possible, and the tissues around the socket are reddened and swollen. Such a wound heals longer than usual. But if on the second or third day there is no relief and the temperature persists, and the swelling increases, then an infection has occurred, an abscess is developing and you need to urgently consult a doctor.

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Gum abscess of tooth

A gum abscess is also called a flux. It is an accumulation of tissue that has died as a result of inflammation. The purulent area spreads to the soft tissues of the gum, without affecting the bones of the tooth. However, if no measures are taken to eliminate it, the abscess can spread to other areas, including the tooth.

Abscess of a baby tooth

It is dangerous because there is a rudiment of a permanent tooth underneath it. An infection can get to it from the lower part of the root of the baby tooth and lead to death. A child's tooth enamel is thinner, the pulp chamber is larger than that of an adult. This allows the infection to move deeper into the jaw faster. The danger is that toxins from the inflammation site enter the blood, which can lead to allergies and asthma. Infection of the oral cavity when a fistula forms is fraught with constant colds and sore throats. The child must be shown to a doctor, who will decide whether to treat or remove the baby tooth.

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Frequent dental abscesses

Frequent dental abscesses indicate an untreated infection, its development into a chronic form. Toothache in the presence of an abscess may stop if the nerve endings are already dead, the swelling will subside. But the inflammatory process is not stopped and the infection spreads to neighboring teeth or deep into the jaw bone. Thus, new foci of suppuration arise.

Complications and consequences

The consequences and complications of the disease are serious enough to ignore. The occurrence of a fistula is fraught with infection of other organs. Phlegmon of the oral cavity is an extensive, diffuse purulent inflammation of the tissue that requires great efforts to eliminate. The appearance of abscesses in bone tissue is very dangerous. In addition to tooth loss, an abscess is dangerous due to the possibility of developing osteomyelitis, cellulitis, sepsis, diabetes, inflammation of the brain, pneumonia, cardiovascular diseases. Their treatment will take much more time and money than a visit to the dentist. Relapse of an abscess is also dangerous.

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Diagnostics tooth abscess

A dentist diagnoses a tooth abscess when examining a patient: swelling and redness of the gums are recorded, the degree of sensitivity to cold and hot is determined. Pressing and tapping the tooth will cause pain in the patient. This information will help to make a preliminary diagnosis, and an instrumental examination using X-rays will confirm it.

In case of an abscess, blood and urine tests are performed before and after surgery, and material is also taken from the site of inflammation for microscopic and bacteriological examination.

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Differential diagnosis

The task of differential diagnosis is to identify an abscess from

Cysts, hematomas, tumors, phlegmons. An abscess is a limited inflammation of soft tissues, while phlegmon is a diffuse purulent inflammation, which is more dangerous for humans due to its consequences. The symptoms of a tooth abscess are similar to those of purulent periostitis. The difference is in the localization of the inflammation focus: the latter are located more superficially, in the vestibular surface. Based on clinical observations, diagnostic puncture and bacteriological studies of the collected material, the doctor diagnoses the disease and determines the sensitivity of the pathogen to antibiotics.

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Treatment tooth abscess

Treatment of a tooth abscess consists of eliminating the source of inflammation. To do this, they resort to opening it and the following procedures:

• drainage – the abscess is removed through the drilled tooth, disinfection is carried out, the canal is filled, then a crown is placed on the tooth;
• drainage through a gum incision if the tooth is not affected;
• tooth extraction in case of an extensive abscess and the impossibility of preserving it, scraping out dead tissue;
• use of antibiotics after elimination of suppuration to prevent the spread of the source of infection and its destruction;
• rinsing with warm saline or soda solutions to completely wash out pus and speed up wound healing;
• use of painkillers for severe pain and immunostimulants.

Treatment of recurrent tooth abscess

It happens that after surgery complications arise in the form of bleeding and recurrence of a tooth abscess. At risk are people with obesity, smokers, alcoholics, drug addicts, diabetics, hypertensive patients, taking blood thinners. The body will let you know about a relapse by deterioration of health, fever, suppuration around the wound, its redness and swelling. In this case, you must immediately contact a dentist. Treatment of a relapse of a tooth abscess is carried out according to the same scheme as the primary abscess, with the obligatory prescription of antibacterial agents. Recovery will be more protracted.

