What is Dental Abscess (Cavities)?
Dental infections are usually easy to diagnose and reach, but they can be difficult to deal with on short notice. These infections frequently occur due to tooth decay (which often results from poor oral hygiene), injury, or unsuccessful root canal procedures. If these infections are not treated, they can cause extreme pain and may even spread downwards into the deep neck area or upwards into the sinuses in the skull. It’s important to identify, treat, and educate people about dental infections, as this can provide relief from symptoms and prevent serious complications.
What Causes Dental Abscess (Cavities)?
A dental abscess, or a pocket of pus in your teeth, can be caused by tooth decay, dental injuries, or not taking good care of your teeth. When the hard protective layer of your teeth, called enamel, breaks down, bacteria from your mouth can get into the tooth cavity. This can cause an infection, which leads to a lot of pain as it spreads within the limited space of the tooth and pushes against the inner walls.
This infection can then spread down through the root canal and into your jawbone, depending on where the infected tooth is located. Another common cause of a dental abscess is a tooth that hasn’t completely broken through the gums, like a wisdom tooth. Bacteria can get trapped between the tooth and surrounding soft tissues, leading to inflammation.
There can be a range of other causes too. Some people might have genetic conditions that cause weak enamel, making it more prone to damage. Teeth grinding can also lead to enamel breakdown. Certain medical conditions, like Sjogren syndrome, can cause dry mouth and lead to faster growth of mouth bacteria. Similarly, irritants like meth smoke or lowered immune function from chemotherapy or conditions like HIV/AIDS can also lead to tooth decay and make dental abscesses more likely.
Risk Factors and Frequency for Dental Abscess (Cavities)
Dental caries, or tooth decay, and poor dental health are quite common in the United States. In a survey done by the National Center for Health Statistics between 2011 to 2012, it was reported that 91% of adults aged 20 to 64 had dental caries. However, the rates were lower in Hispanic, non-Hispanic black, and non-Hispanic Asian adults, compared to non-Hispanic white adults. Moreover, around 27% of adults within the same age range had tooth decay that was not treated. This percentage was higher in Hispanic and non-Hispanic Black Americans, at 36% and 42% respectively. In adults over 65 years old, approximately 19% had untreated dental caries.
Dental abscesses, a pocket of pus in the teeth or gums due to bacterial infection, and dental-related hospital emergency room visits are also common. In fact, one study showed that hospital admissions due to dental infections happened at a rate of 1 per 2,600 people in the United States. Pediatric emergency room visits for dental abscesses were even higher, at 47%.
This data suggests that poor dental health, which increases the risk of developing a dental abscess, is rampant. Furthermore, it indicates that racial and likely socioeconomic factors play a significant role in dental health. This may influence the practices of healthcare providers based on the population, racial makeup, and socioeconomic demographics of the community.
Signs and Symptoms of Dental Abscess (Cavities)
Dental abscesses are infections that occur in the teeth, often caused by poor dental hygiene, lack of regular dental check-ups, or untreated dental injuries. These can be identified by various symptoms such as intense toothache that might be localized and worsens when the tooth is touched, facial redness, trouble opening the mouth fully (trismus), difficulty swallowing (dyspnea), fever and swollen lymph nodes. A tooth affected by an abscess can appear discolored, might have visible cracks in the enamel, or might be surrounded by red and swollen gums. It is important to seek immediate medical attention if there is a change in mental status or difficulty breathing as these might point towards serious complications.
- Severe toothache
- Poor dental hygiene
- Lack of regular dental check-ups
- History of untreated dental trauma
- Localized tooth pain that worsens when touched
- Facial redness
- Difficulty opening the mouth fully (trismus)
- Difficulty swallowing (dyspnea)
- Fever
- Swollen lymph nodes
- Discolored tooth/teeth
- Visible enamel breaks
- Red and swollen gums around the affected tooth
- Change in mental status
- Difficulty breathing
Testing for Dental Abscess (Cavities)
If doctors suspect that a patient may have an abscess, they typically use scans like CT and MRI, as these are known to be very reliable at detecting this condition. An initial check-up would usually comprise of a head and neck X-ray, and a blood test called complete blood cell count.
An X-ray of the head and neck helps doctors see if there’s any pressure or shifting of the windpipe, or if there is air beneath the skin that could suggest decayed tissue. These scans are especially helpful if doctors need to find out if a bacterial infection has spread upwards to the sinus cavities.
