Earlier today, we saw a patient with a broken tooth. This tooth was very broken with only about a quarter of the crown of the tooth remaining, but there was no history of any pain or any other symptoms. In fact, apart from being broken, this tooth looked in pretty good condition, no decay and no other visually detectable problems. We were discussing the possible options for this tooth and as part of the investigations, took an x-ray.
That’s when the whole picture became clear. The x-ray showed a MASSIVE abscess associated with the broken tooth and this changed the options for this tooth. It was also obvious that this abscess had been present for years without the patient being aware at all that they were harbouring a huge infection.
The point of the case story above is to establish that not all abscessed teeth cause pain and that in turn, absence of pain is not a definitive indicator of health. It also serves to illustrate the important role x-rays have in determining possible indications of disease. Here are some things which may indicate that there may be a problem
A person may be suffering from an abscessed tooth if:
- There is a pimple or swelling on the gum that is also filled with pus. The pimple is referred to as a draining fistula and this can usually be ruptured to release the pus. Evidently, this is a very noticeable indication of infection. Further, other tooth abscess signs are unpleasant odour in the mouth or bad taste.
- there is discomfort or pain in pressing on the tooth or when eating. The abscess that has disseminated in the area of the tip of the root causes the surrounding bone and gum to be affected. At times, the pulsating or throbbing pain is so serious that it can no longer be relieved with pain medications. Moreover, this is commonly linked with the spread of the infection and eventually causes more pressure on the nearby structures of bones and gums.
- The fall-out of the dead pulp tissue which flows into the permeable layer of the tooth causes discolouration which turns the tooth dark in colour compared to the neighbouring teeth.
- There are cases when an abscessed tooth does not produce any symptoms at all. Since the tooth has lost its capability to feel stimuli or has lost its vitality, there may be no discomfort or pain linked to it. But, the abscess is still present and may still disperse the infection. Occasionally, an abscessed tooth is diagnosed during X-ray examination where the patient has not encountered any symptoms of this condition.
How is an Abscessed Tooth Diagnosed?
The diagnosis of an abscessed tooth is generally identified by:
- Signs and symptoms as reported by the patient
- What is observed or visualized with X-rays
- Tests and examinations which are performed by the dentist
The Treatment for an Abscessed Tooth
The common treatment for an abscessed adult tooth starts with carefully and thoroughly removing the infection. Hinging on how much infection has proliferated, the course of action typically comprises of draining the tooth and its surrounding structures of the infection and also through the help of oral antibiotics.
In some cases, the infection can disseminate rapidly and necessitate urgent attention. Likewise, if the dentist is unavailable and there is already swelling in the face and in the jaw as well as fever, then, it is advisable to go to the Emergency department in hospital and have it checked out. It is also important to go to the Emergency department immediately if the patient is suffering from difficulty in swallowing and breathing as some dental abscesses may result in very serious systemic or life-threatening infections.
Patients’ often ask us why treating these infections using antibiotics alone does not work. This is explained by thinking about the structure of the tooth. The dead pulp which has caused the initial infection still remains inside the tooth following a course of antibiotics. It will therefore remain as a constant source of new infection unless the dead and infected pulp tissue is physically removed either by performing a root canal treatment on the tooth or extracting the tooth if it cannot be effectively and predictably restored.
