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Periapical Abscess

Localized purulent infection at the root apex of a non-vital tooth, often resulting from untreated pulpitis.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ağız ve Diş Sağlığı department. Book Appointment →

What is Periapical Abscess?

Periapical abscess (apical abscess) is a localized collection of pus at the apex of a tooth root caused by bacterial infection extending from a necrotic pulp into the periapical tissues. It is a sequela of untreated pulpitis, dental trauma or failed endodontic therapy. The polymicrobial infection involves anaerobes (Prevotella, Porphyromonas, Fusobacterium) and facultative streptococci.

Acute (acute apical abscess) presents with severe spontaneous tooth pain, exquisite tenderness to percussion, swelling, fever and possibly extraoral facial swelling. Chronic (chronic apical abscess) is typically asymptomatic with intermittent drainage through a sinus tract (parulis or gum boil). Untreated abscesses can spread to fascial spaces causing cellulitis, Ludwig angina, cavernous sinus thrombosis or sepsis.

Symptoms

Severe spontaneous tooth pain (acute)
Exquisite pain on biting or percussion
Tooth feels elevated in socket
Localized swelling of gum
Pus discharge from gum (sinus tract)
Facial swelling (cellulitis development)
Fever, malaise, lymphadenopathy
Chronic dull ache with intermittent flare-ups
Bad taste in mouth from drainage

Risk Factors

Untreated dental caries
Tooth fracture or trauma
Failed root canal treatment
Cracked tooth syndrome
Periodontal disease with retrograde infection
Poor oral hygiene
Diabetes mellitus
Immunosuppression
Bruxism causing tooth fracture

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe throbbing tooth pain
  • Tooth pain with facial swelling
  • Fever with dental pain (emergency)
  • Difficulty opening mouth or swallowing
  • Eye swelling near upper teeth
  • Pus drainage from gum
  • Persistent dental pain

Treatment Methods

01
Clinical examination including percussion, palpation
02
Vitality testing showing necrotic tooth
03
Periapical radiograph or CBCT showing apical lucency
04
Drainage through tooth (access opening) or incision and drainage
05
Pus culture only in severe or refractory cases
06
Antibiotics: amoxicillin or amoxicillin-clavulanate first-line
07
Penicillin-allergic: clindamycin
08
Add metronidazole for severe anaerobic infection
09
Definitive root canal treatment (RCT) preferred
10
Apicoectomy for failed RCT or anatomical challenges
11
Tooth extraction if non-restorable
12
Pain management with NSAIDs (ibuprofen)
13
Hospital admission for facial cellulitis or systemic toxicity

Which Department to Visit?

You can visit our Ağız ve Diş Sağlığı department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Ağız ve Diş Sağlığı Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.