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Dental abscess – NHS
A dental abscess is a collection of pus that can form inside the teeth, in the gums or in the bone that holds the teeth in place. It’s caused by a bacterial infection.
An abscess at the end of a tooth is called a periapical abscess. An abscess in the gum is called a periodontal abscess.
Dental abscesses are often painful, but not always. In either case, they should be looked at by a dentist.
It’s important to get help as soon as possible, as abscesses do not go away on their own.
They can sometimes spread to other parts of the body and make you ill.
Symptoms of a dental abscess
Symptoms of an abscess in your tooth or gum may include:
- an intense throbbing pain in the affected tooth or gum that may come on suddenly and gets gradually worse
- pain that spreads to your ear, jaw and neck on the same side as the affected tooth or gum
- pain that’s worse when lying down, which may disturb your sleep
- redness and swelling in your face
- a tender, discoloured or loose tooth
- shiny, red and swollen gums
- sensitivity to hot or cold food and drink
- bad breath or an unpleasant taste in your mouth
If the infection spreads, you may also develop a high temperature (fever) and feel generally unwell.
In severe cases, you may find it hard to fully open your mouth and have difficulty swallowing or breathing.
What to do if you have a dental abscess
You should see a dentist as soon as possible if you think you have a dental abscess.
Avoid visiting a GP, as there’s little they can do to help.
You can get help from:
You may have to pay for emergency NHS dental treatment, depending on your circumstances.
Find out about NHS dental charges
Relieving pain from a dental abscess
While you’re waiting to see a dentist, painkillers can help control your pain.
Ibuprofen is the preferred painkiller for dental abscesses, but if you’re unable to take it for medical reasons, you can take paracetamol instead.
Aspirin should not be given to children under 16.
If 1 painkiller does not relieve the pain, taking both paracetamol and ibuprofen at the doses shown in the medicine leaflet may help.
This is safe for adults, but not for children under 16.
It may also help to:
- avoid hot or cold food and drink if it makes the pain worse
- try eating cool, soft foods if possible, using the opposite side of your mouth
- use a soft toothbrush and temporarily avoid flossing around the affected tooth
These measures can help relieve your symptoms temporarily, but you should not use them to delay getting help from a dentist.
Treatments for a dental abscess
Dental abscesses are treated by removing the source of the infection and draining away the pus.
Depending on the location of the abscess and how severe the infection is, possible treatments include:
- root canal treatment – a procedure to remove the abscess from the root of an affected tooth before filling and sealing it
- removing the affected tooth (extraction) – this may be necessary if root canal treatment is not possible
- incision and drainage – where a small cut (incision) is made in the gum to drain the abscess (this is usually only a temporary solution and further treatment may be needed)
Local anaesthetic will usually be used to numb your mouth for these procedures.
More extensive operations may be carried out under general anaesthetic, where you’re asleep.
Antibiotics are not routinely prescribed for dental abscesses, but may be used if the infection spreads or is particularly severe.
What causes dental abscesses?
Your mouth is full of bacteria, which form a sticky film on your teeth called plaque.
If you do not keep your teeth clean, acids produced by the bacteria in plaque can damage your teeth and gums, leading to tooth decay or gum disease.
The following can increase your chances of developing a dental abscess:
- poor oral hygiene – plaque can build-up on your teeth if you do not floss and brush your teeth regularly
- consuming lots of sugary or starchy food and drink – these can encourage the growth of bacteria in plaque and may lead to decay that can result in an abscess
- an injury or previous surgery to your teeth or gums – bacteria can get into any damaged parts of the teeth or gums
- having a weakened immune system – this includes people with certain underlying health conditions, such as diabetes, and those having treatment, including steroid medication or chemotherapy
Preventing dental abscesses
You can reduce your risk of developing dental abscesses by keeping your teeth and gums as healthy as possible.
To do this, you should:
- use floss or an interdental brush at least once a day to clean between your teeth and under the gum line
- brush your teeth with a fluoride toothpaste twice a day – spending at least 2 minutes each time
- avoid rinsing your mouth with water or mouthwash after brushing because this washes the protective toothpaste away – just spit out any excess toothpaste
- cut down on sugary and starchy food and drinks – particularly between meals or shortly before going to bed
- visit your dentist regularly – your dentist can suggest how often you should have a check-up, based on your oral health
Read more on how to keep your teeth clean and dental check-ups.
Page last reviewed: 05 February 2019
Next review due: 05 February 2022
Abscess – Treatment – NHS
Abscesses can be treated in a number of different ways, depending on the type of abscess and how large it is.
The main treatment options include:
Some small skin abscesses may drain naturally and get better without the need for treatment. Applying heat in the form of a warm compress, such as a warm flannel, may help reduce any swelling and speed up healing.
However, the flannel should be thoroughly washed afterwards and not used by other people, to avoid spreading the infection.
For larger or persistent skin abscesses, your GP may prescribe a course of antibiotics to help clear the infection and prevent it from spreading.
Sometimes, especially with recurrent infections, you may need to wash off all the bacteria from your body to prevent re-infection (decolonisation). This can be done using antiseptic soap for most of your body and an antibiotic cream for the inside of your nose.
However, antibiotics alone may not be enough to clear a skin abscess, and the pus may need to be drained to clear the infection. If a skin abscess is not drained, it may continue to grow and fill with pus until it bursts, which can be painful and can cause the infection to spread or come back.
Incision and drainage
If your skin abscess needs draining, you’ll probably have a small operation carried out under anaesthetic – usually a local anaesthetic, where you remain awake and the area around the abscess is numbed.
During the procedure, the surgeon cuts into the abscess, to allow the pus to drain out. They may also take a sample of pus for testing.
Once all of the pus has been removed, the surgeon will clean the hole that is left by the abscess using sterile saline (a salt solution).
The abscess will be left open but covered with a wound dressing, so if any more pus is produced it can drain away easily. If the abscess is deep, an antiseptic dressing (gauze wick) may be placed inside the wound to keep it open.
The procedure may leave a small scar.
The pus usually needs to be drained from an internal abscess, either by using a needle inserted through the skin (percutaneous abscess drainage) or with surgery.
The method used will depend on the size of your abscess and where it is in your body.
Antibiotics will usually be given at the same time, to help kill the infection and prevent it spreading. These may be given as tablets or directly into a vein (intravenously).
If the internal abscess is small, your surgeon may be able to drain it using a fine needle. Depending on the location of the abscess, this may be carried out using either a local or general anaesthetic.
The surgeon may use ultrasound scans or CT scans to help guide the needle into the right place.
Once the abscess has been located, the surgeon drains the pus using the needle. They may make a small incision in your skin over the abscess, then insert a thin plastic tube called a drainage catheter into it.
The catheter allows the pus to drain out into a bag and may have to be left in place for up to a week.
This procedure may be carried out as a day case procedure, which means you’ll be able to go home the same day, although some people will need to stay in hospital for a few days.
As with the incision and drainage procedure for skin abscesses, percutaneous drainage may leave a small scar.
You may need to have surgery if:
- your internal abscess is too large to be drained with a needle
- a needle cannot get to the abscess safely
- needle drainage has not been effective in removing all of the pus
The type of surgery you have will depend on the type of internal abscess you have and where it is in your body. Generally, it involves making a larger incision in your skin to allow the pus to be washed out.
Page last reviewed: 04 November 2019
Next review due: 04 November 2022
Abscess – Causes – NHS
Most abscesses are caused by an infection with staphylococcal bacteria.
When bacteria enter the body, the immune system sends white blood cells to fight the infection. This causes swelling (inflammation) at the site of infection and the death of nearby tissue. A cavity is created, which fills with pus to form an abscess.
The pus contains a mixture of dead tissue, white blood cells and bacteria. The abscess may get larger and more painful as the infection continues and more pus is produced.
Some types of staphylococcal bacteria produce a toxin called Panton-Valentine leukocidin (PVL), which kills white blood cells. This causes the body to make more cells to keep fighting the infection and can lead to repeated skin infections.
In rare cases, an abscess may be caused by a virus, fungi or parasites.
When bacteria gets under the surface of your skin, an abscess can form. This can occur anywhere on the body, although skin abscesses tend to be more common in the:
- hands and feet
Bacteria can get into your skin and cause an abscess if you have a minor skin wound, such as a small cut or graze, or if a sebaceous gland (oil gland) or sweat gland in your skin becomes blocked.
Abscesses that develop inside the tummy (abdomen) are caused by an infection reaching tissue deeper within the body. This can occur as a result of:
- an injury
- abdominal surgery
- an infection spreading from a nearby area
There are many ways an infection can spread into the abdomen and cause an abscess to develop.
For example, a lung abscess can form after a bacterial infection in your lungs, such as pneumonia, and a burst appendix can spread bacteria within your abdomen.
In addition to the specific causes mentioned above, things that increase the likelihood of an abscess developing can include:
- having a weakened immune system – this could be because of a medical condition such as HIV, or a treatment such as chemotherapy
- having diabetes
- having an underlying inflammatory condition, such as hidradenitis suppurativa
- being a carrier of staphylococcal bacteria
However, many abscesses develop in people who are otherwise generally healthy.
Page last reviewed: 04 November 2019
Next review due: 04 November 2022
Causes, Symptoms, Tests, and Treatment
A skin abscess is a tender mass generally surrounded by a colored area from pink to deep red. Abscesses are often easy to feel by touching. The vast majority of them are caused by infections. Inside, they are full of pus, bacteria and debris.
