Tooth abscess
A tooth abscess is an acute purulent process in the root area, during which a cavity filled with purulent contents is formed. The pathological condition is infectious in nature. It is rarely primary, usually it is a secondary disorder, a complication of a particular pathological condition. An abscess never goes away on its own. It only progresses, creating more and more conditions for the development of complications.
The disorder is accompanied by pronounced symptoms of localized purulent inflammation: pain, general malaise, and more. Only a specialist can determine the exact nature of the pathology and prescribe competent, appropriate treatment. Consultation with a dental surgeon is indicated . Correction is surgical in all cases. Conservative treatment is used as an addition, but not as the main approach.
Causes of tooth abscess
The causes of purulent inflammation of tissues, damage to the structures of the periodontium, gums or root area are numerous. A tooth abscess is always infectious. It mainly develops due to an odontogenic factor. That is, against the background of the presence of affected teeth (carious, affected by periodontitis). The disease is very common. According to existing estimates, abscesses are in second place in the number of purulent processes, giving way only to various forms of periodontitis (which, interestingly, are almost always complicated by the formation of an abscess).
For secondary prevention to be successful, it is important to find out what caused the disease. If you cure the abscess but do not eliminate the basis of the process, the primary disease, there is a high probability of relapse. Re-development of the purulent process in the patient.
Direct causes of pathology
The immediate cause of a Tooth abscess is the penetration of an infectious agent into the structures of the tooth tissue, periodontium and periodontium. The pathological condition develops rapidly and acutely. In most cases, it begins unpredictably. All because of the nature of the bacteria that provoke inflammatory phenomena. They are very aggressive. Midst the maximum shared culprits of the sickness:
- golden streptococci;
- other streptococcal agents, sometimes even more active, often resist antibiotics and develop pronounced resistance to drugs;
- viridans, beta-hemolytic streptococci;
- actinomycetes.
And not only that. There are more than a dozen bacteria, each represented by several strains. And each serotype acts in its own way, differs in different degrees of virulence, aggressiveness.
The immediate conditions for infection penetration into the periodontal or periodontal tissues play a major role. Catching managers can enter the structures of the periodontal interstellar in the next ways:
- when moving down the root canals, this is the most typical way, first pulpitis develops, then periodontal inflammation, in the root area, then an Tooth abscess – this is a logical chain, interrupting pathological changes, however, enamel hypoplasia is possible at any stage of the disorder;
- in case of root perforation, an infectious process is possible when a perforated defect is formed in the root area, usually this is the result of root canal filling, dental intervention, and sometimes a consequence of an inflammatory process in the tooth itself;
- In case of root fracture, an Tooth abscess of the root zone often develops as a result of deep and serious dental trauma, as a typical complication.
Please note!
Sometimes the reasons are not so obvious. For example, in dental practice there is a disease known as abscessing periodontitis. Periodontitis, that is, inflammation of the periodontium, is usually infectious in nature, but without a purulent component. That is, bacteria have already penetrated the tissues, but there is no Tooth abscess formation. This form of the pathological process occurs in only 3-7% of cases. It cannot be written off, since the probability always remains in one form or another.
Pathogenesis of the disorder
The pathogenesis of the purulent process, tooth abscess is quite linear. Several links, the mechanism of the development of the pathological condition can be identified:
- first, the degree of contamination of the oral cavity with bacterial agents of varying degrees of aggressiveness increases (usually this is a whole system of infectious agents);
- then a destructive process develops in the soft tissues or the tooth itself;
- inflammatory phenomena appear, the focus is always infectious, aseptic forms of inflammation in the oral cavity and bruxim practically do not occur, this is a great rarity ;
- with the active penetration of a grates number of bacteria. The body initiates the process of an active immune response. Hence the formation of pus;
- to localize the inflammation, the body encapsulates the lesion, the Tooth abscess is separated from the external environment by a special fibrous capsule;
- the environment becomes acidic almost from the very beginning of inflammation, ideal for the proliferation of less aggressive bacteria;
- as a result, further progression of inflammation, activation of a new phase of the immune response, and so on in a circle.
The development of the inflammatory process can be interrupted at any stage of the pathological process. This is the job of a dentist. You will not be able to eliminate the disorder on your own. The dental lesion will not go away on its own either, the pus will remain, the Tooth abscess too. Therefore, there is no need to waste time looking for a handy solution.
