What Is Alevolar Abscess?
- A localised suppurative inflammation of tissues about the apex of the root of a
- abscess is a localised collection of pus in a cavity formed by the disintegration of
- An abscessis a natural defence mechanism in which the body attempts tolocalise an infection and wall off the microorganisms so that they cannot spread throughout the
- Left untreated, these infections can be not only extremely painful but also pose a significant risk of descending into the deep neck space or ascending to intracranial sinuses.
- When symptomatic apical periodontitis is left untreated, it turns into acute apical abscess.
- It is a disease of the periradicular tissues.
Classification of Periradicular Disease
1. Symptomatic periradicular diseases
a.) Symptomatic apical periodontitis (previously known as acute apical periodontitis)
i. Vital tooth
ii. Nonvital tooth
b.) Acute alveolar abscess
c.) Acute exacerbation of asymptomatic apical periodontitis (phoenix abscess)
2) Asymptomatic periradicular diseases
a.) Asymptomatic apical periodontitis (previously known as chronic apical periodontitis)
b.) Chronic alveolar abscess
c.) Radicular cyst
d.) Condensing osteitis
3) External root resorption
4) Persistent apical periodontitis
5) Diseases of the periradicular tissues of nonendodontic origin
Sequelae of Periradicular Diseases
Post Treatment Sequelae of Periradicular Diseases
What Is Acute Alveolar Abscess?
- An acute alveolar abscess is an inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation, and eventual swelling of associated tissues.
- An acute alveolar abscess is painful and rapidly progressing sequelae of symptomatic apical periodontitis.
- distinguishable from asymptomatic apical periodontitis in which the tooth has no pain on percussion and has distinct radiographic periradicular bone changes.
Synonyms
- Acute abscess
- Acute apical abscess
- Acute dentoalveolar abscess
- Acute periapical abscess
- Acute radicular abscess
Causes
- Dental Decay (Caries): Bacteria present in plaque and tartar on the teeth produce acids that can erode the enamel, leading to cavities. If left untreated, these cavities can progress to infect the dental pulp and spread to the surrounding bone, causing an abscess.
- Periodontal Disease: Advanced gum disease can cause the gums to recede, creating pockets where bacteria can accumulate and cause infection in the supporting alveolar bone.
- Dental Trauma: Trauma to the tooth, such as a fracture or a deep crack, can provide an entry point for bacteria, leading to infection and abscess formation.
- Failed Root Canal Treatment: In some cases, a previously performed root canal treatment may fail to completely remove all infected tissue, resulting in persistent infection and abscess formation.
- When no outlet is present and no drainage is possible, the infection continues to extend in the direction of least resistance, i.e., through the apical foramen, and thereby involves the periodontal ligament and the periradicular bone.
Symptoms
- first symptom is tenderness of the tooth.
- Later symptom: severe, throbbing pain, with attendant swelling of the overlying soft tissue. The swelling becomes more pronounced and extends beyond the original site.tooth becomes more painful, elongated, and mobile
- At times, the pain may subside or cease entirely while the adjacent tissue continues to swell.
- If left unattended:
- Acute alveolar abscess → chronic apical abscess.
- contained pus may break through to form a sinus tract, usually opening in the labial or buccal mucosa
- Trismus may occur.
- Systemic manifestations may also develop, including:
- Person may become pale, irritable and weakened from pain
- Loss of sleep due to pain
- Fever
- In mild cases – mild increase in temperature (99-100°F)
- In severe cases – temperature may reach higher (102-104°F)
- fever often preceded or accompanied by chills.
- Lymphadenopathy
- Malaise
- Headache
- nausea
- May further progress on to osteitis, periosteitis, cellulitis, or osteomyelitis. (Because the acute reaction to endodontic infection may develop very quickly, the involved tooth may not show radiographic evidence of periradicular bone destruction.)
- When swelling becomes extensive, the resulting cellulitis may distort the patient’s appearance.
- The tissue at the surface of the swelling appears taut and inflamed; pus starts to form beneath it.