Painful and warm to touch, abscesses can show up any place on your body. The most common sites on the skin in your armpits (axillae), areas around your anus and vagina (Bartholin gland abscess), the base of your spine (pilonidal abscess), around a tooth (dental abscess), and in your groin. Inflammation around a hair follicle can also lead to the formation of an abscess, which is called a boil (furuncle).
Unlike other infections, antibiotics alone will not usually cure an abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be opened with the help of a warm compress or by a doctor in a procedure called incision and drainage (I&D).
When our normal skin barrier is broken, even from minor trauma, or small tears, or inflammation, bacteria can enter the skin. An abscess can form as your body’s defenses try to kill these germs with your inflammatory response (white blood cells = pus). Obstruction in a sweat or oil (sebaceous) gland, or a hair follicle or a pre-existing cyst can also trigger an abscess.
The middle of the abscess liquefies and contains dead cells, bacteria, and other debris. This area begins to grow, creating tension under the skin and further inflammation of the surrounding tissues. Pressure and inflammation cause the pain.
People with weakened immune systems get certain abscesses more often. Those with any of the following are all at risk for having more severe abscesses. This is because the body has a decreased ability to ward off infections.
Other risk factors for abscess include exposure to dirty environments, exposure to persons with certain types of skin infections, poor hygiene, and poor circulation.
Most often, an abscess becomes a painful, compressible mass that is red, warm to touch, and tender.
- As some abscesses progress, they may “point” and come to a head so you can see the material inside and then spontaneously open (rupture).
- Most will continue to get worse without care. The infection can spread to the tissues under the skin and even into the bloodstream.
- If the infection spreads into deeper tissue, you may develop a fever and begin to feel ill.
Abscess Treatment: Self-Care at Home
- If the abscess is small (less than 1 cm or less than a half-inch across), applying warm compresses to the area for about 30 minutes 4 times daily may help.
- Do not attempt to drain the abscess by squeezing or pressing on it. This can push the infected material into the deeper tissues.
- Do not stick a needle or other sharp instrument into the abscess center, because you may injure an underlying blood vessel or cause the infection to spread.
When to Seek Medical Care
Call your doctor if any of the following occur with an abscess:
- You have a sore larger than 1 cm or a half-inch across.
- The sore continues to enlarge or becomes more painful.
- The sore is on or near your rectal or groin area.
- You develop a fever.
- You notice red streaks, which can mean the infection is spreading.
- You have any of the medical conditions listed above.
Go to a hospital’s Emergency Department if any of these conditions occur with an abscess:
- Fever of 102°F or higher, especially if you have a chronic disease or are on steroids, chemotherapy, or dialysis
- A red streak leading away from the sore or with tender lymph nodes (lumps) in an area anywhere between the abscess and your chest area (for example, an abscess on your leg can cause swollen lymph nodes in your groin area)
- Any facial abscess larger than 1 cm or a half-inch across
Exams and Tests
The doctor will take a medical history and may ask you:
- How long the abscess has been present
- If you recall any injury to that area
- What medicines you may be taking
- If you have any allergies
- If you have had a fever at home
The doctor will examine the abscess and surrounding areas. If it is near your anus, the doctor will perform a rectal exam. If an arm or leg is involved, the doctor will feel for a lymph gland either in your groin or under your arm.
The doctor may open and drain the abscess.
The area around the abscess will be numbed with medication. It is often difficult to completely numb the area, but local anesthesia can make the procedure almost painless.
- The area will be covered with an antiseptic solution and sterile towels placed around it.
- The doctor will cut open the abscess and totally drain it of pus and debris.
- Once the sore has drained, the doctor may insert some packing into the remaining cavity to allow the infection to continue to drain. It may be kept open for a day or two.
- A bandage will then be placed over the packing, and you will be given instructions about home care.
- Most people feel better immediately after the abscess is drained.
- If you are still experiencing pain, the doctor may prescribe pain pills for home use over the next 1-2 days.
- You are usually sent home with oral antibiotics.
Next Steps: Follow-up
Follow carefully any instructions your doctor gives you.
- The doctor may have you remove the packing yourself with instructions on the best way to do this. This may include soaking or flushing.
- Be sure to keep all follow-up appointments.
- Report any fever, redness, swelling, or increased pain to your doctor immediately.
Maintain good personal hygiene by washing your skin with soap and water regularly.
- Take care to avoid nicking yourself when shaving your underarms or pubic area.
- Seek immediate medical attention for any puncture wounds, especially if:
- You think there may be some debris in the wound.
- The puncture wound was caused by a bite – human, insect or animal.
- You have one of the listed medical conditions.
- You are on steroids or chemotherapy.
Once treated, the abscess should heal.
- Many people require antibiotics, but you may not.
- The pain often improves immediately and subsides more each day.
- Wound care instructions from your doctor may include wound repacking, soaking, washing, or bandaging for about 7 to 10 days. This usually depends on the size and severity of the abscess.
- After the first 2 days, drainage from the abscess should be minimal to none. All sores should heal in 10-14 days.
Tooth abscess – Diagnosis and treatment
In addition to examining your tooth and the surrounding area, your dentist may:
- Tap on your teeth. A tooth that has an abscess at its root is generally sensitive to touch or pressure.
- Recommend an X-ray. An X-ray of the aching tooth can help identify an abscess. Your dentist may also use X-rays to determine whether the infection has spread, causing abscesses in other areas.
- Recommend a CT scan. If the infection has spread to other areas within the neck, a CT scan may be used to assess the extent of the infection.
The goal of treatment is to get rid of the infection. To accomplish this, your dentist may:
- Open up (incise) and drain the abscess. The dentist will make a small cut into the abscess, allowing the pus to drain out, and then wash the area with salt water (saline). Occasionally, a small rubber drain is placed to keep the area open for drainage while the swelling decreases.
- Perform a root canal. This can help eliminate the infection and save your tooth. To do this, your dentist drills down into your tooth, removes the diseased central tissue (pulp) and drains the abscess. He or she then fills and seals the tooth’s pulp chamber and root canals. The tooth may be capped with a crown to make it stronger, especially if this is a back tooth. If you care for your restored tooth properly, it can last a lifetime.
- Pull the affected tooth. If the affected tooth can’t be saved, your dentist will pull (extract) the tooth and drain the abscess to get rid of the infection.
- Prescribe antibiotics. If the infection is limited to the abscessed area, you may not need antibiotics. But if the infection has spread to nearby teeth, your jaw or other areas, your dentist will likely prescribe antibiotics to stop it from spreading further. He or she may also recommend antibiotics if you have a weakened immune system.
Lifestyle and home remedies
While the area is healing, your dentist may recommend these steps to help ease discomfort:
- Rinse your mouth with warm salt water.
- Take over-the-counter pain relievers, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others), as needed.
Preparing for your appointment
You’re likely to start by seeing your dentist.
What you can do
Here’s some information to help you get ready for your appointment:
- Make a list of any symptoms you’re experiencing, including any that may seem unrelated to your tooth or mouth pain.
- Make a list of all medications, vitamins, herbs or other supplements that you’re taking, and the dosages.
- Prepare questions to ask your dentist.
Questions to ask your dentist may include:
- What’s likely causing my symptoms or condition?
- What kinds of tests do I need?
- What’s the best course of action?
- What are the alternatives to the primary approach that you’re suggesting?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you’re prescribing?
- Are there any printed materials that I can have? What websites do you recommend?
Don’t hesitate to ask additional questions during your appointment.
What to expect from your doctor
Your dentist is likely to ask you a number of questions, such as those below.
- When did you first begin experiencing symptoms?
- Have you had any recent trauma to your teeth or dental work?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, seems to worsen your symptoms?
Your dentist will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time.
March 01, 2019
- AskMayoExpert. Dental abscess. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019.
- Dental hygiene. Centers for Disease Control and Prevention. https://www.cdc.gov/healthywater/hygiene/dental/index.html. Accessed Jan. 21, 2019.
- Home oral care. American Dental Association. https://www.ada.org/en/member-center/oral-health-topics/home-care. Accessed Jan. 21, 2019.
- Toothache and infection. Merck Manual Professional Version. https://www.merckmanuals.com/professional/dental-disorders/symptoms-of-dental-and-oral-disorders/toothache-and-infection. Accessed Jan. 21, 2019.
- Abscessed teeth. American Association of Endodontists. https://www.aae.org/patients/dental-symptoms/abscessed-teeth/. Accessed Jan. 21, 2019.
- Root canal treatment. American Association of Endodontists. https://www.aae.org/patients/root-canal-treatment/. Accessed Jan. 21, 2019.
- Tooth decay. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/tooth-decay/more-info. Accessed Jan. 22, 2019.
- Bertossi D, et al. Odontogenic orofacial infections. Journal of Craniofacial Surgery. 2017;28:197.
- Robertson DP, et al. Management of severe acute dental infections. BMJ. 2015;350:h2300.
- Toothbrushes. American Dental Association. https://www.ada.org/en/member-center/oral-health-topics/toothbrushes. Accessed Jan. 22, 2019.
- Salinas TJ (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 28, 2019.
