Dental Abscess: Is That a Serious Disease?

Dental infections are quite common in the US. Estimates suggest that 13% of adult patients were treated for dental infections. Due to its severe pain, it causes a loss of productivity. Dental abscesses, when promptly treated, have better patient outcomes.

Key takeaways:
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    Dental abscesses can lead to death and hence must be treated promptly.
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    An abscess may require surgical or medical treatment.
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    Early diagnosis is the key to better patient outcomes.

A dental abscess is an accumulation of pus on the gums or teeth that is triggered by a microbial infection. Dental abscesses are caused by a variety of factors. Dental abscesses are influenced by anatomical factors, bacterial virulence, and host resistance. A tooth abscess can lead to severe sepsis, ultimately causing the death of the patient.

Dental abscesses began to receive serious medical attention in the early 20th century. There has been an increase in the number of patients with dental sepsis who are referred to oral surgery services. A dental abscess is one of the complications that occur due to dental infection.

There is a significant correlation between dental or gum infections and complications and mortality rates for chronic diseases such as liver cirrhosis, diabetes, cancer, and kidney failure. Furthermore, dental abscesses have been reported to occur more frequently as a result of severe dental infections in both pediatric and adult populations.

What causes dental abscesses?

Poor dental hygiene, dental trauma, and dental caries are usually the causes of dental abscesses. Local infection is very likely to occur in teeth that have damaged the protective enamel layer. Oropharyngeal bacteria will easily enter and infect the pulp cavity so that the inner dentin wall is compressed. That's what causes excruciating pain.

A mixture of anaerobic bacteria (Streptococcus milleri, Staphylococcus aureus, Staphylococcus epidermidis, Streptococci, Fusobacterium, and Prevotella) causes this endodontic infection. This mixture of bacteria will spread superiorly or inferiorly into the root canals of teeth and jaws.

Wisdom tooth eruption has also been reported as a trigger for dental abscesses. Inflammation occurs due to the accumulation of bacteria in the gap between the soft tissue and the crown of the tooth. Dental abscesses can also be caused by genetic disorders such as amelogenesis imperfecta. This condition causes a weak and vulnerable enamel layer.

Furthermore, the growth and accumulation of oropharyngeal microbes are also accelerated by certain medical conditions. Sjogren's syndrome has been reported to contribute to the incidence of dental abscesses due to dry mouth in patients.

Finally, medical interventions such as the administration of immunosuppressive agents and chemotherapy can cause dental caries which is a triggering factor for dental abscesses.

What are the symptoms of a dental abscess?

Erythema, swelling, and inflammation of the teeth are symptoms that are often found in patients with dental abscesses. Whenever bacteria accumulate in the teeth, they will cause infections that result in pus building up in the nearby tooth tissue. It could trigger fatal and serious complications. A patient with a severe dental abscess will experience tenderness on palpation of the prominence, fever, and hoarseness.

Complications of a necrotizing mediastinal abscess with a deep neck can also occur in the presence of odontogenic infection. The high mortality rate due to complications of dental abscess is caused by unclear initial symptoms and delay in comprehensive diagnosis. This condition will cause sepsis and vital organ failure in the patient.

What is the treatment for dental abscesses?

Elimination of the source of infection, administration of antibiotics, control of inflammation, and abscess drainage are targets of treatment that need to be done to treat dental abscesses.

Patients with mild symptoms may be given oral antibiotics to treat the infection. If the patient has serious symptoms such as dyspnea, fever, swelling, and breathing problems, intravenous (IV) antibiotics may be given. Cephalosporin and penicillin antibiotics are effective in treating odontogenic infections.

However, the increased rate of antimicrobial resistance due to β-lactamase production should be noted. Thus, combinations of penicillin with β-lactamase blocking agents can be used, such as the ampicillin-clavulanate and ampicillin-sulbactam regimens.

Macrolide antibiotics can only be used if the patient with a tooth abscess has an allergic reaction to penicillin or cephalosporins. Clindamycin can also be an appropriate treatment option for patients with dental abscesses who are allergic to penicillin and cephalosporins.

For patients with dental abscesses due to immunosuppression or severe infection, anti-pseudomonal antibiotics (4th generation cephalosporins) or penicillin spectrum antibiotics are more favorable.

A piperacillin-tazobactam regimen may be considered for severe infections. Carbapenems (such as meropenem) can also be used against gram-negative bacteria, gram-positive bacteria, and resistant bacteria.

Surgical management can be performed on a tooth abscess. Root canal surgery and tooth extraction are performed in severe abscesses. Incision and drainage are required in patients with a periapical tooth abscess.

The surgical procedure is performed by removing the crown of the tooth to expose the root of the tooth. The root of the infected tooth is opened and cleaned by draining the accumulated pus. The clean tooth root is then filled and the crown is replaced. The entire procedure should be performed by an experienced dentist4.

Dental sepsis can be fatal but timely treatment can help in managing the disease effectively. Schedule an appointment with your dentist if you notice symptoms of a dental abscess. With proper medication and surgical intervention, dental abscesses can be cured. It is important to maintain oral hygiene later to prevent their recurrence.