Risk factors for purulent process
Risk factors for the pathological condition increase the likelihood of the disorder in patients. Among them:
- young age, in 50-55% of cases dental abscesses develop in young people, under 35 years of age;
- middle age, in another 40% of cases suppuration, the formation of a visible Tooth abscess occurs in patients under 45 years of age;
- somatic diseases, chronic pathological processes, as they undermine the body;
- disruption of the normal functioning of the patient’s immune system; immune status is important for containing flora and preventing purulent processes;
- active bacterial contamination of the oral cavity, negative condition of the root canals, various forms of periodontitis and periodontal diseases, general negative condition of the oral cavity – all these are factors in the development of the pathological process;
- taking certain medications: hormonal agents, antibiotics, as well as cytostatics and others, in large doses or on a long-term basis;
- poor oral hygiene, plaque accumulation, removal of only part of the deposits.
Correction of risk factors helps to significantly reduce the likelihood of developing not only an Tooth abscess, but also other dental diseases.
Classification and types of Tooth abscess
Abscesses are classified according to their course, location and severity & presence of complications.
Depending on the course, an abscess can be acute or chronic. An acute tooth abscess is violent, with a large number of symptoms. The clinical picture is vivid, but an Tooth abscess can be confused with other pathological processes: periostitis, periodontitis. Differential diagnostics is indicated. A chronic tooth swelling is convoyed by a inactive clinical portrait. There is pain, then there is none. Swelling appears and disappears. This continues until the next exacerbation.
Depending on the location, there are several other types of tooth abscess:
- periodontal, located in the thickness of the periodontium, develops against the background of abscessing periodontitis or trauma;
- periapical, located near the roots, in the periodontal zone.
There are many variations in the cataloging of maxillofacial blisters. But if we talk about localization specifically in the area of teeth and gums, we can distinguish only two varieties.
If the division is carried out according to the course of the pathological process, the following are distinguished:
- mild form of abscess, minimal pus, clinical picture is quite mild, the disease progresses slowly;
- moderate or average form, the abscess affects the area of two teeth, accompanied by pronounced clinical symptoms;
- severe form, the Tooth abscess is large, affects more than 2 teeth, clinical features of a purulent process are observed, there are complications.
Most often, the disease is accompanied by a mild or moderate course. Severe is diagnosed in patients with impaired immune function.
Finally this division is made according to these presence or absence of complications. The disorder can be complicated or uncomplicated.
The classification of the pathological process can also be carried out by nature, the main cause of the disorder. As a rule, all forms of periapical abscess are odontogenic in nature. Simply put, the disease develops due to third-party pathologies of the dental system, the patient’s oral cavity. In this case, the abscess is of secondary nature. It develops as a response to untreated caries, pulp inflammation, periodontitis. The formation of periodontal Tooth abscessor purulent foci in the apical region of the root is characteristic.
Basically, the capsule clearly outlines the abscess zone. Another variant of origin is traumatic. An abscess develops when the root, soft tissues of the periodontal space are injured. According to our estimates, this form is rare. Lymphogenous and hematogenous forms of infection develop even more rarely. That is, the penetration of the agent into the tissue with the blood or lymph flow.
Dentist-therapist
Symptoms of a tooth abscess
The clinical picture is determined by the severity of the pathological process and its form. Acute forms of abscess usually have the following clinical picture:
- painful sensations at the site of the abscess formation, pain in the projection of the affected area, also often radiating nearby, along the trigeminal nerve, affecting several teeth at once, is clearly localized quite rarely;
- puffiness of the jawbone, half of the face, boldness, in the prognosis of the localization of the infected fiery progression;
- eating disorders due to limited amplitude of mouth opening and inability to chew normally;
- increase in the patient’s body temperature;
- other symptoms of general intoxication of the body.
As a rule, the picture is quite typical. The jaw not only hurts, but also swells. The gums may turn red. At the same time, the surrounding tissues most often turn pale, have a cyanotic tint. In some cases, when the infection penetrates and an abscess is formed, the clinical picture is much milder, erased. Usually, such a picture is typical for patients who eliminate discomfort with shock doses of anti-inflammatory drugs or take antibiotics on their own. This should not be done, since it complicates the diagnosis of the disorder.
In most cases, a bump is visible on the gum during visual assessment. This is the boil pill, situated in the breadth of the matter. Even if the abscess is located in the area of the root apex. In about two thirds of cases, inflammation occurs with the formation of a fistula. A superficial defect for the release of pus. This is a natural drainage. Exudate also comes out through the gum.