Dental Abscess with Facial Cellulitis
A dental abscess is an infection at the base of a tooth. It means a pocket of fluid (pus) has formed at the tip of a tooth root in your jawbone. If the infection isn’t treated, more serious infections may spread to the face (facial cellulitis). This makes your face swell. Facial cellulitis is an infection of the skin and underlying soft tissues. This is a very serious condition. Once the infection and swelling starts, it can spread quickly.
A dental abscess often starts with a crack or cavity in a tooth. The pain is often made worse by having hot or cold drinks, or biting on hard foods. The pain may spread from the tooth to your ear, or to the area of your jaw on the same side.
Follow these tips when caring for yourself at home:
Don’t have hot and cold foods and drinks. Your tooth may be sensitive to changes in temperature. Don’t chew on the side of the infected tooth.
If your tooth is chipped or cracked, or if there is a large open cavity, put clove oil right on the tooth to ease pain. You can buy clove oil at pharmacies. Some pharmacies carry an over-the-counter toothache kit. This has a paste that you can put on the exposed tooth to make it less sensitive.
Put a cold pack on your jaw over the sore area. This can help reduce pain.
You may use over-the-counter medicine to ease pain, unless another medicine was prescribed. Talk with your provider before using acetaminophen or ibuprofen if you have chronic liver or kidney disease. Also talk with your provider if you’ve had a stomach ulcer or GI (gastrointestinal) bleeding.
An antibiotic will be prescribed. Take it exactly as directed. Don’t miss any doses.
Follow up with your dentist or an oral surgeon, as advised. Severe cases of cellulitis must be checked again in 24 hours. Once a tooth infection occurs, it will be a problem until the infection is drained. This is done through surgery or a root canal. Or you may need to have your tooth pulled.
Call 911 if any of these occur:
Swelling spreads to the upper half of your face or neck
Your eyelids start to swell shut
Headache or a stiff neck
Weakness or fainting
Trouble swallowing or breathing
When to get medical advice
Call your healthcare provider right away if any of these occur:
Pain gets worse or spreads to your neck
Fever of 100.4°F (38°C) or higher, or as directed by your provider
Dental abscess: Symptoms, treatment, and causes
A dental abscess, or tooth abscess, is a buildup of pus that forms inside the teeth or gums.
The abscess typically comes from a bacterial infection, often one that has accumulated in the soft pulp of the tooth.
Bacteria exist in plaque, a by-product of food, saliva, and bacteria in the mouth, which sticks to the teeth and damages them and the gums.
If the plaque is not removed by regular and proper brushing and flossing, the bacteria may spread inside the soft tissue of the tooth or gums. This can eventually result in an abscess.
Signs and symptoms of a dental abscess include:
- pain in the affected area when biting or when touching the affected area
- sensitivity to cold or hot food and liquids
- a foul taste in the mouth
- a generally unwell feeling
- difficulties opening the mouth
- swallowing difficulties
The main symptom of a dental abscess is pain. This may be a throbbing pain and is often intense. The pain usually starts suddenly and becomes more intense over the following hours or days. In some cases, the pain may radiate to the ear, jawbone, and neck.
There are three types of dental abscess:
- Gingival abscess: The abscess is only in the gum tissue and does not affect the tooth or the periodontal ligament.
- Periodontal abscess: This abscess starts in the supporting bone tissue structures of the teeth.
- Periapical abscess: this abscess commences in the soft pulp of the tooth.
The type of abscess will dictate the severity and location of symptoms.
Any person with symptoms linked to a dental abscess should see a dentist immediately. Dental abscesses are easily diagnosed by a qualified dentist.
People who have swallowing and breathing problems should go straight to the emergency department of their local hospital.
If you cannot get to a dentist immediately, visit a family doctor.
A doctor cannot treat an abscess, but they may prescribe medication and advise on self-care and pain management and are also likely to know the fastest way of getting emergency treatment if required.
Incision: The abscess needs to be cut out and the pus, which contains bacteria, drained away. The doctor will administer a local anesthetic.
Treating a periapical abscess: Root canal treatment will be used to remove the abscess. A drill is used to bore a hole into the dead tooth so that the pus can come out. Any damaged tissue will be removed from the pulp. A root filling is then inserted into the space to prevent subsequent infections.
Treating a periodontal abscess: The abscess will be drained and the periodontal pocket cleaned. The surfaces of the root of the tooth will then be smoothed out by scaling and planing below the gum line. This helps the tooth heal and prevents further infections from occurring.
People with a periapical abscess and a recurring infection may need to have diseased tissue surgically removed. This will be done by an oral surgeon.
Those with a periodontal abscess and a recurring infection may have to have their gum tissue reshaped and the periodontal pocket removed. This procedure will be performed by an oral surgeon.
If a dental abscess comes back, even after surgery, the tooth may be taken out.
Over the counter (OTC) painkillers may help reduce the pain while an individual is waiting for treatment. It is important to follow the information on the packet carefully. Painkillers are only there for pain reduction and cannot replace a visit to a dentist.
Aspirin, ibuprofen or Tylenol (paracetamol) are effective painkillers. However, some are unsuitable for certain types of patients (read below):
- Ibuprofen and asthma: If you are asthmatic, do not take ibuprofen.
- Ibuprofen and stomach ulcers: Do not take ibuprofen if you have, or ever had stomach ulcers.
- Aspirin and children: Do not give aspirin to children under 16 years of age.
- Aspirin and pregnancy and breastfeeding: Do not take aspirin if you are pregnant or breastfeeding.
Antibiotics may be prescribed to prevent the infection from spreading and may be taken together with painkillers. Examples of antibiotics include amoxicillin or metronidazole. In no way should antibiotics be seen as a way of substituting treatment with a dentist, or postponing treatment.
A dental abscess is, in most cases, a complication of a dental infection. Bacteria, often bacteria present in plaque, infect and make their way into a tooth.
Bacteria enter the tooth through tiny holes caused by tooth decay, or caries, that form in the hard outer layer of the tooth. Caries eventually break down the softer layer of tissue under the enamel, called dentine. If the decay continues, the hole will eventually penetrate the soft inner pulp of the tooth and become infected.
This is known as pulpitis. As the pulpitis progresses, the bacteria make their way to the bone that surrounds and supports the tooth, called the alveolar bone, and a periapical abscess is formed.
When bacteria which are present in plaque infect the gums, the patient has periodontitis. The gums become inflamed, which can make the tissue surrounding the root of the tooth separate from the base of the tooth.
A periodontal pocket, a tiny gap, is formed when the periodontal ligament separates from the root. The pocket gets dirty easily and is very hard to keep clean. As bacteria build up in the periodontal pocket, a periodontal abscess is formed.
Patients can develop periodontal abscesses as a result of a dental procedure which accidentally resulted in periodontal pockets. Also, the use of antibiotics in untreated periodontitis, which can mask the symptoms of an abscess, can result in a periodontal abscess. Sometimes gum damage can lead to periodontal abscesses, even if no periodontitis is present.
There are actions you can take at home to relieve the pain.
- Avoid food and drink that is either too hot or too cold.
- Chewing on the side of your mouth without an abscess will probably be less painful
- Do not floss around the affected area.
- Use a very soft toothbrush.
While home remedies can help make a person more comfortable while they wait for treatment, it is important to visit a healthcare professional for treatment to avoid any of the complications of a dental abscess.
In the vast majority of cases, complications only occur if the abscess is left untreated. However, complications can occur, even after seemingly effective treatment, but this is very rare. Possible complications include:
Dental cysts: A fluid-filled cavity may develop at the bottom of the root of the tooth if the abscess is not treated. This is called a dental cyst. There is a significant risk that the cyst will become infected. If this happens, the patient will need antibiotics, and possibly surgery.
Osteomyelitis: The bacteria in the abscess gets into the bloodstream and infects the bone. The patient will experience an elevated body temperature, severe pain in the affected bone, and possibly nausea. Typically, the affected bone will be near the site of the abscess. However, as it may have spread into the bloodstream any bone in the body may be affected. Treatment involves either oral or intravenous antibiotics.
Cavernous sinus thrombosis: The spread of bacteria causes a blood clot to form at the cavernous sinus, a large vein at the base of the brain. Cavernous sinus thrombosis is treated with antibiotics, and sometimes surgery to drain the sinus. In some cases, the condition can be fatal. This is a very rare complication.
Ludwig’s angina: This is an infection of the floor of the mouth when the dental abscess bacteria spread. There is swelling and intense pain under the tongue and in the neck. In severe cases, the patient may find it hard to breathe. Ludwig’s angina is a potentially fatal condition. Patients are treated with antibiotics. People with severe Ludwig’s angina may require a procedure to open the airway if there are breathing problems.
Maxillary sinusitis: The bacteria spread into small spaces behind the cheekbones, called the maxillary sinuses. This is not a serious condition but can be painful. The patient may develop a fever and have tender cheeks. Sometimes the condition resolves on its own. Depending on the severity, the doctor may prescribe antibiotics.
Oral abscess, treatment, diagnosis and prosthetics
What is an oral abscess?
Oral abscess is an acute inflammatory disease characterized by the formation and accumulation of pus in the tissues of the gums, tongue or cheeks. The abscess is accompanied by local swelling and compaction of soft tissues, severe pain on palpation, fever and general weakness. The disease is diagnosed by a dentist after a visual examination of the tissues, after which urgent surgical intervention is required: opening the abscess, followed by cleaning and taking anti-inflammatory drugs.