Treatment of tooth abscess during pregnancy

Pregnancy is a predisposing factor for the development of the disease, since during this period the woman's immunity decreases. Treatment of a tooth abscess during pregnancy is complicated by the undesirability of using antibiotics. The specialist carries out the same treatment measures to eliminate the source of infection as other patients, weighing the risks and benefits of using analgesics and antibacterial drugs, and prescribes mouthwash. For anesthesia, preference is given to agents with a moderate content of vasoconstrictor components, which slow down the absorption of the drug into the blood, and accordingly, into the placenta.

Medicines

Medicines used in the treatment of abscesses include anesthetics that relieve pain during surgical procedures and in the postoperative period, antibiotics, mouthwashes, immune-boosting drugs, and vitamins. Most often, so-called infiltration anesthesia is used, in which a series of injections are made in close proximity to the diseased tooth. It is used as a means long used in dentistry - lidocaine, novocaine, and new generation - ultracaine, scandonest, septanest.

Ultracaine - its dosage depends on the time of the surgical intervention and the depth of anesthesia. Usually 1.7 ml of the substance is enough. It is unacceptable to inject the drug into a vessel. To prevent this, a trial aspiration is done (the syringe is pulled towards itself after being injected into soft tissues and, if the needle hits the vessel, blood gets into the syringe). Possible side effects: headache, increased blood pressure, arrhythmia, blurred vision, nausea, vomiting, itchy skin, urticaria. The drug is contraindicated in patients with an allergy to its components. It is not recommended for patients with bronchial asthma, heart failure, arterial hypertension. Ultracaine can be used during pregnancy due to its insignificant penetration into the placenta.

Septanest - begins to act 1-3 minutes after administration for an hour or more. A sufficient dose for intervention in case of a tooth abscess is 1.7 ml. It cannot be used by children under 4 years of age and patients with serious cardiovascular diseases, such as those who have had a myocardial infarction. Side effects are expressed in the form of arrhythmia, increased pressure, sensitivity to the drug.

Antibiotics for tooth abscess

To avoid negative consequences and complications in dentistry, broad-spectrum antibiotics are used for tooth abscess. These include amoxicillin, lincomycin, ciprofloxacin, metronidazole, azithromycin, clindamycin, oxacillin.

Amoksilin is a bactericidal drug, available in the form of tablets, capsules for oral use and powder for injections. The dose is determined by the doctor depending on the severity of the condition. The recommended dose is 0.5 g three times a day (for body weight exceeding 40 kg). If necessary, it is increased to 1 g per dose. Children 5-10 years old - 0.25 g three times a day. Amoksilin is contraindicated in case of hypersensitivity to penicillins, mononucleosis. Pregnant and lactating women should exercise caution. In this case, only a doctor can determine whether the benefits outweigh the negative effects of the drug. Side effects can manifest as skin rashes, rhinitis, conjunctivitis, joint pain.

Lincomycin is a drug from the lincosamide family. It is very popular in dentistry for the treatment of various inflammatory processes, including dental abscesses, due to its ability to accumulate in bone tissue and prevent relapses. It is available in capsules, ointments and solutions for intramuscular and intravenous administration. Adults take capsules 3-4 times a day, 500 mg, several hours before meals. Injections of 600 mg are given twice a day. For children, doses are calculated based on the proportion of 30-60 mg of the drug per 1 kg of weight, intravenously - 10-20 mg. The drug is not recommended for pregnant women, lactating women, in case of allergy to its components, kidney and liver diseases. Side effects include nausea, diarrhea, urticaria, swelling, gastrointestinal pain.

Oxacillin - its dosage form - tablets and powder for injections. Tablets of 0.5-1 g are recommended to be taken every 4-6 hours. Injections are administered intramuscularly or intravenously at the same interval (0.25-0.5 g of powder per 1.5-3 ml of water for them). Side effects from the digestive tract, genitourinary system, and allergies may occur. The drug has contraindications for hypersensitivity to its components, bronchial asthma, renal failure, and breastfeeding. Prescription to pregnant women is permissible if the potential benefit outweighs the risk to the fetus.

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Vitamins

To strengthen the immune system, the body should receive a sufficient amount of vitamins and microelements with food. To strengthen teeth and enamel, calcium and fluoride are needed, which are contained in natural dairy products, carrots, apples, citrus fruits. You can drink a pharmacy complex in which all the necessary elements are balanced.

