Dental Abscess

Definition and types

"An abscess corresponds to the accumulation of pus within a closed tissue space. This pus is a pathological secretion that results from inflammation of bacterial origin."

Depending on its origin, two categories can be distinguished: the periodontal abscess and the peri-apical abscess, the latter being consecutive to the necrosis of the dental nerve.

The periodontal abscess

It originates at the level of the gum and most often affects patients with gum recession. It is linked:

• to the accumulation of germs between the gum and the root of a tooth whose ossification is no longer complete;
• to the passage of bacteria between the wisdom tooth and the gum, when the wisdom tooth has only partially emerged on the arch.

The peri-apical abscess

It originates from the necrosis of the tooth's nerve. If the pus does not manage to escape through the external part of the tooth (cavity hole, for example), it then escapes through the end of the root into the bone.

Its causes can be:

• an untreated deep cavity;
• a dental fracture;
• an incomplete root canal treatment (devitalisation), leading to the proliferation of bacteria in the root up to the maxillary bone;
• a dental filling that is aggressive to the nerve (composite or white filling placed without protective material between the composite and the bottom of the dental cavity).

How does a dental abscess manifest itself?

For the periodontal abscess:

• pain;
• swelling of the gum around the tooth;
• discharge of yellow pus around the gum;
• trismus (impossibility of fully opening the mouth) when the infection of a wisdom tooth reaches the tendinous insertion of the jaw muscles.

For the peri-apical abscess:

• tooth painful to pressure;
• "long tooth" sign (the tooth that the patient touches first when closing the mouth);
• pain increased by heat, relieved by cold;
• on examination: negative cold test, pain on percussion, mobility of the tooth, presence of submandibular lymph nodes.

Consequences of an untreated dental abscess

Without management, a dental abscess:

• may become less painful if the pus finds an evacuation path through the gum (fistula);
• may transform into an apico-dental cyst (cyst attached to the end of the dental root);
• may, when it affects a molar or a second upper premolar, lead to a maxillary sinus infection;
• may extend to the tonsil in the case of an abscess on a wisdom tooth.

Treatment of the dental abscess

We distinguish between the treatment of the abscess, which constitutes a medical emergency, and the treatment of its cause.

The treatment of the abscess

Like any abscess, it must be drained to evacuate the pus:

• incision of the gum;
• opening of the tooth's nerve.

This drainage is supplemented by antibiotic therapy.

Next comes the treatment of the cause

• extraction of the tooth when it is not preservable (loosening too advanced, large cyst around the roots, wisdom tooth that cannot find its place on the arch and likely to be at the origin of new infectious episodes if not removed);
• conservative treatment (keeping the tooth):
  • gum surgery in order to eliminate a periodontal pocket responsible for the accumulation of germs between the gum and the tooth;
  • obturation of the roots of the non-vital tooth to avoid their bacterial colonisation;
  • apical resection, which consists in removing 1 to 3 mm of the end of the root as well as the cyst attached to it, combined at the same time with the obturation of the root by classic endocanal route, or by the placement of an obturation on the surgically resected root end;
  • dismantling of an incomplete canal filling and its revision up to the end of the root.

All these treatments can be carried out within the dental practice in Cannes.