Oral abscess is one of the most common complications in the practice of surgical dentistry. It can be observed in patients of different ages. Untimely treatment can lead to the transition of inflammation to the chronic stage. Against her background, sepsis and phlegmon may develop. That is why, if the slightest symptoms of an abscess occur, you must immediately visit the dentist.
Varieties of abscess by localization
An abscess is classified based on the location of the inflammation.The following types of pathology are distinguished:
- Gum abscess
- The most common type, inflammation forms near a particular tooth. If untreated, an abscess can provoke: leakage of pus from the formed fistula, putrid breath and intoxication of the body.
- Abscess of the floor of the mouth
- Formed under the tongue, which causes severe pain and discomfort during communication or eating. With a spontaneous opening of the abscess, the infected fluid is poured into the oral cavity and can provoke a new focus in the pharynx and neck.
- Abscess of the palate
- Occurs against the background of not completely cured or transferred periodontitis of the teeth of the upper jaw. In the future, inflammation can spread to the peritonsillar area and other tissues of the palate, which will lead to osteomyelitis of the palatal plate.
- Cheek abscess
- The depth of the lesion in this area of the mucous membrane determines the localization of inflammation, which can sit inside the cheek or go to the outer surface. Such abscesses are extremely dangerous, because the infection can affect nearby facial organs and tissues.
- Tongue abscess
- Among the obvious signs are swelling of the tongue, pain during meals, difficulty speaking and breathing. This type of abscess, according to doctors, is the most dangerous and requires immediate treatment.
Diagnosis of an oral cavity abscess is carried out by a visual examination by a dentist of the patient’s mucous tissues. Arbitrary opening or application of antibacterial drugs is strictly prohibited! This can aggravate and complicate the course of the disease.Before contacting a specialist, the patient can only rinse the mouth with an antiseptic solution and take analgesics. To relieve swelling of the cheek, you can apply cold to its outer surface.
Reasons for the development of an abscess in the oral cavity
An abscess in the oral cavity occurs as a complication of advanced periodontitis and periodontitis. These diseases are characterized by damage to the teeth and gums, followed by the formation of pockets in the periodontium. They accumulate pathogenic microorganisms that provoke inflammation.Among other things, an abscess can occur due to infection in the damaged area of soft tissue (trauma, syringe needle, instrument). The cause of the disease is often staphylococcal and streptococcal tonsillitis, as well as boils on the face.
Inflammation in the oral cavity also appears as a complication after the flu or acute respiratory viral infection, which weaken the immune system, as a result of which the body is not able to fight the infection.
An abscess is characterized by rapid development.At first, the patient may be disturbed by only minor attacks of pain, similar to the sensations that arise with caries or periodontitis. Subsequently, the pain is localized in one place and gradually increases. In a specific place, there is a swelling, sometimes a neoplasm on the gums, sometimes reaching the size of a walnut. If the inflammation is localized closer to the outer surface, then the swelling and redness can be observed with the naked eye. If you find the first symptoms, we recommend that you consult a dentist.
An abscess of the tongue is characterized by an increase in organ volume, difficulty in swallowing, chewing and even suffocation. Any abscess is accompanied by fever, deterioration and general weakness, insomnia, and loss of appetite. The progression of the disease leads to a breakthrough of the abscess, which manifests itself in a decrease in temperature, a decrease in swelling and an improvement in general well-being. However, there is no reason to stop treatment, as the inflammation can continue and develop into a chronic form. This can lead to tooth loss, sepsis and cellulitis.
Treatment of an oral cavity abscess
Treatment of an abscess requires surgical intervention. In order to eliminate the infectious focus and stop the spread of inflammation, the dentist-surgeon in stages:
- opens the abscess;
- drains the cavity;
- is cleaning the pocket;
- rarely sutures if the incision is large.
After the removal of pus, the patient’s well-being improves, the geometry of the face is restored.Taking antibiotics, antihistamines, immunostimulants and a vitamin complex significantly accelerates the healing process. Sometimes the doctor may prescribe physiotherapy procedures (UHF therapy and fluctuating).
For a while, the patient needs to exclude solid food from the diet and adhere to the rules of a healthy diet.
Prediction and prevention of oral abscess
The success of treatment of oral abscesses depends on the stage of the disease the patient seeks for help and how strong the body’s defense mechanism is.With timely treatment, the prognosis for eliminating inflammation is quite favorable. In the absence of complications, strong immunity and a well-performed opening of the focus, an abscess of the oral cavity can be cured in a couple of weeks.
Prevention of the disease consists in observing the following recommendations:
- regular teeth cleaning and professional oral hygiene at least once every six months;
- minimizing the risk of injury to the mucous membrane;
- timely treatment of caries and periodontal diseases;
- visit for a preventive examination of the dentist once every 6 months.
reasons, diagnostics, treatment methods – dentistry President
Phlegmon, abscess and periostitis (flux) are different degrees of purulent inflammatory diseases of the maxillofacial region. Most often they appear against the background of advanced caries.
In modern medicine, the term “flux” as such no longer exists. The once popular word has now been replaced by “odontogenic periostitis.”
Periostitis is the first stage of jaw inflammation, which almost always occurs due to advanced caries.Rarely manifests itself as a result of a bruise, the entry of pathogenic bacteria into the pocket between the tooth and the gum. Previously treated pulpitis may be a prerequisite.
- persistent toothache, aggravated by pressure or tapping on the tooth;
- severe tooth decay;
- swelling of the cheek;
- in especially severe cases – an increase in body temperature.
90,057 swelling of the tissues around the tooth;
Abscess – the second stage of inflammation
An abscess practically does not differ functionally from periostitis.The symptoms in this case are the same. Pus, as with flux, is limited to the periosteum, but it can penetrate deeper into the tissues.
Phlegmon – a dangerous omission
Phlegmon is the third, most severe stage of purulent inflammation in the tissues around the tooth. Pus in this case is not limited to the periosteum alone, but freely walks through the tissues, often penetrating into the facial muscles, cervical regions, and behind them into the trachea, esophagus, heart.
IMPORTANT! If phlegmon is not cured in time, it can be fatal!
Treatment of periostitis, abscess
The first and most important step in treating a flux is to visit a doctor.During the procedure, the dentist makes an incision in the mouth, releasing the accumulated pus, after which a so-called drainage – a rubber strip – is inserted into the wound. Further, the treatment continues at home with the prescribed anti-inflammatory drugs.
Treatment of an abscess differs from the elimination of periostitis only by the duration of the drainage. Usually the rubber strip stays in the mouth for a little longer.
What happens after treatment?
Usually, the first 2 days, unpleasant sensations persist, although the body temperature gradually begins to decrease, and the pain is no longer so obvious.A sharp improvement in the condition and appearance occurs on the third day.
Infiltrate – tissue compaction in the focus of inflammation – can persist for quite a long time. Gradually, the “bump” should dissolve.
Drainage – rubber strip – should remain in the wound for some time after the procedure. It prevents the incision from tightening ahead of time, leaving an open path for pus to escape. It is strictly forbidden to loosen, push out, correct drainage in any way.If the strip falls out, see a doctor right away. Call a specialist even if you do not feel better 12 hours after opening the flux.
Prohibited for inflammation:
- to make warming compresses and dressings;
- independently prescribe antibiotics and other medications;
- take painkillers before visiting a doctor;
- Drink aspirin (before and after opening).
Finally, I would like to say one thing: please, do not be afraid to go to the doctor at the first symptoms of caries.Treating a tooth is still less painful than trying to cope with inflammation in the tissues later. Take care of yourself!
Abscesses of the oral cavity: causes, types, treatment
A sick tooth cannot be cured by rinsing with soda, using analgin and a wonderful paste for self-sealing teeth. Various dental drops, heating pads and so on are also ineffective and harmful. Sooner or later, you will “swell”. Believe me, it’s better not to bring it up to this.
Purulent inflammatory diseases of the maxillofacial region are most often complications of caries.Depending on the severity, they are arranged in the following order: periostitis, abscess, phlegmon.
The term “flux” is of German origin, it means “flow, flow”. Now you will not hear it from any dental professional: the flux has been renamed once and for all to odontogenic periostitis . This is the most common “reward” of patient patients who have avoided the dentist for a long time.
Most often, the culprit of periostitis is a tooth affected by caries.However, it is possible that the whole point is in mechanical injury (bruise) or inflammation of the gum pocket – the space between the tooth and the gum. In any case, an infection is involved in the occurrence of the flux, which provokes the development of a purulent process.
As mentioned above, most often the cause of odontogenic periostitis lies in a diseased tooth. From the top of the tooth, pus makes a channel for itself in the bone tissue, trying to escape outward, and breaks through the bone, stopping under the periosteum of the upper or lower jaw (in Latin – periostum).It is from here that the name periostitis came from.
About periodontitis is said when:
- toothache is persistent,
- pain increases when pressing on the tooth, chewing or when trying to knock on the tooth with any object (fork, for example),
- tooth badly destroyed,
- this tooth was previously treated for pulpitis.
If the symptoms listed above are accompanied by edema of the tissues surrounding the tooth, swelling of the cheek from the side of the diseased tooth, this is already periostitis .Particularly severe cases of periostitis can be accompanied by an increase in body temperature.
