An endodontic abscess is a pocket of pus that forms in the jawbone at the tip of a tooth root. You may realize you have an abscess because the tooth hurts when you tap or bite on it, you have a bad taste in your mouth, the tooth sometimes contacts the opposing tooth first upon biting, or you experience pain and swelling. On the other hand, you may be unaware of an abscess because you have none of these symptoms at all. An endodontic abscess begins when bacteria, which are naturally present in your mouth, infect the inner pulp layer of the tooth. Although sometimes there is no apparent reason for the bacterial invasion, bacteria commonly get through the enamel and dentin layers of the tooth and into the innermost pulp layer through deep cavities, breaks, fractures, or injuries to the tooth. The infection can then spread from the pulp chamber, down the root canals, and through the tip of the root.
If the infection continues, a hole is formed in the jawbone at the tip of the root. This hole is an endodontic abscess. It contains pus, a liquid that results from the body’s immune response to the infection, and is surrounded by a membrane that forms around the infected area. An abscess is a natural defense mechanism that the body uses to wall off the invading bacteria, but as the abscess grows, it creates pressure inside the bone and ligaments surrounding the tooth, and this pressure can eventually cause excruciating pain.
The body will often try to relieve the pressure by forming a gumboil. A gumboil, sometimes called a fistula, is a tube-like passage from the abscess to the outside, and this can allow some of the pus and bacteria to drain through the gum near the infected tooth. Left untreated, an endodontic abscess can damage the adjacent soft tissue in the mouth and face, lead to bone loss, be a continuing source of infection that drags down your immune system, and may even be life threatening. Because of the damage and pain that an endodontic abscess can cause, it’s important to treat it right away.
To treat an endodontic abscess, we must drain the abscess and remove the source of infection. Root canal therapy is often the treatment of choice because it removes the infection, relieves the pressure, and usually heals the abscess. Sometimes however, even after a root canal, the infection continues to grow. In that case, retreating the tooth with root canal therapy or a further surgical procedure, called an apicoectomy, will stop the infection and restore the health of your tooth. Antibiotics, though they can’t cure an abscess by themselves, may be prescribed to prevent infection from spreading. We may also recommend using anti-inflammatory pain relievers.