Periapical Abscess

Why Is A Periapical Abscess Potentially Dangerous?


What is the difference between a periapical abscess and an abscessed tooth? That’s somewhat of a trick question, since a periapical abscess is an abscess in a tooth, but not all abscessed teeth have this particular type of an abscess. The term periapical refers to the area around the apex of the root of the tooth. The apex of the root of a tooth is located in the pulp cavity in the interior of the tooth. The cavity is located within the neck portion of the tooth, which is that part of the tooth that sits slightly above and slightly below the gum line. An abscess can form anywhere in the body where an infection exists, and what we would call a tooth abscess can form in the pulp cavity, in the root canal, or in the gum tissue adjacent to a tooth. Some abscesses are plainly visible and some are not. An abscess in the periapical region of the tooth would generally not be visible, unless or until it breaks through the dentine surrounding the root of a tooth and then proceeds to burst through the gum tissue.

It Usually Starts With A Cavity


It would seem that the inner portion of the tooth, being surrounded by enamel and dentine, would be well protected against infection. This would normally be the case, if it were not for cavities. A cavity is literally a hole in the tooth, and it is a hole filled with bacteria. If the cavity is not taken care of, it will eventually expand to reach the central part of the tooth, the periapical region, where the bacteria will attack and kill the tooth’s nerve. The end result is a dead tooth, and a dead tooth is an ideal place for a periapical abscess to form.


No Tooth Pain? Not Necessarily A Good Sign


Once the nerve in a tooth is killed, a toothache which may have been experienced previously will usually cease. After all, if there is no longer a nerve ending to irritate, there will been no feeling in the tooth. A cessation of pain can be a welcome sign, but in this case it could be interpreted as a warning of things to come. Infection can spread though the dead part of the tooth, which is to say the pulp and the roots. This infection may not be accompanied by pain, which is not a good thing, since the owner of the tooth may be completely unaware that he or she not only has a problem, but a potentially serious one at that.

If the infection begins to cause pain, it would be because an abscess has formed, and as the abscess continues to grow, it will put pressure on the tissues in the vicinity of the tooth. An expanding abscess can even try to push the tooth away from its socket, which could happen if the gums and other surrounding tissues become badly infected.


The tooth however is a dead tooth. If the abscess is drained, and/or the infection is taken care of, the tooth can sometimes be saved by having a root canal procedure performed. The possible loss of the tooth is not the real danger however. The real danger lies in the possible spreading of the infection, which could then affect the gums  (periodontitis) , the jawbones (osteomyelitis) , soft facial tissue (facial cellulitis), and even the brain, given the close proximity of the brain to the mouth. Sepsis can also be a potential danger, sepsis being the condition where the bloodstream becomes infected. That simple little tooth abscess has a potential for being life-threatening if not treated in time.

It should be mentioned that cavities are not the only things that might lead to a periapical abscess. An imperfectly performed root canal procedure could open the door to infection, as could an injury to the tooth. Most of the time, however, it’s a cavity that’s to blame.


Treating A Periapical Abscess


The treatment given for this type of an abscess will vary somewhat in accordance with the severity of the infection, but it usually consists of three steps. First, an attempt will be made to try to stop the infection, which can often be accomplished through the use of antibiotics. Second, an attempt will be made to try to save the tooth by means of a root canal procedure. The third step, if necessary, is to prevent complications, which could consist of surgically draining the abscess, removing the tooth if necessary, and dealing with any infection that has spread beyond the tooth, as well as taking steps to heal those bodily tissues that may have become damaged.


The pain caused by a periapical abscess may not seem to be all that different from the pain caused by any other tooth problem. The right approach of course is to see your dentist whenever you have a toothache, or even suspect that you may have a tooth problem of some sort. You may save yourself some added discomfort, save a tooth, or even save your own life by doing so.