If you have such a nuisance, immediately run to the dentist. The treatment of periostitis looks like this: under anesthesia, an incision is made in the oral cavity, releasing pus. A rubber strip is inserted into the incision – drainage. After that, the patient is prescribed antibacterial and anti-inflammatory drugs.
An abscess is a limited collection of pus in tissues.At its core, periostitis is also an abscess, but limited to the periosteum. Abscesses are also opened and drained, but the drainage (rubber strip) is kept longer.
Phlegmon – diffuse purulent inflammation. Pus is not limited by anything and can penetrate into different parts of the face between the muscles, go to the neck and even go down into the mediastinum – the part of the chest cavity in which the heart, trachea and esophagus are located.
This disease is very dangerous and can cause death.Agree, it’s stupid to die because of a tooth not healed during.
How not to harm?
- Do not under any circumstances make warming compresses, this procedure promotes the spread of the process.
- Don’t give yourself any bandages. The “sick” ones with a bandaged cheek tied with a scarf are many times replicated in various drawings and cartoons – a very bad example. The bandage is not a remedy.
- Do not drink antibiotics without first talking to your doctor.Antibiotics are drunk according to a certain scheme, otherwise they are completely ineffective. Microbes adapt to the drug, and the antibiotic becomes useless in the future, along the way, you harm the liver and kidneys.
- Do not take pain relievers less than 3 hours before your doctor’s appointment. Otherwise, you will complicate the diagnosis.
- If you have an incision, do not drink aspirin. Aspirin can cause bleeding. Moreover, as an anesthetic in this case, it is absolutely unsuitable.
- If, despite the incision, you do not feel better within 12 hours, see your doctor again.
- Do not prescribe or discontinue medication for yourself.
- Do not listen to the opinion of your friends, even if they (according to their stories) had the same problem.
Do not expect instantaneous disappearance of edema and infiltration, edema may even increase slightly. However, on the 3rd day you should be on the mend dramatically.An infiltrate – an area of soft tissue compaction in the affected area – can persist for quite a long time.
Within a few hours after opening the abscess or periostitis, the bursting pain in the area of the focus should subside, and the temperature should begin to decrease. There may be slight discomfort along the incision line, but there should be no severe pain.
A rubber strip is usually inserted into the incision – drainage, which will not allow the wound to close prematurely. Do not pull, push or try to fix it.If the drainage has fallen out, see a doctor as soon as possible.
If anything goes wrong as written here, consult your doctor.
I would like to emphasize that the widespread accusations of doctors that they “brought in an infection” when a tooth was removed do not have the slightest rational basis. It is enough to recall how many bacteria of various species normally inhabit the human oral cavity to understand the absurdity of such statements. Yes, you may have developed an exacerbation after the treatment or extraction of a tooth, but this usually occurs despite the extraction or treatment of the tooth.
Dmitry Borisovich Konev
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90,065 90,000 causes, symptoms and treatment in the article of the dentist-surgeon Kozlov P. Yu.
Date of publication March 3, 2020 Updated April 26, 2021
Definition of the disease. Causes of the disease
Abscess of the oral cavity – inflammation of tissues with their melting (destruction, disruption) and the formation of a purulent cavity.
Most often, the cavity is located between the bone tissue and the periosteum (periostitis, subperiosteal abscess), less often – in the interfascial, intermuscular spaces and in the bone tissue (abscess of the floor of the oral cavity, abscess of the pterygo-jaw space, abscess of the jaw-lingual groove).Separately, an abscess of the buccal region can be distinguished, which can be located between the mucous membrane and the muscle, in the intermuscular space and between the muscle and subcutaneous fat. In almost all cases, oral abscesses are odontogenic, in other words, the cause of their occurrence is a tooth, moreover, an affected, infected one. In an outpatient clinic, acute purulent periostitis occurs most often in comparison with other inflammatory diseases of the maxillofacial region     .
An abscess of the oral cavity develops as a result of a reaction of local and general immunity in response to infection. The severity of the course of the disease depends on the joint interaction of all defense mechanisms of the body   .
The most common cause of oral infection is acute or aggravated periodontitis. Periodontitis is a type of complicated caries, which can be clinically manifested by a carious cavity, or by a destroyed coronal part of the tooth with direct involvement in the pathological process of the tooth cavity and bone tissue behind the root apex.Radiographically, periodontitis is characterized by a change in the bone structure behind the apex of the tooth root, the degree and severity of the changes depends on the form of periodontitis.
The development of an oral cavity abscess from exacerbation of chronic periodontitis against the background of hypothermia clearly shows the dependence of the onset of the disease on systemic immunity. A patient can live for years with a large number of decayed teeth, which are foci of chronic infection, and only with a decrease in the general defenses of the body can an exacerbation develop with the appearance of an abscess.
The main role in the development of oral abscesses is played by streptococci and staphylococci of various types, gram-positive and gram-negative bacilli and putrefactive bacteria. Of these, about 75% are anaerobic bacteria (able to survive without oxygen) and 25% are aerobic (exist only in an oxygen environment). According to the literature, this ratio is variable, as is the resistance (resistance) of bacteria to antibiotic therapy, and depends on the region  .
In addition to periodontitis, abscesses of the oral cavity can be caused by suppuration of radicular cysts, which are hollow neoplasms in the apex of the tooth root filled with serous fluid.Also, abscesses can form as a result of infection of a bone wound with fractures of the bones of the facial skeleton, as well as difficult eruption of the lower wisdom tooth: in this case, the cause will be chronic inflammation, which is formed due to the multiplication of microorganisms between the wisdom tooth and the mucous membrane (hood) hanging over it.
Separately, an abscess of the pterygo-maxillary space can be removed, which can develop as a complication after performing local anesthesia on the lower jaw.
If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!
Symptoms of an oral abscess
Symptoms of an oral abscess are variable and depend directly on the type and location of the abscess. In acute purulent periostitis, patients complain of pain in the area of the causative tooth or jaw segment, swelling of soft tissues. The face of such a patient is asymmetrical.
When the causative tooth is localized in the anterior part of the upper jaw, the edema is located in the upper lip and infraorbital region, the nasolabial fold is smoothed.If the diseased tooth is located in the frontal part of the lower jaw, swelling of the soft tissues is noted in the area of the lower lip and chin. When the causative tooth is located in the lateral part of the dentition, perifocal edema (near the infectious focus) is located in the buccal region.
Acute purulent periostitis is usually not accompanied by restriction of mouth opening. On palpation of regional lymph nodes, signs of acute lymphadenitis (enlarged lymph nodes) are often determined.Examination of the oral cavity reveals the causative tooth, which usually reacts sharply to tapping (percussion). This is due to the presence of a pathological process behind the apex of the root. When examining the vestibule of the oral cavity, a painful inflammatory infiltrate is determined, over which there is an edematous and hyperemic (red) mucous membrane. According to the literature, periostitis is more often located on the side of the cheek or lips, less often on the palatine and lingual sides   .
Often, abscesses of the jaw-lingual groove, buccal region, pterygomandibular space are considered as a complication of acute purulent periostitis.However, in some cases, these diseases develop on their own, so there is no reason not to consider them in this review.
Abscess of the maxillofacial groove is characterized by a more serious course. The patient complains of pain when swallowing, moving the tongue to the sides, limiting the opening of the mouth. A visual examination determines the swelling of the submandibular region, acute lymphadenitis. Examination of the oral cavity is often difficult and is possible only after blockade of the motor branches of the mandibular nerve.When examining the oral cavity, acute or aggravated periodontitis of the chewing tooth of the lower jaw or difficult eruption of the lower wisdom tooth is determined. When examining the jaw-lingual groove, its bulging is determined; on palpation, an inflammatory, sharply painful infiltrate can be detected.
With abscess of the pterygo-jaw space , the patient notes an increase in body temperature, pain in the pharynx, difficulty swallowing, mouth opening is limited, in some cases almost impossible.Perifocal edema is often absent visually. Examination of the oral cavity can be performed only after blockade of the motor branches of the mandibular nerve. In the oral cavity, difficult eruption of the lower wisdom tooth is usually determined, as well as a hyperemic and edematous pterygo-mandibular fold.
The clinical picture of the buccal region abscess largely depends on the depth of the abscess. With a superficial abscess, hyperemia (redness) of the skin is determined, a local increase in temperature, the skin is tense, does not collect in a fold.With an average and deep location, there is a pronounced swelling of the buccal region, the skin is not externally changed, it is difficult to fold into a fold. Local hyperthermia (fever) is usually not observed. With a deep location of the abscess on the mucous membrane of the cheek, teeth marks are determined.
The condition of patients with these abscesses is usually assessed as moderate. Treatment, as a rule, is carried out in a hospital of maxillofacial surgery under supervision in order to prevent the development of severe complications.Patients often have symptoms of general intoxication of the body (fever, headaches and muscle pains).
Pathogenesis of an oral abscess
Inflammatory fluid (pus) in the tissues around the apical third of the tooth root may not be emptied through the root canal, in which case it will spread from the periodontium towards the periosteum. In this case, the infection penetrates through the compact plate along the nutritional and osteon canals (structural units of the compact substance of bone tissue).An important role in this process is played by resorption (resorption) in the compact plate of the alveolar wall. Microorganisms can also spread under the periosteum by hematogenous (through blood) and lymphogenous (through lymph) pathways.
