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A Root Canal Abscess

What Causes an Endodontic Abscess?

An endodontic abscess is caused by infected pulpal tissue. This acute disease process then spreads to the outside of the root and enters the bone and soft tissues around the tooth. An endodontic abscess is oftentimes accompanied by a cascade of symptoms. These symptoms may include:

• Pain to hot liquids, touch, or biting pressure.
• Pressure that partially pushes the tooth out of the socket, causing it to contact the opposing tooth first upon biting.
• A loose tooth resulting from infection and subsequent pressure that builds around the outside of the tooth.
• Swelling localized to the tissue around the tooth.
• Swelling that spreads from the gums around the tooth into the cheek, lips, or neck areas. These tissues can become swollen resulting in an exaggerated asymmetry of the face.

In cases of extreme dental infection, the eye can become swollen shut or breathing can become difficult as pressure builds against vital structures. In these instances of severe infection, hospitalization may become necessary.

What Is Involved in the Emergency Management of an Abscessed Tooth?

An endodontic abscess can be extremely painful and emergency treatment is directed towards promptly relieving the patient's pain and, if present, reducing the swelling as quickly as possible. Emergency management would usually include getting the area profoundly numb and then creating a small window through the biting surface of the tooth and into the pulpal space. By opening the tooth in this manner, the dentist can relieve the pressure that has built up inside the tooth and allow the infected area to drain. Usually, the only procedures that are performed at the emergency visit are the ones that are necessary to eliminate acute pain and control the infection. Subsequent care an endodontic abscess will be necessary when the patient is more comfortable and relaxed in order to properly complete root canal treatment. At the conclusion of the emergency visit, the patient may require medications for pain and/or infection control and these will be prescribed by the doctor if they are necessary.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

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Endodontics: What Happens at a Root Canal Appointment?

At the root canal treatment appointment, whether it is an emergency visit or a regularly scheduled visit, the patient will be cared for by various members of a trained and professional team. A primary goal of the dental team is to make certain that the patient is comfortable physically and emotionally during every stage of treatment. In addition to relieving tooth pain, if present, the goals of endodontic treatment are to eliminate endodontic disease and move the patient towards a state of health. With modern endodontic techniques, these goals can generally be achieved. Root canal treatment may take one or more visits to complete and usually progresses through the following stages:

1. The dentist reviews the findings and recommendations from the examination and consultation visit. If any additional radiographs are needed before starting treatment, they may be taken at this time.
2. The patient is typically given a local anesthetic. With newer techniques and devices, these anesthetics can usually be administered painlessly. The tooth can be made "profoundly" numb so that the patient is completely comfortable during treatment.
3. After achieving the required level of anesthesia, the dentist "isolates" the tooth using a "dental dam." This is a sheet of rubber material that fits over the tooth to be treated and forms a tight seal around it. The rubber dam serves to keep the saliva away from the area being treated and it also prevents the various disinfecting and cleaning solutions used during the procedure within the tooth from entering the mouth.
4. After the tooth has been isolated, the dentist prepares a window (an "access" opening) through the biting surface of the tooth in order to gain access into the diseased root canal space.
5. Once the access preparation is complete, the dentist begins to "clean" the root canal space by removing the diseased pulp tissue, bacteria, and related irritants. This is done using special solutions and small flexible instruments, called "files." The solutions penetrate and clean areas of the canal where the instruments cannot physically reach.
6. As the root canal system is being cleaned, it is also being "shaped." Shaping is the process of enlarging the root canal space in such a way that it can be thoroughly cleaned and subsequently filled and sealed. A root canal space that is not properly shaped may still harbor bacteria.
7. Following cleaning and shaping procedures, the root canal space is ideally filled and sealed in all its dimensions by a dentist. This is most commonly accomplished using a sealing cement in combination with a unique material called "gutta percha." Gutta percha is a special material that can be softened with heat and then pressure molded to precisely fill the root canal space.
8. Once the tooth is three-dimensionally sealed, it is generally "provisionalized" (temporarily restored) until a more long-lasting protective restoration can be placed. A protective restoration helps minimize the chances of future tooth fracture.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS