Chronic Gum Abscess: Seeking Solutions for Persistent Tooth Pain

Recurrent gum abscesses?

The first molar has been experiencing recurrent abscess pain for several years, with episodes occurring anywhere from every few months to every six months.
Initially, the regular dentist would only perform a cleaning and prescribe medication.
Later, the dentist suggested extraction due to gum recession and exposed tooth roots, stating that the periodontal pockets were quite deep.
If I was unwilling to extract the tooth, I could consider a costly procedure of opening the gums and scraping to remove potential deep calculus, though there was no guarantee of its effectiveness.
Currently, even without noticeable swelling or pain, when I gently press on the gums while brushing at night, a small amount of white-yellow pus is always expelled.

I have consulted several dentists; some advised maintaining good oral hygiene, keeping a regular schedule, and avoiding staying up late.
Others suggested gently squeezing the gums daily and using mouthwash.
One dentist recommended cutting one of the molar roots to facilitate deeper cleaning, as there were small dark spots at the root that might indicate deep-seated debris.
Another dentist indicated that periodontal disease was the cause, leading to alveolar bone loss, and that it wouldn't improve but could only be managed to slow down deterioration.
Additionally, one dentist believed that the issue stemmed from a cavity in the wisdom tooth, which was extracted, but four months later, the first molar is still swollen and painful.

I am unsure what more proactive measures I can take to improve this situation.
I do not want to lose this tooth and would like to save it! Thank you, doctor.

Qiao Qiao, 30~39 year old female. Ask Date: 2018/05/12

Dr. Lin Jiayong reply Dentistry

Due to the inability to observe the actual condition inside the mouth, I cannot provide you with specific advice.
However, if the issue of loose teeth and pus is caused by periodontal disease, a gingival flap surgery may indeed be appropriate for treatment.
If the cause is different, there are other treatment options available.

Reply Date: 2018/05/12

More Info

Chronic gum abscesses can be a persistent and painful issue, often leading to frustration and confusion about the best course of action. Based on your description, it seems you have been dealing with recurrent pain and swelling associated with your first molar for several years. The fact that you have seen multiple dentists and received various recommendations indicates the complexity of your situation.
First, it’s essential to understand that a chronic gum abscess typically arises from an underlying infection, often related to periodontal disease or a failing root canal. The presence of pus, especially when you can express it by applying pressure to the gums, suggests that there is still an active infection or inflammation in the area. This can be exacerbated by factors such as poor oral hygiene, deep periodontal pockets, and possibly even systemic health issues that affect your immune response.

Treatment Options
1. Deep Cleaning (Scaling and Root Planing): This is often the first step in managing periodontal disease. It involves cleaning below the gum line to remove plaque and tartar that contribute to gum disease. If you haven’t had a thorough deep cleaning recently, this could be beneficial.

2. Periodontal Surgery: If your dentist has suggested surgical options, such as flap surgery to access deeper areas of infection, this may be necessary if non-surgical methods fail. This procedure allows for better cleaning and can help reduce pocket depth.

3. Root Canal Treatment: If the tooth has a history of root canal treatment and is still symptomatic, it may require retreatment. This involves cleaning out the canals again and sealing them properly to eliminate any remaining infection.

4. Antibiotics: In some cases, systemic antibiotics may be prescribed to help control the infection, especially if there is significant swelling or if you have systemic health issues.

5. Regular Monitoring: If you choose to keep the tooth, regular dental check-ups are crucial. This allows your dentist to monitor the condition of the tooth and surrounding gums closely.

6. Oral Hygiene Improvement: Maintaining excellent oral hygiene is critical. This includes brushing twice a day, flossing daily, and possibly using an antibacterial mouthwash to help reduce bacteria in the mouth.

7. Lifestyle Modifications: As suggested by some of your dentists, ensuring you have a regular sleep schedule and managing stress can positively impact your overall health and immune response, which can help in fighting infections.

When to Consider Extraction
If the tooth continues to be a source of pain and infection despite aggressive treatment, extraction may become a necessary option. However, it’s understandable that you want to preserve your tooth. If extraction is recommended, discuss the possibility of dental implants or bridges to replace the missing tooth, as these can provide functional and aesthetic benefits.

Seeking a Second Opinion
Given the complexity of your case and the varying opinions you’ve received, it may be worthwhile to seek a consultation with a periodontist, a specialist in gum disease. They can provide a more focused evaluation of your periodontal health and suggest targeted treatments.

Conclusion
Chronic gum abscesses can be challenging to manage, but with the right approach, it is possible to improve your situation. Focus on maintaining good oral hygiene, consider the treatment options available, and don’t hesitate to seek further opinions if you feel uncertain about the recommendations you’ve received. Your goal of saving your tooth is commendable, and with persistence and the right care, it may be achievable.

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