Violation of the integrity of periodontal tissues is the cause of functional failure of nonspecific and specific humoral and cellular reactions to suppress infection. Toxins of microorganisms increase sensitization (sensitivity), disrupt hemodynamics (movement of blood through the vessels).Inflammation develops brightly, the body’s response to it can be normal (corresponding to the strength and nature of the stimulus) or hyperergic (exceeding the effect of the stimulus). Further, with an untimely visit to a doctor and an imbalance in the patient’s immune status, the infection spreads to nearby cellular spaces.
The abscess is separated from healthy tissues by an infiltrated shaft of leukocytes. At the same time, the vessels are full-blooded, from their lumens the liquid part of the blood passes into the tissues, forming perifocal edema.In the process of the development of a tissue reaction around the purulent focus and the multiplication of connective tissue cells, a granulation shaft is formed, which limits the purulent focus. With the long-term existence of a limited purulent process, the development of a dense connective tissue pyogenic membrane, which serves as a barrier for the further development of the inflammatory process, is possible.
Classification and stages of development of an oral abscess
- Adjacent to the upper jaw.
- Adjacent to the lower jaw.
For the reason:
- Odontogenic (caused by an infected tooth)
- Tonsilogenic (caused by inflammation of the pharyngeal tonsils).
- Rhinogenic (caused by inflammation of the nasal mucosa).
By the type of inflammatory reaction:
- Hypoergic (slow development of the disease, symptoms are weak).
- Normal (the most typical course of the disease).
- Hyperergic (rapid progression of the disease with pronounced symptoms)  .
Complications of oral abscess
Complications of oral abscesses are phlegmon of the face and neck, sepsis, mediastinitis, thrombophlebitis, meningitis  .
Due to good vascularization (blood supply) and an abundance of cellular spaces, purulent-inflammatory diseases of the maxillofacial region spread rather quickly to nearby areas.A prerequisite for this is the reduced immune status of the patient.
When an inflammatory infiltrate penetrates through the diaphragm of the oral cavity, phlegmon of the floor of the mouth develops. This disease is characterized by a severe course and a rather unfavorable prognosis. Often the root of the tongue is involved, which can lead to closure of the airways. With phlegmon of the bottom of the mouth, the patient has difficulty breathing, it is almost impossible to close the mouth and make swallowing movements.The usual food intake for such patients causes a lot of problems, patients are often exhausted, are in serious condition due to pronounced symptoms of general intoxication of the body. Often, phlegmon of the floor of the mouth spreads to the neck, which aggravates the patient’s condition, especially if the neurovascular bundle of the neck is involved in the process. In some cases, putrefactive-necrotic phlegmon of the bottom of the oral cavity develops, which has a gangrenous character (Ludwig’s angina). This disease has an extremely severe course, with untimely treatment, a fatal outcome is possible.
Sepsis is a pathological condition caused by the entry of microorganisms into the systemic circulation from the focus of inflammation. Sepsis is characterized by severe general disorders and the formation of foci of purulent fusion in various organs and tissues. The most common causative agents of sepsis are staphylococcus, E. coli and Pseudomonas aeruginosa, anaerobes, however, theoretically, sepsis can be caused by any microorganism.
Mediastinitis – inflammation of the mediastinal tissue.It is one of the most severe complications of pyoinflammatory diseases of the maxillofacial region. Infection of the mediastinum occurs by contact (along the length of the neurovascular bundle of the neck due to the spread of pus from top to bottom) or hematogenous / lymphogenous. Mediastenitis is characterized by chest pain, impaired swallowing, hoarseness, and symptoms of a systemic inflammatory response. Symptoms of this disease can vary, they depend on the prevalence of the pathological process, the degree of involvement of the mediastinal organs and the severity of their damage  .
Thrombophlebitis of the facial veins – acute inflammation of the veins with the formation of a blood clot, which develops in pyoinflammatory diseases of the maxillofacial region. In some cases, thrombophlebitis of the sinuses of the brain develops.
Meningitis – purulent or serous inflammation of the brain or spinal cord caused by bacteria, viruses or other agents.
The described diseases are quite dangerous, each of them is characterized by a serious condition of the patient.Cases of a combination of these complications are not uncommon, which affects the prognosis, terms of rehabilitation, as well as complete physical and mental recovery.
Any of the above diseases is an indication for immediate hospitalization in a specialized surgical department. In some cases, after surgery, the patient is admitted to the intensive care unit under constant supervision. Constant monitoring is required, in some cases – consultations or interventions of related specialists (neurosurgeons, thoracic surgeons).
Diagnostics of the oral cavity abscess
Basic and additional research methods are used for the diagnosis of oral cavity abscesses.
At the initial appointment, the doctor assesses the clinical situation and decides on the need for hospitalization of the patient with subsequent treatment in a hospital. The doctor listens to the patient’s complaints, learns the history of the development of this disease, asks about the presence of concomitant common pathologies. Then he conducts a clinical examination, which begins with a visual examination of the patient: in this case, the asymmetry of the face, the color of the skin, the degree of mouth opening are assessed.Particular attention is paid to the study of regional lymph nodes, since their enlargement is a clinical symptom of inflammatory diseases of the maxillofacial region. After a visual examination, the oral cavity is examined, during which it is necessary to identify the causative tooth and the focus of inflammation.
In some cases, especially in severe forms of inflammatory diseases of the maxillofacial region, it is necessary to measure body temperature and blood pressure. In the case of an oral abscess, the results of these examinations help determine changes in the general condition of the body, which can be expressed in the appearance of headaches, malaise, chills, etc.
In an outpatient setting, a sighting X-ray or radiovisiogram is carried out, it is possible to carry out electroodontodiagnostics (assessment of the state of the pulp by checking its reaction to an electric current). Orthopantomogram  is performed with special equipment. These research methods make it possible to establish the causal tooth, because in some cases the clinical picture does not allow this to be done due to the pronounced edema and a large number of decayed teeth.
Currently, more and more patients with purulent-inflammatory diseases of the maxillofacial region, including acute purulent periostitis, are being treated in a maxillofacial surgery hospital. Only in the hospital, the patient is under round-the-clock supervision, which allows him to thoroughly examine him, as well as control and adjust the treatment and rehabilitation.
In inflammatory diseases of the maxillofacial region, a general blood test will be informative, in which special attention is paid to the number of leukocytes, erythrocyte sedimentation rate (ESR) and the presence of a shift in the leukocyte formula.In addition to a general blood test, a general urine test, a biochemical blood test, a blood test for the presence of antibodies to infectious diseases, fluorography and electrocardiography, if necessary, are performed.
To clarify the localization and prevalence of the purulent process, as well as to select the optimal surgical access, an ultrasound scan of the inflammatory infiltrate and adjacent tissues is performed. After opening the abscess, material is taken to study the quantitative and qualitative composition of the flora, as well as its sensitivity to antibiotics.This study will allow prescribing the most effective antibacterial drug that will help the patient recover in the shortest possible time.
Treatment of an oral cavity abscess
Patients with oral cavity abscesses need urgent surgical treatment in the volume of opening the inflammation focus  . In acute purulent periostitis or deep buccal abscess under local anesthesia, the abscess is opened, then local antiseptic treatment of the postoperative wound with antiseptic solutions is performed, followed by drainage.
Patients with abscesses of the maxillofacial groove, pterygoid-maxillary space, superficial and mid-buccal abscesses are increasingly being treated in a maxillofacial surgery hospital. Lancing of such abscesses is also performed under local anesthesia.
It is worth paying attention to the tactics of treating the causative tooth. After clinical and radiological examination, a decision is made to preserve or remove the causative tooth. With a relatively preserved crown part, the diseased tooth is usually preserved.If the tooth is destroyed, there is a pronounced pathological mobility, if, according to the X-ray data, an extensive focus of bone tissue destruction is revealed, the causative tooth is removed. Removal is also performed if the patient refuses to preserve and conservatively treat the causative tooth. In the absence of absolute indications for tooth extraction, a written refusal of the patient to save it is drawn up.
After opening the abscess, the patients are daily bandaged: antibacterial treatment of the postoperative wound and oral cavity, replacement of drainage.Also, the patient must independently observe oral hygiene.
In addition to surgical treatment, antibiotic therapy is prescribed. Its goal is to suppress the pathological microflora. Before the results of antibiotic susceptibility tests are available, empiric therapy is carried out, which involves the use of a broad-spectrum antibiotic. When the results are obtained, the pathogen or pathogens and an antibacterial drug are identified, which most effectively helps to fight the pathogenic flora  .
In connection with the presence of severe pain syndrome in the area of the postoperative wound, symptomatic therapy is carried out. The patient is prescribed non-steroidal anti-inflammatory drugs in injectable or tablet form.
detoxification therapy is being carried out, the essence of which is the intake of a large amount of liquid. Severe patients are shown intravenous infusion with isotonic solution. In some cases, multivitamins and physiotherapy are prescribed.
With timely treatment, correct treatment tactics and correctly selected drug therapy, the prognosis is favorable. In acute purulent periostitis, usually after 3 days, there is a decrease in collateral edema and a decrease in pain in the area of the postoperative wound. Full recovery of working capacity is usually noted on days 3-7, depending on the severity of the disease, the presence of background diseases, compliance with the recommendations and prescriptions of the attending physician.