The complete blood cell count is used to identify if an infection is likely, based on the total quantity of white blood cells and by spotting which type of white blood cell appears the most. If a bacterial infection is present, there is usually an increase in a particular kind of white blood cells called neutrophils, in individuals whose immune system is functioning properly.
Treatment Options for Dental Abscess (Cavities)
Treating a dental abscess often involves draining the abscess, taking antibiotics, managing pain, and addressing the infected tooth. In many cases, taking oral antibiotics and visiting a dentist for treatment of the infected tooth can be enough. Most people with a dental abscess do not need to be admitted to the hospital or to receive antibiotics through an IV, unless they have concerning symptoms such as a fever, difficulty breathing, or problems with their airway due to swelling. The most common treatment is antibiotics that can fight a variety of bacteria.
Penicillins and cephalosporins are antibiotics that can be used for dental infections, but some bacteria are becoming resistant to these drugs due to their ability to produce an enzyme called B-lactamase. So, combining penicillins with other drugs like metronidazole, or using antibiotics with wider range like ampicillin-sulbactam and ampicillin-clavulanate, can be a better option.
There are specific dosages for these drugs. For instance, ampicillin-sulbactam should be injected intravenously 3 grams every six hours. Amoxicillin-clavulanate is taken orally, with 875 mg every twelve hours.
However, another type of antibiotics, macrolides, should not be the first choice unless the patient is allergic to penicillins or cephalosporins. This is because some bacteria are becoming resistant to macrolides.
In addition, metronidazole fights well against anaerobic organisms. But since it does not cover aerobic gram-positive organisms well enough, it is often used together with penicillin.
For those allergic to penicillins and cephalosporins, clindamycin is a suitable option. It fights against a variety of bacteria types and even reaches the bone area effectively.
For severe infections or in patients with weaker immune systems, advanced drugs like fourth-generation or higher cephalosporins, piperacillin-tazobactam or carbapenems like meropenem, should be considered. These antibiotics are effective against a wide range of bacteria, including those that are resistant to common drugs.
What else can Dental Abscess (Cavities) be?
Here are some medical conditions that could potentially be causing symptoms:
- Buccal bifurcation cyst (a cyst near the roots of a tooth)
- Eosinophilic granuloma (a type of lesion in the body’s soft tissues)
- Gingival abscess (infection in the gum tissue)
- Langerhans cell histiocytosis (a rare disease that involves an over-production of certain types of immune cells)
- Lateral periodontal cyst (non-inflammatory cysts along the side of a tooth below the gum line)
- Osteomyelitis (an infection in the bone)
- Periapical abscess (accumulation of pus at the root of a tooth caused by an infection)
- Peritonsillar abscess (a collection of pus developed beside the tonsils)
- Periapical granuloma or cyst (an inflammation or cyst at the end of a tooth where an infection has spread)
- Vertical root fracture (a crack in the tooth that starts at the root and extends toward the chewing surface)
Understanding these potential causes can help doctors pinpoint what might be wrong and decide on the best course of action.
Surgical Treatment of Dental Abscess (Cavities)
If you have a dental abscess, your doctor might suggest a couple of different treatments. This could include a root canal, where the infected roots of your tooth are cleaned out, or even removing the tooth entirely. If the abscess is located at the base of your tooth, it might need to be cut open and drained.
This cut-and-drain procedure can be done in the emergency room or a clinic, but you’ll need to see a dentist afterward for follow-up care. During a root canal, a dentist will take off the top part of your tooth so they can see the infected roots. These roots are then cleaned with a special solution before being filled in and covered again with the top part of the tooth.
However, there can be some complications. Sometimes the tools used to clean the tooth can break off inside it, the tooth could crack, or not all the bacteria may be removed. If any of these things happen, you may need to have the root canal procedure repeated or have the tooth pulled out.
What to expect with Dental Abscess (Cavities)
The outlook for a dental abscess is often positive. However, neglecting to treat a dental abscess can lead to serious consequences; the mortality rate can rise to 40% if the infection spreads to the chest region, which is a condition called mediastinitis. In fact, a severe infection can obstruct the airway, making it necessary to use a tube to facilitate breathing or even create an opening in the neck known as a tracheostomy.
If the infection moves upwards through the sinuses or spreads to the brain through the bloodstream, this can also increase mortality rates and the outlook becomes worse.