Chronic forms of tooth abscess are much less common. In remission, the clinical picture is minimal. Minor pain and discomfort in the area of the causative tooth, slight swelling, malaise in the evenings. Exacerbations begin suddenly. Triggers may be hypothermia, overheating or stress. Respiratory infection. Exacerbation occurs in the same form, with the same symptoms as the acute form of the disorder.
Complications of a tooth abscess
Complications develop in a significant proportion of cases and are common secondary problems.
- loosening of a tooth, loss of a unit due to destruction of alveoli, ligaments, bone tissue;
- phlegmon, develops with abundant discharge of pus into the internal spaces, if the abscess breaks through inward and pus gets into the periodontium, periosteum, this is a purulent process without a capsule;
- formation of large periodontal pockets;
- periostitis or gumboil, inflammation of the periosteum;
- osteomyelitis inflammation of bone tissue & purulent in nature
- sepsis, generalized inflammatory process, blood poisoning;
- mediastinitis, inflammation of the chest space, mediastinum, a life-threatening pathology that requires immediate hospitalization.
The only accessible and effective measure to prevent local and general complications is quality treatment. Surgical intervention to open the abscess. And as soon as possible. The longer the problem exists, the higher the likelihood of complications.
Diagnosis of the disorder
Diagnosis of the pathology is usually not difficult. Signs of a tooth abscess are quite characteristic.
- said investigation to consider complaints and symptoms of a pathological condition;
- accumulating anamnesis shaping the probable nature of the ailment;
- visual assessment, if an abscess forms, it is quite visible;
- radiography allows you to localize the disorder, determine where it is located, and assess the condition of the surrounding tissues;
- CT is completed in multipart belongings when queries persist.
Bacteriological studies are mandatory. It is necessary to understand what flora provoked the inflammatory phenomena, how sensitive it is to drugs, to which ones. Diagnostics helps to understand why the disorder developed, how best to treat it in order to cope quickly and prevent negative consequences. Particular attention should be paid to abscesses of wisdom teeth and upper units. Since the rate of progression of the purulent process is higher, the probability of difficulties is also advanced.
Treatment of tooth abscess
The disorder is treated strictly surgically. Conservative correction makes no sense. At least in isolation. Its use is justified to maintain the result. The essence of the operation depends on the nature of the changes.
To cure the disorder, the abscess of the tooth is opened at the initial stage of correction. The tissues are excised along the entire length of the lesion. Local treatment with antiseptics is mandatory. Infected tissues are removed by open curettage. Next, admittance must be fashioned for the pus to exit. Drainage is installed.
After the operation to remove the tooth abscess, drug correction is carried out. Anti-inflammatory and antibiotics are prescribed. Moreover, antibacterial drugs should be administered even after the symptoms subside. Another 2-3 days.
All procedures are performed under local anesthesia. They are not accompanied by pain or discomfort. They are well tolerated.
Important!
Removing an abscess is only half the battle. In addition to correcting the acute process, it is necessary to treat the disease that is behind the formation of the abscess. If bacteria infect gingival tissues, anti-inflammatory therapy is indicated, often along with surgical intervention. If we are talking about advanced peritonitis, the root tip is often removed. Or the entire tooth. Less deep-seated intercessions with root canal filling are imaginable. If it is pericoronitis or advanced periodontitis, the gum hood, excess tissue is excised. And so on. How to treat a tooth abscess is decided by the doctor, depending on the situation. But these must necessarily be complex measures.
Prognosis and prevention of the pathological process
The prognosis of the pathological process depends on the form and stage of the disorder. With proper, timely treatment, the abscess disappears completely. Sometimes additional correction is required. For example: a flap procedure when removing resin matter. Fortunately, there are various methods of correcting the primary disorder, restoring teeth, and soft tissue plastic surgery. With the development of complications, the prognosis is significantly worse. It is not worth letting them get to that point. Otherwise, the disorder may acquire a cyclical course, causing life-threatening consequences.
Prevention includes high-quality oral hygiene, plaque removal in the hygienist’s office twice a year. Early treatment of oral diseases is indicated. First of all, those that can provoke the disease. If an abscess has already affected one or more teeth, you need to see a doctor immediately. Warm salt water, oak bark, chamomile and other grandma’s recipes will not help. This is a waste of time.