Patients often neglect the recommendations: they do not observe oral hygiene, do not come for repeated appointments, do not take medications, or take the wrong drug due to various reasons. In some cases, such a negligent attitude towards one’s own health does not bring negative consequences. But sometimes, especially against the background of a weakened general immunity, the presence of severe general diseases, including immunodeficiency, complications develop. In such cases, the patient is shown hospitalization in a maxillofacial surgery hospital under round-the-clock supervision.
Much attention is paid to the prevention of inflammatory diseases of the oral cavity. There are many daytime and nighttime dental clinics, weekends and public holidays, both public and private. The Internet and other media sources of information talk about the need to brush your teeth twice a day, use various mouth rinses. Many dental clinics are organizing campaigns for professional cleaning of the oral cavity, but the number of patients with inflammatory diseases of the oral cavity is not decreasing.
It should be noted that with timely treatment of carious cavities and sanitation of the oral cavity as a whole, the risk of developing odontogenic abscesses of the oral cavity tends to zero. It is also important to maintain a high level of general immunity, lead a healthy lifestyle and observe a work and rest schedule  .
90,000 causes, symptoms and treatment in Moscow
Oral abscess is an acute inflammatory disease of the oral cavity characterized by the accumulation of pus in soft tissues.With an abscess, local swelling and compaction of the mucous membrane is observed, which causes pain when touched and is accompanied by an increase in temperature, a deterioration in the state of the body. This disease is diagnosed by a dentist based on the condition of the tissues during a visual examination and involves surgical intervention, which consists in opening the abscess and conducting anti-inflammatory drug therapy.
An oral abscess is a purulent inflammation of the soft tissue of the gums, palate, tongue, or cheeks.This disease is one of the most common pathologies in dental surgery and occurs regardless of the sex and age of the patient.
Most often, this pathology is formed subsequently by complications of dentition, general infectious manifestations and disruption of the integrity of the mucous membrane. If the abscess is not cured in a timely manner and correctly, it can turn into a permanent form and cause unwanted complications (sepsis, phlegmon), therefore, with this disease, self-medication is strictly prohibited and at the first signs that arise, you must seek advice from a specialist.
Classification of an oral abscess
The basis for the classification of abscesses is their localization in the oral cavity, therefore, the following types of formation of this pathology are distinguished:
- Gum abscess: Considered the most common type of abscess, it forms near a specific tooth. In the absence of proper treatment, this pathology can turn into a chronic form or developed inflammation, which is characterized by a periodic outflow of pus from a formed fistula, exacerbation, an unpleasant odor from the oral cavity and intoxication of the whole body;
- Abscess of the floor of the mouth: localized under the tongue, thus causing discomfort and severe pain while talking and eating.In the case of a breakthrough or self-opening of the lesion, the outflow of pus can provoke a repeated focus of inflammation in the neck and pharynx;
- Abscess of the palate: formed as a result of incomplete treatment or postponed periodontitis of the dentition of the upper jaw. It can become complicated and spread to the peritonsillar region and adjacent tissues of the palate, thereby causing the formation of osteomyelitis of the palatine plate;
- Cheek abscess: given the depth of injury to the mucous membrane, this pathology can be both inside and outside, coming out to the surface of the cheek.Such localization of the abscess is extremely dangerous, since there is a possibility of the spread of the disease to the nearby tissues of the face;
- Tongue abscess: The main indicators of the disease will be swelling of the tongue, difficulty eating, speaking and even breathing. This type of oral abscess, according to experts, is considered the most dangerous, therefore, when the first signs form, you should immediately consult a doctor.
Forecast and prevention of oral abscess
The success of the treatment of oral abscesses is due to a timely visit to a doctor, as well as the general condition and characteristics of the body.In the case of a timely start of treatment measures, the prognosis will be favorable. The absence of complications, a stable immune system of the patient’s body, as well as a high-quality and timely operation, make it possible to heal an oral abscess in a few weeks.
As a preventive measure, the following recommendations must be followed:
- implementation of high-quality and systematic oral hygiene;
- avoidance of injury to the mucous membrane;
- Timely therapy of caries, periodontal and gum tissue diseases;
- Regular visits to the dentist for preventive examinations.
Causes of oral abscess
- Most often, oral abscess occurs due to complications of dental pathologies, such as advanced periodontal disease and periodontitis. These pathologies are characterized by damage to the periodontal joints and the formation of periodontal pockets, in which the number of pathogenic microorganisms increases intensively, which causes inflammation of the gingival tissues.
- The development of an abscess in the oral cavity can be triggered by the introduction of infection into the damaged area of the soft tissue with the broken integrity of the mucous membrane (mechanical injury, anesthesia, syringe needle).
- Also, the cause that causes the development of the disease can be staphylococcal and streptococcal tonsillitis, boils in the face area.
- It was noticed that this pathology can appear against the background of influenza or common infectious diseases that weaken the human immune system.
- In many cases, an oral abscess can be triggered by an infection that consists of three or more microorganisms, the etiological agents of which are gram-negative anaerobic flora, streptococci and staphylococci.
Symptoms of an oral abscess
Abscess formation occurs relatively quickly.Initially, pain may occur, which is similar to the signs of periodontitis, when the pain is concentrated in the area of one tooth and gradually intensifies, after which a dense and painful swelling forms in this place. Outwardly, it looks like a round neoplasm on the gum, sometimes reaching the size of a walnut.
An abscess of the tongue is characterized by increasing pain in the thickness of the organ, it rapidly increases in volume. This pathology is accompanied by such signs as difficulty in swallowing and chewing, as well as the appearance of suffocation.If the inflammation is closer to the skin surface and under the soft tissue mucosa, swelling and redness at the site of the lesion can be observed on physical examination.
Any abscess in the oral cavity is accompanied by a deterioration in the general condition of the body, sleep and appetite disorders, as well as increased body temperature. The progression of an abscess is accompanied by a breakthrough of the abscess, this brings the patient some relief and manifests itself in a decrease in temperature, pain, a decrease in swelling, and an improvement in the general condition of the body.However, this should not be a pretext for stopping treatment. Even in this case, the process of inflammation can continue, spread to neighboring tissues, transform into a permanent form, and also lead to such serious consequences as the loss of teeth, the formation of sepsis and phlegmon.
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Diagnostics of the oral cavity abscess
An oral abscess is diagnosed by a specialist based on a visual assessment of the condition of the mucous membrane during a dental examination.Spontaneous opening or use of antibacterial agents by the patient is completely unacceptable, since this can only worsen the condition and complicate the course of the disease.
At the first signs of pathology, it is necessary to consult a doctor and preferably before opening the focus of inflammation. The only thing that the patient can do before consulting a specialist is to rinse the oral cavity with an antiseptic solution and take painkillers, and to relieve swelling, it is permissible to install a cold compress on the affected outer surface.
Treatment of oral cavity abscess
The abscess is treated surgically. To eliminate the focus of infection and prevent the spread of the inflammation process, the dentist-surgeon performs the following step-by-step manipulations:
- opening the abscess;
- drainage of the inflammation focus;
- antiseptic cleansing of the cavity.
Since the incision is small, stitches are not required after surgery. After the elimination of pus, the patient’s well-being significantly improves and the outlines of the face are restored, however, in the case of a widespread abscess, the healing process may slow down.
After the operation, the patient is prescribed antihistamines, antibiotics, immunostimulants and a mineral-vitamin complex, and physiotherapeutic procedures (UHF therapy and fluctuorization) are also permissible.After treatment, the patient is advised to exclude the use of solid food and adherence to good nutrition.
This article is posted solely for informational purposes only for educational purposes and is not scientific material
or professional medical advice. See your doctor for diagnosis and treatment.
Neck cellulitis – symptoms and treatment
By Evgeny Basin,
maxillofacial surgeon, d.M.Sc.
Phlegmon of the neck is an acute or chronic inflammation that develops and proceeds in the neck region: from the edge of the lower jaw to the level of the collarbones and jugular notch. Due to the anatomical structure of this area and the highly developed lymphatic system, purulent and inflammatory changes spread in it extremely quickly.
Cellulitis of the neck is characterized by a rapid spread and is a life-threatening condition, and if not treated and diagnosed promptly can be fatal.
Reasons for the development of phlegmon of the neck
Most often, neck phlegmon develop due to a long-standing focus of infection, the symptoms of which are often ignored.
