Periapical Abscess – Symptoms, Treatment, X-ray Radiology, with/without Sinus

A periapical abscess, commonly known as a tooth abscess, is a type of dental abscess that occurs at the tip of a tooth root. It’s a serious condition that can lead to severe pain and, if left untreated, significant risk of life-threatening complications. Understanding tooth abscess symptoms, causes, and treatments is crucial for anyone experiencing this dental issue.

Key Facts

A periapical abscess is a collection of pus at the root of a tooth, typically caused by bacterial infection

This dental condition can be extremely painful and if left untreated, the infection can spread and lead to serious health complications

Oral hygiene practices, such as regular brushing and flossing, can be effective in preventing periapical abscess

Treatment involves draining the abscess, treating the infection, and taking steps to prevent future infections

A periapical abscess is different from a periodontal abscess, which affects the gums rather than the root of the tooth

What is a Periapical Abscess (Dental Abscess)?

A periapical abscess, commonly known as a tooth abscess, is an accumulation of pus that occurs at the apex or tip of a tooth’s root. It is typically caused by a bacterial infection and can occur when the tooth’s nerve is dead or dying. This infection can originate from the inside of the tooth when it’s exposed to bacteria due to cavities, cracked teeth, or old dental work. When the bacteria invade the pulp (the innermost part of the tooth that contains blood vessels and nerves) it can lead to the formation of an abscess.
The abscess is essentially a defense mechanism, where the body tries to localize the infection to prevent it from spreading. However, it can cause pressure and inflammation, leading to intense pain. When left untreated, a periapical abscess can lead to serious complications such as bone loss in the jaw and the spread of infection to other parts of the body. It’s a serious condition that can lead to severe pain and, if left untreated, significant risk of life-threatening complications. Understanding tooth abscess symptoms, causes, and treatments is crucial for anyone experiencing this dental issue.

Periodontal Abscess vs. Periapical Abscess

It is essential to differentiate between a periapical abscess and a periodontal abscess to ensure proper treatment. While both types of abscesses are collections of pus due to bacterial infection in the mouth, they have different origins and implications.
A periapical abscess is located at the root of the tooth. It generally arises from an infection inside the tooth, primarily when the pulp is affected. This can happen due to dental caries, trauma, or a fractured tooth.
On the other hand, a periodontal abscess involves the gums and is located in the supporting structures of the teeth, not inside the tooth itself. This type of abscess usually occurs due to infection or blockage in the periodontal pockets (the spaces between the teeth and gums). It may be caused by severe gum diseases, trapped food particles, or a foreign body getting stuck in the gum.
In essence, a periapical abscess is an endodontic problem (related to the inside of the tooth), whereas a periodontal abscess is a periodontal issue (related to the supporting structures of the teeth).

What are the Symptoms of a Periapical Abscess?

The main symptom of a periapical abscess is a throbbing toothache. This pain can be intense and persistent, often described as a throbbing pain in the affected area. Recognizing the symptoms of a periapical abscess is crucial for timely intervention. The symptoms may vary depending on the severity of the infection.
Common symptoms include:

Severe Toothache: One of the most prominent symptoms is a throbbing and continuous toothache that can radiate to the jawbone, neck, or ear.
Sensitivity to Temperature: The affected tooth may become extremely sensitive to hot or cold temperatures.
Pressure Sensitivity: There may be pain when biting or chewing, or when pressure is applied to the tooth.
Swelling: Swelling may be present in the face or cheeks. The gums around the affected tooth may also be swollen and red.
Fever: A raised body temperature or fever may indicate that the body is fighting an infection.
Swollen Lymph Nodes: The lymph nodes under the jaw or in the neck may become tender and swollen.
Bad Breath or a Bad Taste in the Mouth: There may be a foul taste in the mouth or bad breath due to the pus and bacterial infection.
Pus Drainage: In some cases, there may be oozing of pus from the abscess. This may provide temporary relief from the pain as the pressure is reduced.

A periapical abscess will not resolve on its own and requires professional dental intervention to treat the infection and alleviate the pain. Early treatment can help in preventing potential complications associated with an untreated abscess. Other symptoms of a tooth abscess include sensitivity to hot or cold food and drink, swelling in the gum line or face, and a sudden rush of foul-tasting fluid in the mouth if the abscess ruptures. If an abscess leads to fever, swelling of the face or neck, or difficulty breathing or swallowing, it should be treated as one of the dental emergencies, and one should head to the emergency department immediately.

What Causes a Periapical Abscess?

