An infected tooth, or abscess, occurs when bacteria invade the innermost part of the tooth (the pulp) or the surrounding tissues. This infection typically results from untreated decay, a fractured tooth, or failed dental work. While many people worry about removal, dental professionals prioritize saving the natural tooth whenever possible. Extraction is considered only after assessing the infection’s severity, the tooth’s remaining structure, and the patient’s overall health. Extraction is a potential outcome, but it is not the automatic first choice for treatment.
Initial Assessment of the Infected Tooth
Treatment begins with a diagnostic process to understand the infection’s extent. The dentist starts with a clinical examination, inspecting the tooth and gums for swelling or draining sores. They may gently tap the tooth to test for sensitivity, as pain often indicates inflammation around the root tip.
Dental X-rays provide a detailed view of the tooth’s structure and surrounding bone. These images detect a periapical abscess, which appears as a dark shadow at the root end where bone has been destroyed. X-rays also reveal the depth of decay and any existing root damage.
The dentist also performs pulp vitality testing to assess the health of the nerve tissue inside the tooth. This involves applying cold or heat, or using an electric pulp test. A non-responsive pulp often confirms a deep infection, indicating the need for internal intervention. These collective findings guide the decision on whether the tooth can be saved or requires extraction.
Treatment Alternatives to Extraction
If the tooth structure is intact and the infection is localized, root canal therapy is the standard first approach. This procedure removes the source of bacteria from the tooth’s interior.
Root Canal Therapy
The process begins by creating a small opening in the crown to access the pulp chamber, which houses the inflamed and infected tissue. Specialized instruments clean out the infected pulp and shape the canals extending into the root. After cleaning, the interior is disinfected to eliminate remaining bacteria. The empty space is then filled with a sealing material, typically gutta-percha, to prevent future reinfection.
Drainage and Medication
If a large pocket of pus (an abscess) has formed, the dentist may perform an incision and drainage procedure. This involves making a small cut into the swelling to allow the pus to drain, immediately relieving pressure and controlling the acute spread of infection. Antibiotics may be prescribed if the infection has spread beyond the immediate area, causing symptoms like fever or facial swelling. However, antibiotics alone do not eliminate the infection source within the root system, meaning a definitive procedure like a root canal is still required to save the tooth.
When Extraction Becomes the Required Treatment
Extraction becomes necessary when the tooth is damaged beyond the point where conservative methods can ensure long-term function.
Structural Damage
Unavoidable removal is often due to structural compromise, such as a severe vertical root fracture or decay extending deep below the gum line. If insufficient healthy tooth structure remains to support a crown after a root canal, the tooth is not restorable.
Advanced Disease and Failed Treatment
Extraction is also required with advanced periodontal disease, where infection has caused significant bone loss around the root. A tooth that has lost substantial bone support becomes loose and unstable. Furthermore, extraction is indicated when a previous root canal has failed and retreatment is not feasible due to complex anatomy or persistent infection.
Systemic Risk
If the infection has progressed rapidly or the patient has a compromised immune system, immediate removal may be the safest course. Removing the tooth rapidly eliminates the source of bacteria, preventing a dangerous spread to the jaw, neck, or bloodstream. An acutely infected tooth can often be extracted right away, as removal is a direct method of infection control.
Managing Recovery After Tooth Removal
Following an extraction, careful management of the surgical site is necessary to ensure proper healing and prevent dry socket. A blood clot must form in the empty socket to protect the underlying bone and nerves. Disturbing this clot exposes the bone, resulting in severe pain typically starting a few days after the procedure.
Patients should avoid any activity that creates a sucking motion for at least 72 hours, including using straws or smoking tobacco products. Suction can dislodge the clot, and tobacco chemicals interfere with healing. For the first few days, stick to a soft diet to prevent irritation from hard or crunchy foods.
Pain and swelling are managed with medication and by applying ice packs to the cheek. Gentle rinsing with warm salt water can begin 24 hours after the extraction to keep the area clean without disturbing the clot. Patients must contact their provider immediately if they experience excessive bleeding, a high fever, or severe pain unresponsive to medication.