Definition of Root Abscess
A tooth abscess or root abscess is pus enclosed in the tissues of the jaw bone at the tip of an infected tooth. Usually the abscess originates from a bacterial infection that has accumulated in the soft pulp of the tooth. This is usually but not always associated with what is commonly described as a dull throbbing excruciating ache.
A root abscess typically originates from dead pulp tissue, usually caused by untreated tooth decay, cracked teeth or extensive periodontal disease. A failed root canal treatment, may also create a similar abscess.
There are two types of root abscess. A periapical abscess starts in the dental pulp and is most common in children. A periodontal abscess begins in the supporting bone and tissue structures of the teeth, and is the most common type in adults.
A root abscess usually occurs at the end of a root tip. However, it can sometimes be found along any of the root length and even at the top of the tooth where the roots divide. It is a small collection of dead tissue, live and dead cells. Any dental infection can seed bacteria throughout the body and cause other medical problems. It should always be treated as soon as possible. When the source of the irritation is removed, the dental infection goes away and the bone surrounding the tooth heals by filling in the damaged area with new bone.
Root Abscess Presentation / Symptoms
Common symptoms of an acute tooth abscess is a toothache or a persistent, throbbing pain at the site of the infection. Putting pressure or warmth on the tooth, can induce extreme pain.
In some cases, a root abscess may perforate bone and start draining into the surrounding tissues creating local facial swelling. The lymph glands in the neck in some cases will become swollen and tender in response to the infection.
Sometimes a root abscess shows up as a root canal complication after a root canal has been completed. In most cases, retreatment or root canal surgery successfully removes the root canal infection. In root canal surgery, a window is made through the bone and the dental abscess is cleaned out with special dental instruments. Bone is sometimes placed into the surgical area to assist with healing and the patient returns in about a week to have the stitches removed. Fortunately, this procedure is only necessary about one to two percent of all endodontic cases.
A toothache that is severe and continuous and results in gnawing or throbbing pain or sharp or shooting pain are common symptoms of an abscessed tooth. Other symptoms may include: fever; pain when chewing; sensitivity of the teeth to hot or cold; bitter taste in the mouth; bad breath; swollen neck glands; general discomfort, uneasiness, or ill feeling; redness and swelling of the gums; swollen area of the upper or lower jaw; an open, draining sore on the side of the gum.
If the root of the tooth dies as a result of infection, the toothache may stop. However, this doesn’t mean the infection has healed; the infection remains active and continues to spread and destroy tissue. Therefore, if you experience any of the above listed symptoms, it is important to see a dentist even if the pain subsides.
Treatment of Root Abscess
One treatment for an abscessed root is to extract it, thereby removing the source of infection. However, in select cases root canal therapy may be able save the tooth by cleaning the source of infection in the pulp chamber and root canal system.
Root Abscess Untreated Consequences
An untreated severe tooth abscess may become large enough to perforate bone and extend into the soft tissue. From there it follows the path of least resistance. Largely dependent on the location of the infected tooth; the thickness of bone, muscle and fascia attachments, the infection then spreads either internally or externally.
External drainage may begin as a boil which bursts allowing pus drainage from the abscess, intraorally (usually through the gum) or extra orally. Chronic drainage will allow an epithelial lining to form in this communication to form a pus draining canal (fistula). Sometimes this type of drainage will immediately relieve some of the painful symptoms associated with the pressure.
Internal drainage is of more concern as growing infection makes space within the tissues surrounding the infection. Severe complications requiring immediate hospitalisation include Ludwigs angina, which is a combination of growing infection and cellulitis which closes the airway space causing suffocation in extreme cases. Also infection can spread down the tissue spaces to the mediastinum which has significant consequences on the vital organs such as the heart. Another complication, usually from upper teeth, is a risk of septicaemia (infection of the blood), from connecting into blood vessels.
Depending on the severity of the infection, the sufferer may feel only mildly ill, or may in extreme cases require hospital care.
Prevention of Root Abscess
For prevention tooth abscess you should:
- Have a good dental hygiene
- Brushing teeth
- Use antiseptic mouthwash
- Make dental checkups
- Make prompt treatment of tooth decay
- Have low-sugar diet
Following good oral hygiene practices can reduce the risk of developing a tooth abscess. Also, if your teeth experience trauma (for example, become loosened or chipped), seek prompt dental attention.