A periapical abscess occurs due to a bacterial infection at the root of a tooth.
The infection can have various origins:

Dental Caries (Tooth Decay): Also known as cavities or tooth decay, dental caries can erode the outer layers of the tooth. If left untreated, the decay can reach the inner pulp, allowing bacteria to infect it and eventually leading to the formation of an abscess.
Dental Trauma: Trauma to a tooth, such as a fracture or chip, can expose the pulp to bacteria. Even if the damage seems minor, it can still allow bacteria to enter the tooth and cause an infection.
Failed Dental Work: Sometimes, old fillings or crowns may become loose or cracked, and this can provide a pathway for bacteria to enter the tooth.
Advanced Gum Disease: In some cases, gum disease can cause the gums to recede so much that the roots of the teeth are exposed, which can lead to an infection of the root tip and the formation of an abscess.

What are the Risk Factors for a Periapical Abscess?

Certain factors can increase the likelihood of developing a periapical abscess:

Poor oral hygiene practices
Consuming a diet high in sugary and sticky foods
Having a dry mouth (xerostomia) which can be due to medications, certain medical conditions, or other factors
Having a weakened immune system
Previous history of dental infections or abscesses
Using tobacco products
Not receiving regular dental check-ups and cleanings

What are the Complications of a Periapical Abscess?

If left untreated, a periapical abscess can lead to serious complications:

Bone Loss: The infection can spread to the bone surrounding the root of the tooth, leading to bone loss.
Spread of Infection: The infection can spread to adjacent teeth or into surrounding tissues and spaces in the face and neck.
Abscess Rupture: The abscess can rupture, and while this may provide temporary pain relief, it can spread the infection.
Sepsis: Rarely, if the infection spreads to the bloodstream, it can cause sepsis, which is a life-threatening body-wide response to infection.
Ludwig’s Angina: This is a serious infection that occurs in the floor of the mouth, under the tongue. It can be life-threatening if it causes swelling that obstructs the airways.

How is a Periapical Abscess Diagnosed?

Diagnosis of a periapical abscess generally involves a combination of a dental examination and imaging tests:

Dental Exam: The dentist will start by reviewing the patient’s medical history and symptoms. Then, they will examine the mouth, teeth, and gums to check for signs of infection, swelling, or other abnormalities.
Dental X-rays: X-rays are essential in visualizing the health of the teeth and the underlying bone. They can reveal the abscess, as well as bone loss or other changes associated with infection.
Dental CT scan: In certain cases, especially if the infection is suspected to have spread to surrounding areas, a dental CT scan may be used. This provides a more detailed, three-dimensional image of the teeth and jaws, and can help in assessing the extent of the infection.

After diagnosing a periapical abscess, the dentist will suggest an appropriate treatment plan to address the infection and alleviate symptoms. Treatment often includes antibiotics to fight the infection, and procedures to drain the abscess and treat the source of infection. In some cases, root canal therapy or tooth extraction may be necessary.

Treatment: How is a Periapical Abscess Treated?

At the first sign of a tooth abscess, it’s important to see a dentist immediately for prompt treatment. Delayed treatment can lead to the spread of the infection to other parts of the body, including the sinus cavity and maxillary sinuses. The treatment of a periapical abscess focuses on eliminating the infection, preserving the tooth, and preventing complications. A dentist will typically drain the abscess to get rid of the infection and may perform a root canal to save the infected tooth. In severe cases, extraction of the tooth may be necessary.
The following are the common steps involved in treating a periapical abscess:

Draining the Abscess: The dentist may make a small incision in the abscess to drain the pus. This can provide immediate relief from pain due to pressure.
Root Canal Therapy: Often, a root canal procedure is necessary to remove infected tissue within the tooth and prevent the infection from recurring. During this procedure, the dentist will drill into the tooth, remove the diseased pulp, clean and shape the root canals, and then fill and seal the space.
Use of Antibiotics: If the infection has spread beyond the abscessed area or if the immune system is compromised, the dentist may prescribe antibiotics to help fight the infection.
Tooth Extraction: In severe cases where the tooth cannot be saved, extraction may be necessary. This is usually the last resort if the tooth is too damaged.
Pain Management: Pain relief medications may be prescribed or recommended to manage pain associated with an abscess.
Dental Restoration: After a root canal, the tooth may need a crown or other restoration to protect it from breaking and to restore its normal function and appearance.

How Can I Lower My Risk for Periapical Abscesses?

