How we treat dental abscesses at the tooth's root
While rare, dental abscesses are one of the most serious conditions that cause tooth pain. But beyond the pain, an abscess is a serious signal from your body that something is happening deep within the structure of your tooth—specifically, at the root.
An abscess isn't just a toothache; it's an infection that's found a stronghold in the jawbone at the tip of your tooth's root. Ignoring it won't make it go away, and delaying treatment can actually lead to much bigger health issues down the road.
The good news is that modern endodontics has come a long way. At West Fort Worth Endodontics, we have the tools, the technology and the expertise to not only stop the infection but also save your natural tooth in the process. This blog post will tell you everything you need to know about dental abscesses and how Dr. Nieves and Dr. Fitzhugh treat them at our Fort Worth practice.
Understanding dental abscesses
A dental abscess is essentially a pocket of pus that forms due to a bacterial infection. While abscesses can occur in different parts of the mouth, a periapical abscess occurs at the tip of the tooth's root. This specific type of abscess is usually the result of an untreated dental cavity, an injury or prior dental work.
The process often starts silently. Bacteria invade the dental pulp—the innermost part of the tooth containing nerves, blood vessels and connective tissue. As the infection spreads down to the root, your body's immune system tries to contain it, resulting in inflammation and the formation of pus.
Symptoms can vary, but they are often hard to miss. You might experience severe, persistent throbbing tooth pain that can radiate to the jawbone, neck or ear. Other common signs include sensitivity to hot and cold temperatures, sensitivity to the pressure of chewing or biting, fever, swelling in your face or cheek and tender, swollen lymph nodes under your jaw or in your neck. If you notice a rush of foul-tasting, salty fluid in your mouth and pain relief shortly after, the abscess may have ruptured—but this doesn't mean the infection is gone.
If left untreated, the infection won't resolve on its own. It can spread to your jaw, neck or head. In rare cases, it can even develop into a life-threatening condition called sepsis. This is why prompt treatment is absolutely critical.
Root canal infections: a closer look
To understand how to treat an abscess at the root, you have to understand the environment where it grows. The root canal system is complex. It's not just a single smooth tunnel; it often has tiny branches and crevices where bacteria can hide.
When bacteria breach the protective enamel and dentin layers of your tooth, they reach the pulp. Once the pulp becomes infected, it can't repair itself. The pulp eventually dies, a process known as pulp necrosis. Necrotic pulp becomes a feast for bacteria, allowing them to multiply rapidly and travel down the root canals to the very tip of the root.
This is where the infection exits the tooth and enters the surrounding bone, causing the abscess. The pressure from this inflammation is what causes that intense, sharp pain associated with biting down or tapping on the tooth. The bone around the tip of the root begins to break down, which we can often see as a dark spot on an X-ray.
Some patients ask if they can just be prescribed antibiotics in order to remove the infection. Unfortunately, because the pulp can’t repair itself, the damage inside the tooth has already progressed to a state where the infection will need to be removed. Taking antibiotics at this point would just “hide” the symptoms, not to mention the possibility of the infection spreading (as mentioned in the paragraph above).
When to see an endodontist
You might be wondering if you should see your general dentist or a specialist. While general dentists are trained to perform root canals, an endodontist is a dentist who has undergone two or more years of specialized training specifically in diagnosing tooth pain and performing root canal treatments.
If you have a dental abscess, especially one that is complex or difficult to diagnose, a referral to an endodontist is often the best course of action. Endodontists limit their practice to endodontic treatments, meaning we perform root canal therapy and endodontic surgeries daily. This high volume of specialized cases gives us a level of precision and expertise that is hard to match.
Put another way, we consider ourselves specialists in saving teeth. Even if a tooth seems significantly damaged by an abscess, an endodontist has the advanced techniques and knowledge to disinfect the root system thoroughly and restore the tooth's health, preventing the need for extraction.
Root canal therapy: the treatment process
The phrase "root canal" often triggers anxiety, but for a patient with an abscess, it is actually the path to relief. The procedure is designed to eliminate the bacteria from the infected root canal, prevent reinfection of the tooth and save the natural tooth.
Here is what you can generally expect during the procedure:
Anesthesia: We start by numbing the area thoroughly. Modern anesthesia techniques are very effective, meaning you shouldn't feel pain during the procedure.
Access: We create a small opening in the crown of the tooth to access the pulp chamber.
Cleaning and shaping: Using small, specialized instruments, we remove the infected or dead pulp. We then clean, shape and disinfect the root canals. This is the crucial step in treating the abscess, as it removes the source of the infection.
Filling: Once the space is cleaned and shaped, we fill the root canals with a biocompatible material called gutta-percha. This creates a seal to prevent bacteria from re-entering.
Restoration: After the root canal is finished, you will return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.
Many patients worry that the procedure will take a long time, but most root canals can be completed in one or two appointments. Most importantly, the treatment relieves the pressure and pain caused by the abscess almost immediately.
Apicoectomy for cases with persistent infection or inflammation
An apicoectomy, also known as root-end surgery, is a minor surgical procedure used to treat a dental abscess or persistent infection at the root of a tooth, particularly when a standard root canal treatment isn’t effective. This procedure targets the root tip and the surrounding infected tissue, ensuring that the area is thoroughly cleaned and sealed. It's often considered a last-resort treatment to preserve and save a tooth that might otherwise require extraction.
Here's how the process of performing an apicoectomy generally goes:
Preparation and anesthesia: Your endodontist begins by applying a local anesthetic to numb the area around the affected tooth. This ensures the patient feels comfortable and pain-free during the procedure.
Incision: A small incision is made in the gum tissue near the tooth. This allows access to the underlying bone and root tip.
Removal of bone and root tip: The bone overlying the tip of the root is carefully removed to expose the root end. Your endodontist then removes the infected root tip (apex) along with any surrounding diseased tissue.
Cleaning and sealing: Once the infected area is cleared, the root canal is cleaned from the root end, and a small filling is placed to seal the root and prevent further infection.
Closing the incision: The gum tissue is repositioned and sutured back into place. These stitches may dissolve on their own or need to be removed during a follow-up appointment.
Post-surgery care: You'll be given specific instructions for aftercare from our staff, which may include pain management, avoiding certain foods and maintaining oral hygiene. Healing typically occurs over a few weeks, and follow-up visits ensure the area is healing properly.
An apicoectomy is a highly effective procedure for treating persistent infections and preserving natural teeth. It allows patients to maintain their original tooth structure while preventing the spread of the infection.
Don't ignore the pain; contact WFWE today
A dental abscess at the tooth's root is a serious condition, but it is treatable. The most important takeaway is that tooth pain is your body's way of telling you to take action. Ignoring it won't solve the problem and could lead to the loss of a tooth that could have been saved.
At West Fort Worth Endodontics, Dr. Nieves and Dr. Fitzhugh are dedicated to using their specialized training and advanced technology to diagnose and treat these infections effectively. We believe in saving your natural teeth whenever possible and getting you out of pain quickly. If you are experiencing symptoms of a dental abscess, don't wait. Contact us to schedule an appointment and take the first step toward restoring your oral health.