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Section Questions and Answers

Tooth and Gum Abscess

  1. What is an abscess?
  2. Where are abscesses usually found?
  3. What is pus?
  4. What are the signs of an acute abscess?
  5. Are all abscesses painful?
  6. What does periapical mean?
  7. How are periapical problems treated?
  8. What is periapical surgery?
  9. What is an apicectomy?
  10. Is treatment for periapical problems painful?
  11. What is a fistula?

 
1. What is an abscess?

  • An abscess is a confined area of pus, which is usually caused by decay in the tooth. It is a localised red swelling and can be very painful.
    • When decay in a tooth or severe injury affects the nerves and blood vessels, they become infected and die. The tooth is then referred to as being non-vital.
    • These dead tissues decompose to become pus, which can spread outside the tooth.
    • The pus can spread down the roots, to infect the bone at the end of the root, creating an abscess, or a cyst.
    • Food wedged between a tooth and gum can also cause an abscess.

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Decay and abscess
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Illustration of x-ray
showing decay

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2. Where are abscesses usually found?

  • Gingival abscesses occur in the gums only.
  • Periodontal abscesses can involve the gum, bone and the periodontal membranes.
  • Peri-coronal abscesses are found around the crowns of teeth. The most commonly affected are the wisdom teeth.

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Gingival abscess

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3. What is pus?

  • Pus is a thick, yellow or green fluid. It has a rotten smell and sour taste.
    • It is made up of dead nerves, blood vessels, and other tissue cells.
    • Cells are the units that make up living tissue.

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4. What are the signs of an acute abscess?

  • Some or all of the following can be experienced and seen:
    • Pain, which may be severe and throbbing.
    • Pain on chewing and when the tooth makes contact with other teeth.
    • Lying down makes the pain worse.
    • The tooth may be sensitive to hot foods and liquids.
    • There can be swelling around the tooth that may extend to the jaw.
    • The lymph glands in the neck may become swollen.
    • A fever.
    • Feeling unwell.
    • Bad breath and a sour taste if the abscess leaks into the mouth.
    • X-rays show a dark area at the apex of the root.

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5. Are all abscesses painful?

  • No, chronic abscesses may not have painful symptoms.

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6. What does periapical mean?

  • "Peri" means around, and "apical" is derived from apex or tip.
    Periapical refers to the area around the tip of the root. Periapical problems, like some abscesses, occur around the apex or end of the root.

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Periapical abscess
Dark area around root

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7. How are periapical problems treated?

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8. What is periapical surgery?

  • Periapical surgery is the treatment of the area around the end of the roots.
    • An area around the end of a root may not heal after a root canal treatment.
    • This is because there is still some infection left in or around the end of the root.
    • The treatment is to make a small opening through the gum and bone over the apex of the root, and to clean out the infection.
      The area will then heal, and all the symptoms will subside.

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9. What is an apicectomy?

  • Apicectomy means the "removal of the apex of the root."
    • During periapical surgery, a small piece of the tip of the root is removed.
    • The root canal is then sealed with a special material.
    • This is necessary when some infection remains at the end of the root.
    • The purpose of this apicectomy is to make sure that there is no remaining infection in the area.

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Before
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After apicectomy
White spot is the seal

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10. Is treatment for periapical conditions painful?

  • All periapical treatments are carried out under local anaesthesia, and the patient should not experience any pain.
  • The tooth may be sensitive for a few days.

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11. What is a fistula?

  • A fistula is a tract or passage between the periapical area and the mouth, usually close to an infected tooth.
    • It is formed when an abscess forces a path through the bone and gum into the mouth, to allow the pus to escape.
    • The pain often disappears after the pus drains into the mouth.
    • This fistula will remain until the cause of the problem is removed.
    • The treatment for a fistula is a root canal treatment to remove the cause, but periapical surgery may also be necessary.

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