- unsatisfactory filling of the root canals of the teeth and the development of peri-maxillary abscesses and phlegmon with extension to the neck,
- Difficulty erupting wisdom teeth (third molars),
- dental diseases (caries, pulpitis, periodontitis)
- sialoadenitis – inflammation of the submandibular salivary gland or the formation of calculus (stone),
- diseases of the lymph nodes – lymphadenitis, which can proceed as a “hot” or “cold” abscess, as well as a manifestation of systemic diseases: metastases in malignant neoplasms of the head and neck, specific diseases: syphilis, tuberculosis, actinomycosis,
- skin diseases: carbuncles, boils, wounds and abrasions contribute to the development of superficial abscesses and phlegmon of the neck,
- consequences of trauma – untimely treatment of fractures or pathological fractures of the jaws (with bisphosphonate, antiresorptive, desomorphine, radiation osteonecrosis of the jaws),
- Neck cysts (lateral and median) are often diagnosed only when they are inflamed, which requires anti-inflammatory therapy and their subsequent removal in a planned manner,
- periopharyngeal or paratosillar abscesses contribute to the spread of a purulent-inflammatory process to the neck,
- foreign bodies,
- thyroid disease,
- neck injury
Symptoms of neck phlegmon
With phlegmon of the neck, the condition worsens rapidly.The body temperature rises to 38 °, edema grows in the neck area, the skin becomes hypertensive, swallowing is impaired, and general intoxication develops. Other characteristic symptoms also appear:
- Presence of swelling, “ball”, lymph node in the neck, previous pain in the tooth, jaw or ENT organs, which “subsided”, but swelling appeared on the neck
- Skin redness
- Feeling of fullness in the neck
- Change voice
- Respiratory Distress
- Putrid or bad breath
- Inability to open mouth and chew food
- Impaired Speech
- Swallowing disorder
Diagnosis of phlegmon of the neck
For timely diagnosis and treatment due to the threat to life and the high probability of surgical treatment, an immediate examination by a maxillofacial surgeon or an ENT doctor is recommended.
During the initial examination, the doctor specifies the anamnesis, which makes it possible to recognize the “entrance gate” of the infection.
Next, he palpates the maxillofacial region to determine the primary boundaries of the inflammatory process in the neck.
Based on the results of examination and palpation, the doctor prescribes blood tests to determine the general condition of the patient.
Ultrasound of the neck tissues is the primary element in the diagnosis of cystic and common inflammatory diseases.
If there is a suspicion of metastases or specific damage to the neck tissues, a puncture is performed under ultrasound control.
To assess the state of the oral cavity, it is necessary to conduct a cone-beam computed tomography.
Computed tomography and MRI studies with contrast enhancement can determine the boundaries and spread of the inflammatory process or neoplasm.
What not to do if you suspect phlegmon of the neck
Self-administration and administration of antibacterial drugs contributes to the aggravation of the condition, the slow spread of inflammation and complicates postoperative treatment due to the development of antibiotic-resistant strains of microorganisms.
Warming up or, conversely, applying a cold compress promotes the spread of the process or its transition into a “cold” abscess.
Effective treatment is possible only with urgent medical attention at the first symptoms of the disease!
Complex treatment is prescribed individually depending on the reasons for the development of neck phlegmon. Hospitalization is required with surgical treatment – opening of a purulent-inflammatory process, antibioticogram to determine the sensitivity of microflora, in some cases a biopsy is performed to determine the boundaries and nature of the neck disease.
- secondary mediastinitis (damage to the mediastinum)
- deep vein thrombosis of the lower extremities
- damage to the respiratory system (pneumonia, pneumothorax), pericarditis
- Disseminated intravascular coagulation syndrome
The best prevention of purulent-inflammatory neck diseases is oral cavity sanitation and orthopantomogram or cone-beam computed tomography once a year.We recommend that you regularly visit a dental hygienist for professional oral hygiene twice a year to identify possible problems and, if necessary, dental treatment.
90,000 Oral abscess – causes, symptoms, diagnosis and treatment
Abscess of the oral cavity is an acute inflammatory disease of the oral cavity, which is characterized by focal accumulation of pus in the tissues. With an abscess of the oral cavity, there is a limited compaction and swelling of the mucous membrane, painful to touch, which is accompanied by a deterioration in general well-being and an increase in body temperature.An oral abscess is diagnosed by a dentist during an examination based on an assessment of the condition of the tissues. Treatment of an oral cavity abscess includes a surgical operation – opening the abscess, as well as anti-inflammatory drug therapy.
Oral abscess is a local purulent inflammation of the tissues of the gums, tongue, palate or cheeks. This disease is one of the most common problems in dental surgery and manifests itself regardless of the age and gender of the patient.Most often, an abscess of the oral cavity occurs as a result of complicated dentoalveolar pathology, but its development is also possible due to a violation of the integrity of the mucous membrane or in general infectious diseases.
In the absence of timely and correct therapy, an oral abscess can flow into a chronic form, as well as cause severe complications such as phlegmon and sepsis. Therefore, self-medication with an oral abscess is strictly prohibited. In order to prevent the consequences, it is necessary to urgently consult a specialist at the first symptoms of the disease.
Abscess of the oral cavity
Most often, an abscess of the oral cavity occurs as a complication of dental pathologies, for example, periodontitis or advanced periodontal disease. These diseases are characterized by the destruction of the periodontal joints and the formation of the so-called periodontal pockets, in which there is an intensive multiplication of pathogenic microorganisms that cause the inflammatory process.
An abscess of the oral cavity can form as a result of infection in the wound when the integrity of the mucous membrane is violated, for example, with a syringe needle during anesthesia or in case of mechanical injury.The reason that provokes the development of pathology can be boils in the face, streptococcal and staphylococcal sore throats. It is noticed that abscesses of the oral cavity often occur against the background of influenza or other common infectious diseases that weaken the immune system.
In most cases, an oral abscess is caused by an infection involving more than 3-5 microorganisms. The most common etiological agents are staphylococci, streptococci and gram-negative anaerobic flora (Eikenella corrodens, Porphyromonas gingivalis, Enterobacteriaceae spp.and etc.).
Depending on the location, there are several types of oral abscesses:
- Gum abscess appears next to a specific tooth. This is the most common type of abscess. In the absence of proper treatment, it can flow into a diffuse inflammation or into a chronic form, which is characterized by periodic exacerbations, the outflow of pus from the fistula formed, a bad smell from the oral cavity and intoxication of the body.
- Abscess of the floor of the mouth is located under the tongue, causing severe pain while talking and eating. With a spontaneous opening, pus leakage can cause secondary foci of inflammation in the pharynx and neck.
- Palate abscess most often occurs due to periodontitis of the teeth of the upper jaw. Threatens with the transition of infection to the adjacent tissues of the palate and peritonsillar area, as well as the development of osteomyelitis of the palatine plate.
- Cheek abscess , depending on the depth of the lesion, can be localized both inside – on the side of the mucous membrane, and out to the outer surface of the cheek. An abscess of this localization is extremely dangerous due to the possible spread to nearby facial tissues.
- Tongue abscess is characterized by swelling of the tongue, difficulty eating, speaking and even breathing. This type of abscess is the most dangerous; with the development of the first symptoms, urgent hospitalization is necessary.
Symptoms of an abscess
The formation of an abscess in the oral cavity, as a rule, occurs rather quickly. At first, painful sensations may appear that resemble the symptoms of periodontitis – the pain is localized in the area of a particular tooth and intensifies when biting. Soon after this, a painful and dense swelling to the touch occurs at the site of the development of the pathological process. Outwardly, it is a rounded formation on the gum, which in some cases can reach the size of a walnut.
Tongue abscess develops rapidly – rapidly growing pain appears in the thickness of the organ, it rapidly increases in volume; the patient has difficulty with the processes of chewing and swallowing, and in severe cases, suffocation occurs. When the inflammation is localized under the mucous membrane of the soft tissues of the oral cavity, as well as closer to the surface of the skin (face or submandibular region), on examination, redness and swelling can be observed at the site of the focus of infection.
Any abscess of the oral cavity, as a rule, proceeds against the background of a deterioration in general well-being, an increase in body temperature, sleep and appetite disorders.The progression of pathology can lead to a breakthrough of the abscess. The release of pus brings significant relief to the patient: pain decreases, swelling subsides, temperature decreases, general well-being improves, but this should not be a reason for calming down due to the possible development of complications.
The inflammatory process can continue, flow into a chronic form and spread to nearby tissues. An abscess of the oral cavity threatens with many serious consequences, for example, the loss of one or more teeth, the development of phlegmon and sepsis.In order to avoid complications, it is necessary to consult a doctor as soon as possible, who will prescribe the correct treatment.
An oral abscess is diagnosed by a specialist based on a visual assessment of the condition of the mucous membrane during a dental examination. The expectation of spontaneous opening of an oral abscess or the independent use of antibacterial agents is completely unacceptable. To relieve symptoms, you can use pain relievers and rinse your mouth with warm antiseptic solutions before going to the doctor.
Treatment of an oral cavity abscess
An oral abscess is treated exclusively by surgery. In order to eliminate the focus of infection and prevent the spread of the inflammatory process, the dentist will open the abscess, drain and antiseptic the cavity. Suturing after such an operation is usually not required, as the size of the incision is small.
After removal of pus, as a rule, the patient feels better, the pain subsides, the swelling subsides, normal facial contours are restored, but if the oral abscess has developed significantly, then the final recovery may be somewhat delayed.
In the postoperative period, antibiotics, antihistamines, immunostimulants and vitamin-mineral complexes are prescribed. In some cases, physiotherapy, such as fluctuating or UHF therapy, is used for a speedy cure. It is also recommended to avoid solid foods after surgery and eat a good diet.
Forecast and prevention
In general, the success of the treatment of oral abscesses depends on the timeliness of the visit to the doctor and the general condition of the patient’s body.It is very important to start treatment measures as early as possible – in this case, the prognosis is usually favorable. If the surgery is performed on time and there are no complications, the oral abscess will heal completely within 1–2 weeks.
To prevent an oral cavity abscess, it is necessary to follow the rules of hygiene, avoid injuries to the mucous membrane, and in the presence of periodontal diseases, timely treat them.