- The surface tissues become distended from the pressure of the underlying pus and finally rupture from this pressure and lack of resistance caused by continued liquefaction.
- The pus may extrude through a tiny opening, which becomes larger with time, or from two or more openings, depending on the degree of softening of the tissues and on the amount of pressure from the contained pus. This process is the beginning of a chronic alveolar abscess.
- The sinus tract ultimately heals by granulation after the elimination of the infection in the root canal.
- Intestinal stasis
- Halitosis (foul breath)
- Maxillary anterior tooth involved:
- swelling of the upper lip
- may extend to one or both the eyelids.
- Maxillary posterior tooth involved:
- the cheek may swell to an immense size
- distort the patient’s facial features.
- Mandibular anterior tooth:
- the swelling can involve the lower lip and chin, and in severe cases, the neck.
- Mandibular posterior tooth:
- swelling of the cheek
- may extend to the ear or even around the border of the jaw into the submaxillary region.
Diagnosis
- Diagnosis made from clinical examinations and subjective history given by the patient.
- In the early stages – difficult to locate the tooth because of the absence of clinical signs and the presence of diffuse, annoying pain.
- The tooth is easily located when the infection has progressed to the point of periodontitis and extrusion of the tooth.
- A radiograph shows:
- a cavity
- a defective restoration
- slight widening of the apical periodontal ligament space of the involved tooth.
- A diagnosis can be confirmed by means of the electric pulp test and by thermal tests. The affected pulp is necrotic and does not respond to electric current or to application of cold.
- The tooth may be tender to percussion
- Pain on mastication
- Apical mucosa tender to palpation.
- Tooth may be mobile and extruded.
Differential Diagnosis
- Symptomatic apical periodontitis – Pain on percussion
- Asymptomatic apical periodontitis – no pain on percussion, distinct radiographic periradicular bone changes.
- Periodontal abscess – an accumulation of pus along the root surface of a tooth that originates from infection in the supporting structures of the tooth.
- Features of periodontal abscess:
- The tooth is vital.
- Periodontal pocket formation
- Pus may exude from the sulcus on pressure.
- swelling usually located opposite the midsection of the root and gingival border.
- Respond to vitality test.
- Caries may not be present.
Bacteriology
- Concentration of microorganisms unusually large
- Streptococci and staphylococci generally recovered.
- Purulent material may also be sterile.
Histopathology
- The marked infiltration of polymorphonuclear leukocytes – chief inflammatory cells
- rapid accumulation of inflammatory exudate in response to an active infection
- distend the periodontal ligament and elongate the tooth
- If the process continues, the periodontal Fibers separate and the tooth become mobile
- Microscopically, one sees an empty space or spaces, where suppuration has occurred, surrounded by polymorphonuclear and some mononuclear cells.
- The root canal itself may appear to be devoid of tissue, and instead, clumps of microorganisms and debris may be observed
Treatment
SURGIAL TREATMENT:
- Immediate treatment is incision and drainage.
- Needle aspiration
- Trephination and decompression may be required.
- If non restorable, extraction is indicated.
ENDODONTIC TREATMENT
- Root canal treatment followed by crown.
- Occlusal adjustment
PHARMACOTHERAPY:
- Analgesics and anti-inflammatory NSAIDs
- Antibiotics
- Opioids
Post Operative Instructions
- Avoid chewing sticky foods.
- Avoid biting hard foods and hard substances.
- Take medication recommended by the doctor.
- Maintain good oral hygiene.
Prognosis
- The prognosis for the tooth depend on the degree of local involvement and the amount of tissue destruction.
- Prognosis favourable when tissue destruction is less.
- pain and swelling generally subside if adequate drainage is established.
- In most cases, the tooth can be saved by endodontic treatment.
- When purulent material has been discharged through the gingival sulcus and the periodontium has been extensively destroyed, the prognosis is guarded.
- In selected cases, combined periodontal and endodontic treatment restore the tooth to functional health.
