Gingival suppuration
In September 2016, I felt discomfort in my upper left second molar, which had undergone root canal treatment five years prior and had been crowned for about three years.
After an examination by the dentist, a suspected root fracture was identified.
Following a cleaning procedure, I experienced no pain for about six months, although occasionally a dental abscess would develop on the inside.
Eventually, the abscess grew significantly on the outside.
After undergoing drainage treatment at the clinic, a 3D CT scan was performed, and I was advised to be referred to a hospital for an apicoectomy on April 17, 2017.
Since the surgery, the abscess has not reappeared, but I still notice a small amount of pus when pressure is applied to the gum.
During several follow-up visits, the doctor has stated that recovery is going well and that further cleaning is the only option.
What could be the cause of this issue?
Cai Xiaojie, 40~49 year old female. Ask Date: 2017/08/08
Dr. Huang Tingfang reply Dentistry
Dear Ms.
Tsai,
Hello! As mentioned, the tooth root may have a vertical fracture.
It can be difficult to detect in the early stages on X-rays, and if it becomes more severe, extraction may be necessary.
Please communicate frequently with your dentist.
Thank you! Wishing you well!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry
Reply Date: 2017/08/08
More Info
A gum abscess, also known as a dental abscess, is a localized collection of pus that can occur in the gums or around the roots of teeth. It is typically caused by a bacterial infection, which can arise from various factors such as untreated tooth decay, gum disease, or a previous dental procedure that may have led to complications, such as a root fracture or incomplete root canal treatment.
In your case, it seems that the discomfort in your left upper second molar, which had undergone root canal treatment five years ago, may have been due to a fracture in the tooth root. This could have allowed bacteria to enter the tooth and surrounding tissues, leading to an infection and the formation of an abscess. The fact that you experienced intermittent discomfort and the development of a dental bump (or abscess) indicates that the infection was not fully resolved.
After the initial cleaning and treatment, it is not uncommon for an abscess to recur or for pus to continue to form, especially if the underlying cause, such as a fractured root or residual infection, has not been completely addressed. The fact that you underwent an apicoectomy (root-end surgery) suggests that your dentist was trying to remove the infected tissue and seal the root tip to prevent further infection. While this procedure can be effective, it does not guarantee that all bacteria are eliminated, especially if there are complications such as a persistent infection or if the tooth structure is compromised.
The presence of pus when you apply pressure to the gum area indicates that there may still be some infection or inflammation present. This could be due to several reasons:
1. Incomplete Healing: Sometimes, the surgical site may not heal completely, allowing bacteria to persist and cause ongoing issues.
2. Residual Infection: If the infection was extensive or if there were multiple canals in the tooth that were not adequately treated, it could lead to ongoing problems.
3. Gum Disease: If there is underlying gum disease, it can contribute to the formation of abscesses and may require additional treatment.
4. Fractured Tooth: If the root fracture is still present, it may continue to harbor bacteria, leading to recurrent abscess formation.
In terms of treatment, it is essential to follow your dentist's recommendations for cleaning and monitoring the area. If the pus continues to form or if you experience pain, swelling, or other symptoms, it may be necessary to revisit your dentist or seek a second opinion from an oral surgeon or periodontist. They may recommend further imaging studies, such as a 3D cone beam CT scan, to assess the situation more thoroughly.
Recovery from a gum abscess can vary depending on the severity of the infection and the effectiveness of the treatment. In many cases, with appropriate dental care, the infection can be resolved, and the gum tissue can heal. However, if the underlying issues are not addressed, there may be a risk of recurrence.
In summary, while your initial treatment may have alleviated some symptoms, the ongoing presence of pus suggests that further evaluation and possibly additional treatment may be necessary to fully resolve the issue. Regular dental check-ups and maintaining good oral hygiene are crucial in preventing future complications. If you have concerns about your recovery or the effectiveness of your current treatment plan, do not hesitate to discuss them with your dentist.
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