Periapical and Periodontal Abscesses
Dental abscesses are severe tooth infections that can lead to swelling in the throat or, if left untreated, death. From what I learned during my time shadowing dentists, I found that this was one of the major things that worry dentists, most likely due to the complex procedure required to remove the abscess. There are two primary types of abscess, the dental pulp based periapical abscess and the tissue/bone based periodontal abscess.
The periapical abscess is the more common of the two types of abscess. Once a tooth cavity reaches the dental pulp (or a tooth is cracked), bacteria can begin to infect the root of the tooth. At this point the build-up of infection and pathogens can lead to the formation of a periapical abscess on the apex of the root. This results in a highly decayed tooth and a swelling visible through the gum. Periapical abscesses are fairly easy to prevent as brushing regularly prevents the formation of cavities, and the prevention of cavities prevents the possibility of pathogens reaching the dental pulp. Even if a dental cavity does arise through lack of brushing or otherwise, a quick trip to the dentist for a filling removes the risk of an abscess.
Periodontal abscesses are slightly rarer than the periapical abscesses as periodontal disease is almost a prerequisite to getting the abscess. The infection begins by a build-up of plaque around the gingival tissue (gums), once the soft mouth tissues have been subject to plaque build-up for 2-4 days an initial lesion will begin to form due to increased numbers of leucocytes dissolving collagen and connective tissue. From this stage the lesion will continue to grow, eventually resulting in a periodontal abscess. The abscess causes increased tooth mobility due to large amounts of fluid accumulating in the gingiva, which begins to damage the bone of the maxilla or mandible.
Both abscesses can give rise to septicaemia, which in turn gives rise to sepsis (blood poisoning). Once a patient is infected with sepsis it can begin to spread around the body infecting most major organs, systematically shutting them down. Due to the dangers affiliated with dental abscesses, the importance of keeping teeth clean was repeated on numerous occasions.
Dental abscesses can be treated in two ways, extraction of the tooth or pulpectomy. Pulpectomy is simply root canal treatment, followed by apicoectomy to remove the infected root tip(s). The picture below illustrates root canal treatment, whereby the tooth is drilled open and the pulp, infection and nerve are removed before filling up the tooth with a biocompatible material or plastic and crowning the tooth. The apicoectomy removes the root tip, and the dental abscess along with it. Tooth extraction is a relatively simple procedure and has been outlined previously during my work experience.