How Do I Know If I Have a Tooth Abscess?
A tooth abscess is an acute, purulent inflammation of the periapical tissues of the tooth root. The inflammation affects both the periodontium, the root cementum and the alveolar bone. It most often occurs as a consequence of untreated pulp inflammation (usually an acute condition), where bacteria present in the tooth cavity spread through the apical root aperture to neighboring tissues.
A tooth abscess is not a periodontal abscess. The basic difference is that in the case of a periodontal abscess, the pulp of the causative tooth remains still alive, and when you press the protuberance formed on the mucous membrane, pus flows out of the gap between the tooth and the gum.
As inflammation develops, the abscess may develop into the following forms:
- Periapical abscess - commonly called periapical abscess, it is an inflammation that affects only the tooth pulp and periapical tissues.
- Subperiosteal abscess − is a consequence of the development of untreated periapical abscess. Purulent exudate enters adjacent tissues and accumulates under the periosteum of the alveolar process (the outermost part of the bone).
- Submucosal abscess − penetrates the inflammation further, overcomes the periosteal barrier and gets under the mucosa.
Tooth abscess − throbbing pain
Tooth abscess has very characteristic symptoms and is difficult to confuse with another type of inflammation of the pulp or periapical tissues. The causative tooth is very sensitive to touch, even "blown out" above the bite line. Severe pain means you can't even touch it, let alone bite it. Such a tooth may also be loose. The pain is continuous, spontaneous, very strong and pulsating. The pain intensifies when lying down horizontally or under the influence of a warm meal or drink. You may feel generally unwell and may develop a fever.
Tooth abscess - swelling of the cheek
In the form of a periapical abscess, the mucous membrane in the projection of the causative tooth is red, tender and painful, but there is no visible swelling. It appears only when inflammation spreads to adjacent tissues. Characteristic swelling then occurs. Depending on the tooth affected by inflammation, there may be severe swelling of the cheek, neck, lip, or infraorbital area.
Tooth abscess - swelling
In the case of a subperiosteal abscess, the patient experiences very severe pain. The pain is even increasing. The periosteum is an exceptionally well-vascularized and innervated tissue, and the purulent exudate collecting under it causes it to separate from the rest of the alveolar process. Hence, severe pain and deterioration of the patient's general well-being. When the periosteum is broken, the purulent contents flow out and the pressure inside the abscess cavity is reduced. Extensive swelling of soft tissues occurs, which may be located on the cheek, on the palate or on the lingual side of the tooth. A characteristic feature of a submucosal abscess resulting from a subperiosteal abscess is the reduction in pain experienced by the patient.
Tooth abscess - complications
With this type of changes, dental intervention is necessary. Untreated abscesses can cause dangerous complications such as serious swelling that makes breathing and swallowing difficult, high fever above 39 degrees C, and trismus. The most dangerous is the spread of purulent exudate to other fascial spaces, especially upwards, to the infraorbital area and nose. These areas are intensively vascularized and have direct contact with the brain through a network of blood and lymphatic vessels.
Tooth abscess – how to get rid of it?
Fortunately, each type of periodontal abscesses causes intense pain and discomfort, which is why patients react quite quickly and consult a dentist to get rid of the abscess. This may include a tooth extraction procedure.