The Dental Abscess

Inside each tooth, under the layer of enamel, and under the layer of dentin, there is a space in the center that is filled with living tissue, blood vessels, and nerves called the pulp chamber.  This chamber of living tissue also extends down the root or roots of the tooth, in canals, and connects to the rest of the body via blood vessels and nerves.  When bacteria enter into the pulp chamber, the tooth becomes infected.  A pocket of infected liquid (pus) collects inside the tooth and expands down the root canal, is forced beyond the root of the tooth, and an abscess is formed.  If the collection of pus expands within the bone, the tooth may become raised in its socket and is painful with chewing.  Sometimes, the abscess will burst and there is a release of pus giving some relief from dental pain.  However, it is important to get treatment for the infected tooth.  Even though there may be less pain, the infection does not go away.

The infection can remain active and spread and destroy other tissues, such as the ligaments that attach the tooth to the jawbone, and into the bone. Besides interfering with sleeping, eating, or a child�s ability to focus in school, if left untreated, the infection can continue to develop and cause serious complications, such as cellulitis which closes the airway space and can cause suffocation in extreme cases.  The infection can also spread down to other vital organs such as to the heart or to the brain.  Other complications can include infection of the bones or blood, swelling, and blood clots in the veins behind the eyes.  

There are several ways bacteria can enter the tooth�s pulp chamber to cause infection.  In children, it is usually caused from tooth decay.  Deep cavities invade the inner part of the tooth which destroys the pulpal tissues.  Since children have thinner enamel, and their primary teeth have a more abundant blood supply (which allows for an increased inflammatory response), abscesses can form more readily.  This is especially true if good oral hygiene practices are lacking, or if their diets consist of frequent exposures to sugar.  Besides decay, a cracked or broken tooth or old fillings that have broken down can be an entryway for bacteria to enter the pulp.  Trauma to the tooth from a large filling or crown may eventually lead to infection as well.  Sometimes, food or debris (such as a popcorn kernel) can get stuck between the gum and bone and cause the infection.

Obviously, the most noticeable symptom is pain.  The pain can be severe and persistent.  It might feel like shooting pain, or throbbing, or sharp pain, especially when biting, chewing, or tightly closing the mouth.  It may also be sensitive to cold or heat.  Other signs that may indicate there is an abscess are fever, red swollen gums, swelling of the jaw or face, swollen lymph nodes, sinus pressure, bad taste in the mouth, bad breath, or a visible blister in the gums that may burst and leak fluid.

If you think your child has an abscess, call your dentist.  If the infection becomes so painful that it cannot be managed by nonprescription medicines, it is especially important to get into a dentist.  Do not wait for your child�s toothache to develop into a medical emergency.   

To read more, go to:

www.emedicinehealth.com  then click on topics A-Z, and click on Dental Abscess
www.webmd.com/oral-health/
www.enotes.com/nursing-encyclopedia/dental-abscess




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