What Are The Tooth Abscess Stages?
A tooth abscess is formed when a collection of pus within a tooth or its adjacent structures. This condition occurs when a person is infected with bacteria in any of the related areas in the mouth:
- the inner core of a tooth is referred to as the tooth pulp
- the gums
- the jaw bone
The main cause of tooth abscesses is the lack of care for dental cavities, resulting in tooth decay. However, they can also occur as a result of periodontal diseases or an oral injury that is left untreated.
A periapical abscess is caused by a disruption or contamination of the nerves and blood vessels in a tooth’s root, which affects the nourishment and health of the tooth structure. Each tooth contains a living nerve and blood vessels that help it function properly.
There are various types of abscesses that can occur without direct connection to the tooth nerve. These types of abscesses are categorized as severe dental infections, but they have a different appearance compared to a typical tooth abscess. The dentist will consider the specific infection you have when making their recommended treatment.
Stage Zero: Tooth Decay
A tooth abscess does not appear out of nowhere, as there is always a logical reason behind it, with tooth decay being the most common cause. Initially, it starts as a small cavity, but if ignored, it can progress into an abscess.
Tooth decay is classified as stage zero in the sequence leading to a tooth abscess. Before discussing abscesses, it is important to understand the different stages of cavity development and progression.
Stages of tooth decay
Bacteria in the mouth feed on sugars consumed, leading to the development of cavities. Tooth decay starts on the outer layer of the tooth called enamel, then progresses to the dentin, eventually reaching the pulp.
This is an illustration that shows the different layers of a tooth:
The first stage of tooth decay begins in the enamel layer, which is the outermost layer of your teeth. This layer is highly durable because of its high hydroxyapatite content, which is a strong mineral found in both teeth and bones.
Appearance: You notice a small brown or black mark on your tooth. A mark can appear on any part of the tooth’s surface, whether it be on the top or the sides. If you try to examine it with an instrument, you will feel a soft and sticky sensation.
Symptoms: During this phase, decay is typically not accompanied by pain or sensitivity, which can make it difficult for individuals to identify the presence of a cavity. The only way to identify oneself would be to either look in a mirror or go to a dental appointment.
Treatment: This decay can be effectively treated with a tiny dental filling, which may not require any numbing injections if the decay is not too deep.
Tooth decay progresses to its second phase when an untreated gap in the outer enamel reaches the layer of dentin underneath. Dentin is located in the middle layer and serves as the second component of your tooth. Dentin is softer than enamel because it has a lower concentration of hydroxyapatite. Once the cavity reaches the dentin, it starts to progress at a faster rate.
Appearance: The appearance is that of a larger and darker mark, resembling either a noticeable brown blotch or a blackened spot. In some cases, it may become a literal cavity when it becomes quite large.
Symptoms: The proximity of the dentin to the nerve can cause sensitivity when eating sugary foods. This sensation may indicate the presence of a cavity, although it is important to note that not everyone will experience sensitivity to sweetness even if there is a cavity in the dentin. Therefore, the lack of sensitivity to sweetness should not be seen as a guarantee of having no cavities.
When prodded by a dental tool, the cavity will feel soft and mushy, indicating its distinct texture.
Treatment: For the treatment of decay, a cavity filling of small to medium size should be sufficient. If the cavity is larger than expected and is close to the nerve but not directly touching it, it may be necessary to use a medicinal liner before placing the filling material.
Tooth decay progresses to its third stage when an untreated cavity extends through the dentin and reaches the sensitive pulp. The pulp is located at the center of your tooth and is the innermost layer. The tooth is nourished by blood vessels and contains nerve tissue, which is essential for its function.
Appearance: The appearance usually appears as a noticeable cavity in the tooth, often with a dark color ranging from deep brown to black. For a cavity to reach the nerve, it needs to have expanded significantly. There is a direct correlation between the magnitude of decay and the dimensions of the brown mark.
Symptoms: When the nerve of the tooth is affected and reaches the pulp, it can cause a severe toothache. This torment may present as a throbbing sensation that occasionally occurs. The peak of discomfort occurs when it causes severe tooth pain, disturbing your sleep indefinitely.
Treatment: When decay reaches the nerve, it requires a root canal procedure as the only solution. The course of action involves removing the nerve from the tooth while keeping the tooth in place in the mouth.
First Stage: Periapical Pathology (PAP)
A tooth abscess is caused by a bacterial infection that spreads from the inner pulp to the tip of the root. Afterwards, the infection slowly damages the nearby bone, eventually forming a visible dark ring that can be seen on a dental x-ray. Therefore, the observation of this dark ring indicates the official diagnosis of a tooth abscess.
Appearance: At this stage, a dental abscess is not visible to the naked eye as it remains hidden within the bone. The only way to detect it is by physically drilling into the bone to reveal its presence. In addition to this method, a dental x-ray is used by dentists as the primary way to visualize the abscess.
Symptoms: The pain caused by a bone abscess is intense due its pus-filled expansion, which leads swelling pressure and makes the pain worse.
Treatment: If an early detection of a tooth abscess is achieved, treatment with a root canal alone may be sufficient. If it is not identified in a timely manner, your dentist may need to use antibacterial medication in your tooth before completing the root canal, which will inevitably make the entire treatment take longer.
Second Stage: Parulis (Abscess on the gum)
A tooth abscess enters its second stage when the infection within the bone completely erodes the bone, leading to the appearance of a pimple on the gums. This specific pimple, also known as a parulis or a gum boil, contains a build-up of pus. The condition may appear similar to a gum abscess, but it is actually an abscess located on the gums. It is important to distinguish it from a gum abscess, as they have different causes.
Appearance: During the initial phase, a dental abscess becomes visible as a pimple-like growth located next to a tooth, appearing in shades of pink or red. When pressure is applied, infections often release pus, which is a fluid that makes up the majority of infections. Usually, the gum boil is located on the gum area around the specific tooth. The bothersome blemish is an inflamed purulent cavity.
Symptoms: During this stage of the abscess, pain is usually not present as the main source of discomfort is the trapped pressure caused by swelling. Once the parulis develops, it can be released evenly, providing relief from the pressure. The formation of this pimple may not cause significant pain. If any pain is experienced, it is typically less severe than the previous discomfort.
Treatment: A root canal procedure may be recommended by your dentist, where medication will be placed inside the affected tooth. In certain situations, if the gum boil is sufficiently large, drainage may be necessary in addition to the root canal treatment.
Third Stage: Facial Swelling
In the progression of a dental abscess, the third phase is characterized by facial swelling caused by the untreated infection. The swelling is caused by the continuous production of pus by the abscess. Without a release for the pus, the face experiences continuous swelling like a balloon being blown up.
Appearance: The abscess is typically located on one side of the face, resulting in swelling that is limited to that area. The untreated swelling is growing larger every day. Therefore, the size of the swelling acts as a gauge for the amount of time that has passed. The swelling has a disfiguring appearance, resembling a golf-sized bulge within your cheeks.
Symptoms: Experiencing such a phenomenon, one can understand the discomfort caused by a face enlarging to such proportions. Sensations of tenderness and warmth can be felt with even the slightest touch. The swelling’s consistency varies depending on its level of development, ranging from pliable texture rigid solidity.
Treatment: To find pain relief, it will be necessary for your dentist to drain the swelling. It is important to complete the full course of antibiotics prescribed to you. Once the swelling goes down, your dentist can address the underlying cause of the infection that started from the offending tooth. The tooth’s fate depends on its condition, and may require either a root canal treatment or extraction.