Dental Cavities and Abscess

Dental Cavities and Abscess

The teeth gums and the circulatory system to the teeth and gums are an extremely important part of our health. The circulatory system brings arterial blood into the central base of the jaw. Branches of the arteries puncture the tips of the teeth at the roots and go up into the central area of the crown of the tooth and form a large ball plexus of blood vessels deep in the crown of the tooth and these arteries supply nutrients to the tooth to grow and continue healthy. The veins drain the arteries and remove waste products and CO2 from the tooth down the tooth, out the tips, and out to the veins and into the main circulatory system where the blood eventually reaches the lungs where it is oxygenated and ready to be re-circulated over and over again.

The tooth has a crown covered in enamel that is usually white in color and covers the tooth to just below the gum line. Underneath the enamel is the dentin, which is a more brownish color, supports spongy tissue, and forms the infrastructure of the tooth. Inside that is the vascular cavity for the arteries and veins. Teeth may have one root, as front teeth, or three four five as the incisors, or six as in molars. The teeth are held in the bone by tiny hairs that go from the root to the bone in the bone socket in the tooth.

When we eat, we crush food with our teeth and mix it with saliva beginning the digestion process. Most of this food is swallowed for digestion; however, very small particles of food can be left between the teeth pressed in between the gum line and the tooth or be stuck in the teeth themselves. The white enamel is somewhat porous like a sponge, and bacteria, more specifically, stapth mutulans, populate the gum line and these little sponge like holes in the enamel. The bacteria eat the food and excrete acid that actually damages the enamel and starts to form small cavities in the enamel.

A dentist recognizes these and likely grinds them off. For deeper holes they may deeply grind and place a filling to stop this process. However these fillings eventually leak at the margins with the bacteria and acid once again attacking the protective enamel coating. The dentist again drills out the filling and the decayed tooth filling it and this process can be repeated several times. Eventually the bacteria get in these marginal seals of the filling and eat their way down with the acid into the vascular cavity. This is when the real trouble starts. Usually you don’t feel anything at this point. The bacteria spread forming pus and destroying the vasculature forming more and more pus. You may, at this time, feel minimal twinges of pain but most people feel nothing. The pus pushes its way down the root and finally exits the tip of the root and a pus ball or abscess forms there and enlarges very quickly. This is when the real pain starts. The pus exits the tip of the root and puts pressure and destroys the bone. This pressure and infection in the bone is what causes the abscess and the pain.

We can help you with pain medications and antibiotics that will kill or severely retard the infection at the tip of the root and give you tremendous relief. You will feel better quickly. However this does not solve the problem. You must get to a dentist and at this point they must either pull the tooth or drill a hole at the top of the tooth and put very fine dental files down the tip of the tooth to drain the pus; alternatively they may use very fine drills to drill to the bottom and drain the pus. Often, the dentist will put you on antibiotics and pain medication to kill of the infection as we would and get this under control first. So a medical doctor, like the dentist, can help control the infection before doing the necessary surgery be it a root canal or extraction.

After the root canal the dentist will place you on antibiotics, give you an antibiotic mouthwash to flush down the root and put a temporary filling. This will let the pus wick up and out of the tooth for several days or a week. They will then go back and place a rubber called gutta purcha rubber cone into the tooth root and seal it with electric cautery, this is done after the infection is totally controlled. They may then ground down the crown of the tooth take an impression and put on a crown. This will usually take about a week to make sure the tooth is healed. They then return with either an enamel or gold crown and replace the top of the tooth and this often lasts many many years.

While we are not dentists we help you control immediately the pain and infection and you may then be referred to a dentist to get the proper surgical intervention. Using certain dental prescription mouthwashes or even Listerine can significantly decrease the bacterial content in your mouth. Electric toothbrushes which actually scrub and push deep into the pockets of the teeth cleaning bacteria and food are a tremendous help. Your probably wondering when you go to the dentist what they mean when they say you have a two or a three or an eight pocket. What he is actually doing is taking a dental probe with a 90degree angle and pressing down in the teeth and measuring depth. One, two, and maybe three depth pockets are good. Four and five are questionable. Six, seven, eight are holding so much bacteria and debris you may have to go back to a periodontist to cut back your gums. The more you use antibiotics, prescription mouthwash, and electric brush making sure to clean these gingival pockets for two to three minutes twice a day, the better your dental health will be. Using the electric toothbrush and prescription mouthwash cannot be understated when preventing this problem.

John Laurusonis, MD
Doctors Medical Center
770-232-1101