A tooth abscess is a localized pocket of pus, typically caused by a bacterial infection, that can form at the tip of a tooth root (periapical abscess) or in the gums surrounding a tooth (periodontal abscess). While a dentist can often extract an abscessed tooth, it is not always the immediate first step. Managing the infection is often necessary before or during extraction.
Immediate Considerations for Extraction
Dentists often do not immediately extract an abscessed tooth due to active infection and swelling. Extracting an actively infected tooth risks spreading infection into the bloodstream (bacteremia), which can lead to systemic health issues, especially for those with compromised immune systems. Significant swelling also makes adequate local anesthesia difficult, increasing patient discomfort.
To prepare the area for a safer procedure, dentists often prescribe antibiotics to reduce infection and swelling. Another common preliminary step is draining the abscess, which involves a small incision to release pus and relieve pressure. This drainage reduces bacterial load and inflammation.
Treatment Approaches for Abscessed Teeth
Treating an abscessed tooth involves several approaches, depending on the tooth’s condition, infection severity, and patient factors.
Tooth extraction is one option, particularly when the tooth is severely damaged, the infection is extensive and untreatable by other means, or due to patient preference or cost considerations. During an extraction, the dentist numbs the area, then uses specialized instruments to carefully loosen and remove the tooth from its socket. Any infected tissue around the tooth is also removed to help eliminate the source of the infection.
Root canal treatment offers an alternative to extraction, aiming to save the natural tooth. This procedure involves removing the infected pulp from inside the tooth. The internal chambers are then thoroughly cleaned, shaped, and disinfected, before being filled and sealed to prevent future infection. A root canal is often preferred when the tooth is salvageable and the surrounding bone is healthy, preserving the tooth’s function and appearance.
Antibiotics and drainage, as described previously, are often used in conjunction with either extraction or root canal treatment, or as initial management steps. While antibiotics help control infection, they typically do not eliminate the underlying cause.
Consequences of Delaying Treatment
Delaying treatment for an abscessed tooth can lead to serious, potentially life-threatening complications.
Locally, the infection can progress beyond the immediate tooth, spreading to surrounding bone, other teeth, and gum tissue, potentially forming a dental cyst. It can also lead to osteomyelitis, a painful jawbone infection. In some cases, a dental fistula, a tunnel through the jawbone that allows pus to drain into the mouth, may develop.
Beyond the mouth, the infection can spread to other parts of the body. Systemic complications include cellulitis, a rapidly spreading skin infection, or more severe conditions like sepsis, a widespread inflammatory response to infection that can lead to organ damage.
Infections from an abscessed tooth can also spread to deeper fascial spaces in the head and neck, potentially causing Ludwig’s angina, a severe infection in the floor of the mouth that can compromise the airway. In rare but serious instances, the infection can travel to the brain, leading to a brain abscess, or cause cavernous sinus thrombosis, a blood clot in the veins at the base of the skull, both of which can have severe and lasting consequences.