What exactly is a tooth infection/abscess?

Development of a dental abscess is considered a dental emergency because they can be very painful and in rare cases cause life threatening complications. During the six years I spent in Dallas in oral surgery residency, I witnessed several patients become permanently disabled… from a tooth abscess! Thankfully, most dental abscesses can be quickly addressed by your dentist or oral surgeon to prevent life threatening consequences.  Furthermore, the risk of serious complications from a dental infection depends upon your health status.  Pre existing conditions such as hypertension, diabetes, immune disorders, and certain medications such as steroid use may increase the risk of the infection spreading more rapidly.

Most dental abscesses are diagnosed using clinical evaluation as well as x-rays.  Depending on the severity of the abscess, more extensive imaging may be required such as a CT scan.  If you have labs drawn, the white blood cell count is typically elevated, indicating an active immune response.

A tooth abscess can be treated by removing the source of the infection.  This can be done in two ways.

#1 – Root canal. Cleaning the inside of the tooth with a root canal in order to remove all bacteria from the inside of the tooth.  Once a root canal is successfully finished, you should have a sterile tooth once again and your body’s immune system will no longer mount an immune response.  Your dentist can perform this procedure or she may refer you to an endodontist, a dentist specializing in root canal therapy.

#2 – Surgical removal of the infected tooth.  Remember, the bacteria inside the tooth causes the abscess.  If the entire tooth is removed, the source of the infection is gone and the body can heal properly.  Depending on the size of the abscess, you may also require an incision and drainage.  This procedure simply relieves the pressure that has built up and allows all the pus that has collected to drain out. Patients often find immediate relief afterwards.  This procedure can usually be done in the dental office under local anesthesia or IV sedation.  If the infection is very severe, the OR setting at a hospital is more appropriate.

I have treated many dental abscesses in my practice by removing the infected tooth with or without incision and drainage and the vast majority of patients do very well with this treatment.  After surgery, you can expect significant reduction in pain and pressure.  The swelling slowly decreases over the next few days and should completely resolve within 1-2 weeks.  Antibiotics are also an important part of treatment, the most common being Amoxicillin or Clindamycin.

If you suspect that you are developing a dental abscess, the best thing to do is to schedule an emergency visit with your dentist.  If you are experiencing rapidly worsening fevers, chills, nausea, difficulty opening your mouth, difficulty breathing, or swallowing, present to the nearest emergency room immediately.  Dental abscesses can be scary but if they are properly treated early, most severe consequences can be avoided.

To your health and prosperity,