Periapical Abscess

Question: What is a periapical abscess and how is it treated?

Explanation: A periapical abscess is a collection of pus at the tip of a tooth root, caused by bacteria from a necrotic pulp escaping into the surrounding bone. It presents with severe pain on biting, a feeling that the tooth is raised, tenderness to touch, and often swelling. Radiographs show a dark radiolucency at the root apex. Treatment requires draining the pus and removing the source, either by opening the tooth for root canal treatment or by extraction. Antibiotics alone are inadequate, as they do not sterilise the necrotic canal.

Related Questions:

Why does the tooth feel taller with a periapical abscess?

Inflammatory exudate accumulates in the periodontal ligament space at the root tip, physically extruding the tooth by a fraction of a millimetre. That is enough for it to contact the opposing tooth first, producing the sensation of a high or raised tooth and pain on biting.

Can a periapical abscess drain by itself?

Sometimes it perforates the bone and gum, forming a sinus tract or gum boil. Pain then reduces dramatically because the pressure is relieved. The infection has not resolved, it has merely found an outlet. Untreated, it persists and slowly destroys bone.

Do I need antibiotics for a periapical abscess?

Only if there is spreading infection, systemic upset, fever, or the drainage cannot be achieved immediately. A localised abscess drained through the tooth needs no antibiotics. Prescribing them instead of draining is a common error that prolongs the infection.