Preventing periapical abscesses involves taking steps to maintain good oral hygiene and to minimize the risk of infection:

Oral Hygiene Practices – Brush and Floss Regularly: Preventing dental abscesses involves maintaining good oral hygiene. Brush your teeth twice a day with fluoride or HAp toothpaste, using a soft toothbrush to avoid damaging the gum line. Regular flossing is also essential.
Regular Dental Check-ups: Visiting the dentist regularly for check-ups and cleanings is key to preventing dental problems that could lead to an abscess. The dentist can detect early signs of decay and gum disease before they progress to an abscess.
Eat a Balanced Diet: Eating a balanced diet and avoiding excessive sugary food and drink can help prevent tooth decay. After treatment for an abscess, sticking to soft foods can help ease discomfort.
Wear a Mouthguard if Necessary: If you participate in sports or have a habit of grinding your teeth, wearing a mouthguard can help protect your teeth from trauma.
Manage Dry Mouth: Dry mouth can increase the risk of tooth decay and abscesses. If you suffer from dry mouth, discuss with your dentist ways to increase saliva production, such as special mouthwashes or lozenges.
Don’t Ignore Dental Pain or Sensitivity: If you experience pain or sensitivity in a tooth, don’t ignore it. This could be an early sign of a problem that could lead to an abscess.

How Long Can a Periapical Abscess Go Untreated?

It is not advisable to leave a periapical abscess untreated for any period. The sooner it is treated, the better the outcome is likely to be. An untreated abscess can quickly progress, with the infection potentially spreading to surrounding tissues and even to other parts of the body. Within days to weeks, the pain can intensify, and serious complications such as bone loss, sepsis, or other infections can occur. Immediate dental attention is recommended if you suspect you have a periapical abscess to prevent complications and preserve the health of the tooth and surrounding tissues.

When Should I See My Dentist?

You should see your dentist if you experience:

A persistent or severe toothache
Sensitivity to hot or cold temperatures
Pain when biting or chewing
Swelling in your face or cheek
Swollen, red gums
Persistent bad taste in your mouth or bad breath
Any sign that suggests an infection in the mouth

Early intervention is key to managing a periapical abscess effectively and preserving the health of the tooth.

When Should I Go to the ER?

While most cases of periapical abscess can be managed by a dentist, there are situations where emergency care is necessary.
Visit the emergency room if you experience:

High fever
Difficulty breathing or swallowing
Severe swelling in the face or cheek that is rapidly worsening
Intense, unmanageable pain despite taking pain relievers

These symptoms may suggest that the infection is spreading rapidly or affecting vital structures and need immediate attention.

What Questions Should I Ask My Healthcare Provider?

When seeing a dentist or healthcare provider for a periapical abscess, consider asking the following questions:

What is the likely cause of the abscess?
What treatment options are available for my condition?
Will I need antibiotics?
Are there any risks or side effects associated with the recommended treatment?
How can I manage pain or discomfort at home?
What steps can I take to prevent future abscesses?
When can I expect to feel relief from my symptoms?
Should I make any changes to my oral hygiene routine?

How Long Does It Take a Bacterial Infection to Form Tooth Abscess?

The formation of a periapical abscess can vary from person to person. It may develop over several weeks to months as an untreated dental infection slowly progresses. However, in cases of severe trauma or a rapidly progressing infection, it can form in just a few days.

Is It Possible to Get a Periapical Abscess After Root Canal Treatment?

Yes, it is possible to develop a periapical abscess after a root canal treatment, although it is relatively uncommon. This can occur if not all of the infected material was removed during the procedure or if there was a reinfection of the treated tooth. It’s important to follow post-operative care instructions and maintain good oral hygiene to minimize the risk.

Is It Possible to Have a Periapical Abscess with Sinus Symptoms?

Yes, a periapical abscess in the upper teeth can sometimes cause sinus symptoms. This is because the roots of the upper teeth are in close proximity to the sinuses. An infection can spread to the sinus, causing symptoms like sinus pressure, nasal congestion, and a runny nose.

Bottom Line

A periapical abscess is a serious dental condition that requires timely intervention. Recognizing the symptoms early and seeking immediate dental treatment can prevent the infection from spreading and causing more serious health issues. Maintaining good oral hygiene and keeping regular dental appointments can significantly reduce the risk of developing an abscess. If you experience severe pain or other symptoms of a tooth abscess (like sensitivity, or swelling), contact your dentist or an oral surgeon immediately to receive the necessary care. In cases where symptoms are severe or rapidly worsening, seeking emergency care is crucial. Following the recommended treatment and engaging in preventative measures can help in managing periapical abscesses and maintaining good oral health.

This article is complete and was published on July 07, 2023, and last updated on December 19, 2023.

Key Facts