Consider this scenario, you go to your dentist for a routine exam and find out that you have an abscessed tooth. This is hard to believe considering you don’t feel any pain and your tooth looks normal on the outside. Seeking a second opinion, you go to another dentist who confirms what your dentist told you is true.
A tooth abscess can be seen on a periapical x-ray. These are typically done once every five years for patients who have healthy teeth with a low risk profile, and show the whole tooth from the crown to the root where the tooth attaches to the jaw.
How to diagnose a tooth abscess
In healthy teeth, there is a blood vessel, a nerve and a lymph vessel. When the tooth dies, there is no longer blood flow or nerve activity – all that is left is bacteria. It’s not causing pain, but it’s a part of your body that is now producing bacteria and could affect your overall health.
A tooth abscess, or dead tooth, is easy to identify on a periapical x-ray. The tooth will have a dark circle at the end of the root, which is called a periapical radiolucency. This can range from the size of a chickpea to the size of a postage stamp. Your dentist should be able to show you this on the x-ray to confirm the diagnosis.
Treatment options for a tooth abscess
The best way to treat a tooth abscess is a root canal. During a root canal, your dentist will drill a small hole in the tooth to remove the bacteria. The area will then be filled and a filling or crown will be placed to restore the tooth’s structure.
However, discussing treatment options for a dead tooth that is not causing pain is a sophisticated conversation. Patients want to avoid tooth pain, but because this doesn’t hurt there isn’t always an urgency to address the problem.
Keeping in mind that patients have many factors that impact dental care – such as time, fear and money – I like to present them with three options.
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1. Do nothing and monitor the tooth.
If the patient isn’t ready to treat this tooth, or there are other factors influencing their decision, I recommend that we do another periapical x-ray at their six-month cleaning. With this x-ray, we are looking to see if the lesion has grown. If it’s grown at all over the last six months, I’ll recommend that we schedule a root canal.
If it’s the same size, there’s a chance that the lesion is dormant. This doesn’t mean the bacteria has gone away. It is still there, but is not getting any bigger. However, your immune system is still policing this tooth, which can be detrimental to your health long-term.
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2. Wait to see if a fistula develops
The second option is riskier. If, after the second periapical x-ray, the lesion has not grown or the patient is still not ready for a root canal, we will wait to see if a blister – or fistula – develops. A dental fistula is essentially a pathway that develops under the gumline to drain bacteria from the tooth abscess.
This may seem like a good thing. However, it comes at the expense of your jaw bone. The patient may still not be experiencing any pain, but the fistula can eat away at your jaw bone. At this point, a root canal is no longer an option and an implant will need to be placed if there is enough jaw bone left.
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3. Perform a root canal
With both of the above options, a root canal will eventually be needed. It’s just a matter of when. If you are not a risk adverse person, I’d recommend getting the root canal now and avoiding possible complications from a fistula.
I always tell my patients that the sooner we treat something, the more predictable and less costly it will be. Putting off dental procedures will never make them cost less, or produce less fear. If anything, it makes them more invasive and costlier.
If you’ve recently been diagnosed with a tooth abscess, it’s important to understand your options and make an educated treatment decision. Aren’t sure where to start? Contact us today to schedule an appointment.
