Thursday August 1, 2002

Dear Dr. Mady: Every time I go to the dentist I seem to have an abscess of some sort. What are abscesses, what causes them, and how can I get rid of them?- Jared in Windsor.

Dear Jared: An abscess is a localized aggregation of purulence in a self formed pocket or cavity that is created from the breakdown of tissue. In simpler terms it is a collection of pus in a specific area of your body from the disintegration of tissue.

Abscesses are usually created by certain bacteria that attack the tissues, often through small openings or wounds in the skin surfaces. They can also be initiated by necrotizing or dying structures within the body itself, or from bacteria in the mouth that may enter into the body via the blood. These bacteria multiply after invading and the result is an infection that sometimes can grow rapidly. The human body uses the abscess as a natural defense by walling-off the localized infection from the rest of your body. If the microorganisms were allowed to spread, the results could be catastrophic.

With respect to your mouth, there are a few specific types of infections that can form. These are a periapical abscess, a gingival or gum abscess and a periodontal abscess.

The periapical abscess is one that forms at the apex or end of the root of a tooth. This kind usually occurs secondary to deep tooth decay. This is caused from an infected pulp or nerve of a tooth, usually from a dying nerve. A gingival or gum abscess is usually a result of an attack on the surface of the gums around your teeth. Lastly, the periodontal abscess is when the bacteria travel deep into the pockets between the gums and the teeth and become blocked down there.

The pain from an abscess can be very intense due to the pressure build-up and may be constant. If it is from a tooth, the particular tooth in question will hurt even more when tapped and may even rise from the pressure at the end, not allowing you to close your mouth completely. Also, the inflammation from within the tooth will increase from eating or drinking warm or hot foods, adding to the agony. On the other hand, cold decreases inflammation and thus may give some relief. This is why patients often show up at their dentist’s office with a glass of cold water or sucking on ice cubes.

If treatment of the abscess is not commenced immediately, the infection could spread. The result could be fever, swelling and even cellulitis. It could even affect the jaw bone and many other surrounding structures. At times an abscess may form it’s own drain to help naturally release some of the pus, and if it is in the mouth, the taste is not pleasant. Failure to treat will eventually breakdown the bone in the area.

If an abscess is called chronic, it means that it has been developing or existing for some time. Acute reflects that it has arose usually within the past twenty-four to fourty-eight hours. A chronic abscess may be painless, but is sometimes the most destructive. This is because it becomes walled off by a fibrous sack called a granuloma, which is only diagnosable with an x-ray.

Treatment of an abscess depends on the type. In all three described previously, the exudates must somehow be drained. Antibiotics may be prescribed and if the abscess is periodontal, deep cleaning will be performed and later an evaluation of the periodontal structures will be required. If there is a periapical abscess, root canal treatment is the treatment of choice unless the tooth or bone structure is too broken down. In that case extraction and replacement should be contemplated.

Whatever the case, if you are in good general health, you will have a better defense with respect to fighting off infections. If you are a diabetic, or immuno-compromised the chances of infection are always greater and it is more of a challenge to eliminate. In extreme cases, surgical intervention may be required.

Do not delay treatment if you have an abscess. Ask your dentist if how much damage has been done, and if it is permanent. They will give you all the treatment options and recommend the best course of action for you. If you are prescribed any medications, be sure to ask what the common side effects are.


This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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