American Medical Association Family Medical Guide - American Medical Association [792]
If an abscess is not treated, it can eat away at the jawbone until it has worn a small canal, or sinus, through the bone and its overlying gum. Just before the canal reaches the surface of the gum, a painful swelling can form. The swelling may remain for weeks. However, in some cases, the abscess bursts, creating a drainage channel called a fistula. When this occurs, foul-tasting pus drains into the mouth, and the pain stops suddenly. The bacteria can invade adjacent bone and spread throughout the body, causing blood poisoning (see page 937).
How an abscess forms
If tooth decay is not treated, the pulp can become infected, and pus may begin to form. Pus at the base of the tooth may form an abscess and seep out through the root of the tooth. Untreated, the infection can damage the jawbone.
Symptoms and Treatment
An abscessed tooth aches or throbs persistently, making biting or chewing extremely painful. The glands in the neck may swell and become tender and, if the abscess spreads, the affected side of the face may also swell. An abscess usually causes a fever and makes a person feel generally ill. If you have swelling around the tooth that spreads to your face or neck, see your dentist immediately. If your dentist is not available, call your doctor, who may prescribe an antibiotic. Then see your dentist as soon as possible.
In the meantime, take acetaminophen or ibuprofen to help relieve the pain. Rinse your mouth every hour with warm salted water, to speed the bursting of the abscess and help relieve the pain. When the abscess bursts, rinse your mouth again to wash away the pus. After the abscess has burst, see your dentist for treatment as soon as possible.
A dentist may remove an abscessed back tooth or primary tooth if it is thoroughly infected. In most other cases, the dentist will try to save the tooth. He or she will drill a small hole through the crown of the tooth into the pulp chamber. If the abscess has not yet burst, drilling the hole will release the pus and relieve the pain. The dentist then cleans out and disinfects the pulp chamber and root canals. During a later visit, after the infection has cleared up, the dentist will place a permanent filling in the pulp chamber, root canals, and drilled hole. About 6 months later the dentist will take X-rays of the area to make sure that new bone and tissue are growing into the cavity left by the abscess. If new tissue is growing in the cavity, further treatment is usually not necessary.
Sometimes, even after root canal treatment, bacteria remain in the tissue around the base of the root of the tooth and cause an abscess to form. If antibiotics cannot clear up the infection, your dentist may recommend that you see an oral surgeon or an endodontist (a dentist who specializes in root canal treatment). If you have already had root canal treatment but still have problems with a tooth, an oral surgeon may perform a procedure called apicoectomy. For apicoectomy, you are given a local anesthetic and the surgeon makes a small cut through the gum, drills away the bone that covers the tip of the root, and removes the infected tissue at the base of the tooth. In rare cases, apicoectomy may not be effective, and the tooth must be removed and replaced with a bridge (see page 1110) or an implant (see page 1111).
Treating an abscess
Your dentist may try to save an abscessed tooth by drilling a small hole through the crown to release the pus. He or she can then clean out and disinfect the pulp chamber and root canals and put in a temporary filling. During a later visit your dentist will remove the temporary filling and replace it with a permanent filling.
Discolored Teeth
A slight yellowing of the teeth occurs naturally with age. However, for a variety of other reasons, teeth sometimes become discolored. Smoking and chewing tobacco