Physiotherapy treatment

Physiotherapeutic treatment is successfully used in dentistry, including for tooth abscesses. It is especially effective in combination with therapeutic methods, both during treatment and rehabilitation. At an early stage of the disease, local hypothermia with UV irradiation, fluctuation (the effect of current pulses) are prescribed. For a more extensive lesion, UHF, electrophoresis with antibiotics are used.

Treatment of tooth abscess at home

A tooth abscess requires specialist intervention, but what can you do at home to ease your condition? Never apply anything hot to the swollen area. You can apply ice to the outside of your cheek and take a painkiller that lowers the temperature and relieves swelling: panadol, ibuprofen, aspirin. You can also rinse your mouth using folk recipes to prepare the liquid.

Folk remedies

Traditional treatment is used if the tooth abscess is open, either after its treatment or after tooth extraction, to avoid further infection and tissue suppuration. To do this, resort to rinsing with salt water. Put a teaspoon of salt in a glass of warm water, put it in your mouth and hold for 20-30 seconds, then spit it out. Raw unsalted lard helps to draw out the abscess. After cutting it into slices, it needs to be cooled in the freezer. Taking them one by one from the refrigerator, apply to the site of suppuration, replacing them with a new, colder portion. You can also use garlic or ginger slices in the same way; they do not need to be cooled.

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Herbal treatment

To treat a tooth abscess with herbs, you need to use those known for their bactericidal and antiseptic effects. These include chamomile, St. John's wort, oak bark, calendula, sage, and arnica. They can be used either on their own or in a collection for rinsing the mouth. You will need a tablespoon of herbs per glass of boiling water. Pour it in, let it brew until it cools, rinse with warm water. You can use the medicinal properties of geranium. To do this, chop up a washed leaf of the plant, grind it to a pulp, put it on a sterile bandage and apply to the sore spot. After holding for 10-15 minutes, rinse your mouth with boiled water.

Homeopathy

Homeopathy in dentistry is a safe and effective method of treatment, which consists in stimulating the body's defenses. Tinctures are made from plant, animal or mineral raw materials. These are concentrated solutions of the main substances based on ethanol alcohol. Their dilutions are used later. For abscesses, ferrum, ferrum phosphoricum, arnica, belladonna, bryonia, mercurius, mezereum, etc. are prescribed.

Ferrum phosphoricum is a mineral salt in tablets used in the initial stages of the inflammatory process. In acute conditions, one tablet is prescribed 6 times a day, 3-4 times for children, in chronic conditions - 1-3 times for adults and 1-2 times for children. Contraindicated in patients with hypersensitivity to the active substance or wheat starch contained in the drug. Side effects in the form of allergies are possible. For use by pregnant women, a doctor's consultation is required.

Arnica - drops, a complex homeopathic preparation. Drop into water (10 drops per 10 ml of water) or directly under the tongue three times a day. Take a quarter of an hour before meals or an hour after. Contraindicated for pregnant women, nursing mothers and children under 18 years of age. Side effects include gastrointestinal disorders.

Mercury - used in the 6th dilution and higher. Side effects are possible from the gastrointestinal tract, kidneys, liver. Contraindicated for children, pregnant women, with pathologies of the digestive tract.

Mezereum - drops, injection solution. The dosage is determined by the doctor depending on the patient's condition. Approximately 10 drops three times a day or first 1 ampoule per day subcutaneously, intravenously or intramuscularly, then several times a week. The instructions for the drug do not contain warnings for use.

Opening of a tooth abscess

Sometimes it is necessary to resort to surgical intervention if the abscess is in an advanced state and has spread to nearby soft tissues. In this case, the opening of the tooth abscess is carried out under general anesthesia. After this, drainage is installed to drain the pus and frequent mouth rinses are recommended.

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Prevention

To prevent a tooth abscess, proper care of the teeth and oral cavity is necessary. To prevent the disease, the following measures are recommended:

• Brush your teeth twice a day with fluoride toothpaste;
• remove tartar in a timely manner;
• visit a doctor at least twice a year for examination and timely treatment of teeth;
• enrich your diet with vitamins and microelements.

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Forecast

The prognosis for treating abscesses is favorable with timely and correct treatment. Otherwise, it may develop into a chronic form or infect other organs, which can become life-threatening.

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