Therapy
In order to be able to completely treat an abscess on a tooth, a surgical intervention is necessary in any case. In case of teeth sensitive to knocking, with bone loss visible in the x-ray, the tooth is opened as a first measure to stop the pain, in order to let the pus flow through the tooth. As long as pus is still flowing, the tooth should be left open.
This means that if the flow of pus has not subsided after about 20 minutes, the patient may be sent home with an open hole in the tooth and further treatment will not take place until the next day or two. In most cases, the pain subsides abruptly after the pus has drained, as the permanent pressure is removed. The tooth is treated with a medicinal inlay and the opening is closed with temporary filling material.
Once the inflammation has subsided, a complete root canal treatment must be carried out. The procedures described above are performed under local anesthesia. In the lower jaw a conduction anaesthesia is applied, in the upper jaw the tooth in question is injected under infiltration anaesthesia.
If the abscess is already very advanced, it is possible that an anesthesia is not sufficient. The anaesthetic intake correlates with the pH value of the tissue. In case of inflammation, the tissue pH decreases and the anaesthetic can no longer be absorbed sufficiently.
By injecting additional anaesthetic and using stronger agents, an attempt is made to still achieve a sufficient depth of anaesthesia. A pure treatment of an abscess with medication is not possible. At the very beginning of the inflammation an attempt can be made to numb the pain with medication and to avoid the formation of pus, but even then a root canal treatment is unavoidable.
If periodontitis is the cause of the abscess, an attempt is made, also under local anaesthetic, to clean the gum pockets and to get the pus to drain away. Generally, the acute infection must always be brought to a halt before further treatment measures can be taken. Deep pockets formed by the abscess may have to be reduced in size by periodontal surgery to ensure that the tooth concerned is stabilized in the jaw.
Untreated abscesses that can continue to grow unhindered will eventually break through their pus capsule and the pus and the bacteria it contains will spread throughout the body. Then an immediate blood analysis as well as an inpatient hospital stay is the normal procedure. An abscess should be opened/slit open as soon as possible.
However, this is only possible once the inflammation has progressed so far that pus has also formed. Once pus has formed, it can no longer drain off by itself or be broken down by the body. Without treatment more and more pus will form and the abscess cavity will become larger and larger due to the increase in pressure.
Depending on its location, it can then spread in different directions and cause severe damage without treatment. By cutting the abscess open, the pus can flow off and the inflammation can heal afterwards. In most cases, root canal treatment or extraction of the guilty tooth is necessary afterwards to ensure complete and lasting freedom from pain.
The earlier the abscess is detected and treated, the better the chances of recovery. A further spread is unlikely with adequate treatment. No.
In any case it is not recommended to open an abscess on the tooth itself. For one thing, you will never be able to work as sterilely at home as the doctor in the practice. The danger of bacteria migrating into the wound and the inflammation – perhaps more than before – flaring up again is immense.
Especially since it is not possible to achieve 100% drainage at home without special equipment. The opening then closes again within a short time and the abscess fills up again. On the other hand, the abscess can be located in a very unfavourable position, for example near a blood vessel or nerves.
These can be hit during the opening and permanent damage can occur. Only the dentist knows exactly where the vessels are located and will spare them if the abscess is opened. One should therefore avoid self-treatment and consult a specialist as soon as possible.
As a rule, a tooth is only extracted after abscess formation if all other therapy attempts have failed beforehand. This includes primarily the relief incision of the abscess and a root canal treatment, if the tooth still contains inflammatory nerve tissue. If the abscess has developed despite an intact root filling, in addition to the incision of the abscess, an attempt is made to perform an apicoectomy and, if necessary, to seal the root filling from retrograde, from below.
In a root apex resection, the root apex of the tooth root is removed by a surgical procedure. After a failed apicoectomy, the dentist can decide whether or not a second attempt at this therapy makes sense. If this therapy has also failed, the tooth is only then extracted as the last resort.
An apicoectomy is necessary in the presence of an abscess if a completed root canal treatment with root filling has failed and the tooth continues to cause discomfort despite the optimal length of the root filling. Radiologically, a roundish whitening around the root tip of the affected tooth becomes visible. In this case, the swollen tissue is surgically removed from the bone to reach the root tip of the affected tooth, which is then shortened by 2 mm.
The area is cleaned and disinfected, if necessary the root filling is additionally sealed from the root tip. After cleaning the bone and tissue, the site is sutured and the wound closure is awaited. If the tooth now becomes asymptomatic and the wound heals, the tooth can again withstand stress as a full member of the dental arch.
However, if the inflammation returns and an abscess forms again, you should consider having the tooth removed. Patients who need antibiotic shielding should take ß-lactam antibiotics throughout the course of the disease to prevent the bacteria in the oral cavity from entering the entire body, especially the heart or brain, and causing unwanted secondary damage. These are patients with acute endocarditis, with immune deficiencies and also people suffering from diabetes, as diabetes slows down the healing process of such inflammations, or in the case of diabetes the self-healing powers of the body are greatly reduced.
In these patients, great importance must be attached to the fact that not too much anaesthetic is given during the injection of the anaesthetic. Patients without health problems do not need antibiotics after the procedure. Antibiotics should only be given if the infection threatens to spread in the body.
This is often amoxicillin or clindamycin. These broad-spectrum antibiotics cover almost the entire germ spectrum and thus kill pathogenic germs before they can cause damage in the body. There are many household remedies known for the treatment of abscesses, but in most cases they only provide short-term relief.
The household remedies only fight the symptoms, but never the cause. Very often the healing power of onions is used, which have an antiseptic effect if you chew a raw slice for several minutes. Chamomile has antibacterial effects and can thus keep other pathogens away from an inflamed area. A strong tea should be boiled and then rinsed with it several times a day. Nettle tea has an anti-inflammatory and blood-purifying effect when taken about three cups daily.
