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A tooth abscess is caused when a tooth infection starts to spread into the surrounding spaces. It is a serious condition that requires immediate intervention to prevent tooth loss or the spread of infection to other parts of the jaw and face.

A tooth abscess is commonly seen in children. It is the result of a severe bacterial infection within a tooth that causes an area of pus and swelling below the bottom of the tooth root. Bacteria spread from the infected tooth to the tip of the root, and then to the surrounding bone. A gum abscess, on the other hand, has pus accumulation in an area of the gums between the teeth, usually due to foreign material or tartar deposits in the area between two teeth.

Both of these types of abscesses can be prevented as well as treated quite easily.

Causes of tooth abscess

  • The most common cause is advanced tooth decay or dental caries, which on contacting the nerve or pulp tissue present in the center of each tooth can lead to a tooth abscess.
  • A chipped or cracked tooth can also provide a portal of entry for bacteria — they can spread into the nerve or pulp tissue via minute cracks running through the tooth, and eventually cause a tooth abscess.
  • Trauma or any injury to the tooth may damage the tooth or the pulp tissue leading to the destruction of the normal structures and then to a tooth abscess.
  • Children who grind their teeth may also suffer from a tooth abscess.
  • Gum abscess may occur in children with severe tartar deposition and in cases where oral hygiene practices of regular brushing and flossing are not being followed.

Signs and symptoms of tooth abscess

  • The presence of a small ball-like swelling on the gum at the base of the tooth, aligning to where the root of that particular tooth would end, indicates a tooth abscess.
  • The concerned tooth may have blackish-brown tooth decay or it may be chipped or broken.
  • Pus may or may not exude when this swelling is pressed.
  • The tooth abscess and the corresponding tooth will be painful on most occasions. Your child may complain of pain on chewing from that side. In some cases, though, there will be absolutely no pain.
  • Your child may experience a bad taste in the mouth along with foul odor emanating from the mouth.
  • There may be a visible swelling on your child's face.
  • The child may have a fever in more severe cases.
  • In case of a gum abscess, the interdental papilla or the triangular gum tissue present between tooth teeth may be swollen, painful and may exude pus on being pressed.

Diagnosis of tooth abscess

If you notice any of these signs and symptoms, and if you suspect your child has a tooth abscess, you must visit a dentist immediately. The dentist will examine the child's mouth and may tap the suspect tooth to check for sensitivity. The dentist may take an X-ray to confirm the diagnosis, and depth of dental caries in the tooth. In very rare cases, a Cone Beam CT may be recommended.

Treatment of tooth abscess

A tooth abscess must be treated as soon as possible as if left untreated, the bacteria can cause further damage to the bone and soft tissue around the tooth and eventually lead to the complete destruction of the tooth. The infection, if it becomes very severe, can also enter the spaces of the mouth, causing big extra oral swellings visible on the face that may even require hospitalization.

Treatment of tooth abscess depends on the type of tooth and age of the child:

  • A root canal or pulpectomy procedure may be required for permanent or primary tooth respectively. The nerve is removed from the center of the tooth in this procedure, and the bacteria are cleaned out, leading to the tooth abscess subsiding. These procedures are usually done under local anesthesia or sedation techniques. Sometimes treatment of an abscessed tooth can be carried out without any anesthesia as the nerve may already be dead.
  • After a root canal or pulpectomy procedure, a crown is recommended to maintain the strength of the tooth.
  • Antibiotics may be prescribed, along with analgesics for the pain.
  • An abscess may need to be drained by the dentist sometimes via a direct incision. This procedure also requires anesthesia.
  • In case of an abscessed primary tooth which is due to be shed shortly, the dentist may recommend removal or extraction of the offending tooth.
  • In rare cases, if the tooth is already very loose, or if the prognosis of the life of the abscessed tooth is poor post the root canal treatment, a dentist may recommend removal of the offending permanent tooth followed by an implant.
  • Scaling and root planning is the treatment of choice to treat a gum abscess to clear away all the tartar, and foreign deposits in the gum pockets.

Prevention of tooth abscess

A tooth abscess can be prevented by following and teaching good oral hygiene practices to the child. Help the child brush until they are six years of age. Practice two minutes of brushing twice a day with a fluoridated toothpaste after the child is one year old. Use a rice grain-sized amount till the child turns two and then use a pea-sized amount.

Start flossing your child’s teeth once the spaces between the teeth close. Ensure that the child gargles after intake of any food or drink.

Avoid giving milk in feeding bottles or sippy cups especially at night, junk food, maintain a diet with low sugar, starch, and refined food. The last bottle must always be water. Regular dental visits are a must after the child turns one.

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