Gum Abscesses: When to Consider Tooth Extraction and Implants

Gum abscess. Thank you?

I have a question about the second to last tooth on the lower left side (which I had a dental implant for over four years ago).
About a month ago, I noticed a swelling on the outer gum with a pus-filled bump that is completely painless.
When I poke it, it bleeds.
Dentist A took an X-ray and found that the tooth itself is fine, but there is a dark shadow under the left root, which is likely an abscess.
The pus is traveling up along the root, causing inflammation of the outer gum.
The recommendation is to extract the tooth and proceed with an implant.
Even if I take antibiotics and the abscess resolves, the issue will still be there, so it’s better to get the implant now while there is no pain.
This way, I might not need bone grafting, and the procedure would be simpler.
Dentist B also took an X-ray, and the tooth appears fine with no dark shadow (due to the equipment being somewhat outdated).
They suspect that the dental implant may have a crack, leading to a bacterial infection, which is causing the gum inflammation.
Since the antibiotics haven’t resolved the issue, extraction and implant placement are necessary.
My question is, since my tooth doesn’t hurt, is it possible that the abscess under the root will not heal? Is it really worth extracting a healthy root? Moreover, dental implants are so expensive; is there no other option? Thank you.

lin, 20~29 year old female. Ask Date: 2012/11/07

Dr. Cui Chongji reply Dentistry

The presence of an abscess indicates an infection, and the underlying cause should be identified and treated.
There are contradictions between A and B in the literature, so it is advisable to consult a third dental clinic for their opinion.
P.S.
Our dental clinic hours in November are every Monday and Wednesday from 2 PM to 4 PM, and Tuesday, Wednesday, and Thursday from 8:30 AM to 11:30 AM.

Reply Date: 2012/11/07

More Info

When dealing with a gum abscess, especially in the context of a tooth that has previously been treated with a dental crown or implant, it is essential to understand the underlying causes and the potential treatment options available. In your case, the presence of a gum abscess, which is characterized by swelling and the formation of a pus-filled pocket, indicates an infection that can stem from various sources, including untreated decay, a failed root canal, or a crack in the tooth or crown.

The fact that your lower left second-to-last tooth has developed a gum abscess, yet you report no pain, is somewhat unusual. Typically, an abscess is associated with discomfort, but it is possible for some individuals to experience minimal symptoms, especially if the infection is localized and not severe. However, the absence of pain does not mean that the infection is not present or that it will resolve on its own.

In your situation, two dentists have provided differing opinions regarding the management of the abscess and the tooth in question. Dentist A suggests that the tooth should be extracted and replaced with an implant, especially since there is a visible black shadow on the X-ray indicating a possible abscess at the root. On the other hand, Dentist B believes that the tooth itself appears healthy and that the abscess may be due to a crack in the crown, which could potentially be treated without extraction.

Here are some considerations to help you make an informed decision:
1. Diagnosis Confirmation: It is crucial to have a definitive diagnosis. If possible, seek a third opinion from a dental specialist, such as an endodontist (root canal specialist) or an oral surgeon. They may recommend a more advanced imaging technique, such as a cone beam CT scan, to get a clearer picture of the tooth's condition and the surrounding bone.

2. Treatment Options: If the tooth root is indeed healthy and the abscess is due to a crown issue, it may be possible to replace the crown or perform a root canal retreatment if the root canal was previously done. However, if the tooth is deemed non-restorable due to significant decay or structural failure, extraction may be necessary.

3. Timing of Extraction and Implant Placement: If extraction is necessary, the timing of implant placement can vary. In some cases, immediate implant placement can be performed if the extraction site is healthy and free of infection. However, if there is significant infection or bone loss, it may be advisable to allow the area to heal before placing an implant.

4. Cost Considerations: Dental implants can be expensive, and it is understandable to be concerned about the financial implications. Discuss with your dentist the possibility of alternative treatments, such as a bridge or partial denture, which may be less costly than an implant.

5. Monitoring and Follow-Up: If you choose to monitor the situation rather than proceed with extraction immediately, ensure regular follow-up appointments to assess the condition of the abscess and the tooth. If symptoms worsen or new symptoms develop, prompt treatment will be necessary.

In conclusion, while the presence of a gum abscess is concerning, the decision to extract a tooth should be based on a thorough evaluation of the tooth's health and the underlying cause of the abscess. It is essential to communicate openly with your dental care providers about your concerns and preferences, and to seek additional opinions if needed to ensure you are making the best choice for your dental health.

Similar Q&A

Understanding Dental Abscesses: When to Extract and Consider Implants

In March, I developed a gum abscess next to a molar that had undergone root canal treatment a long time ago. I had also recently stopped taking herbal medicine for body conditioning. At the end of the month, I visited the dentist, who took an X-ray and said that the tooth appeare...

Dr. Lin Jiayong reply Dentistry
Hello: It is recommended that you visit a medical center's dental department for evaluation. A cone-beam CT scan can be performed to confirm whether there is a fracture in the tooth before making a decision about extraction. Additionally, it would be advisable to consult wit...

Managing Gum Abscess After Dental Implant Surgery: Expert Advice

Hello, Doctor: About 6 to 7 years ago, due to the fracture of the root of the original dental crown, it could no longer support the crown. Therefore, the doctor at Taipei Medical University suggested extracting the tooth with the root canal treatment and using bone graft material...

Dr. Chu Boqin reply Dentistry
Hello, Xinxia: Please return to Beihua Hospital for an examination by your original physician. A routine dental implant procedure requires follow-up checks every six months. So don't hesitate, just head north; I believe your issues will be resolved promptly. Thank you for yo...

Understanding Tooth and Gum Issues: When to Consider Dental Implants

There is a molar in the lower left quadrant that underwent root canal treatment and was capped over a decade ago, and it seems a pin was also placed. In the past couple of years, the gums around the tooth have frequently swollen and even caused pain. Some dentists have helped me ...

Dr. Huang Tingfang reply Dentistry
Dear Ms. Chen, Hello! As mentioned, the periodontal condition of this tooth appears to be severe. If extraction is necessary, you may consider options such as removable dentures, fixed prosthetics, or dental implants. Please communicate further with your dentist. Thank you! Wish...

Dealing with Upper Jaw Abscess: Extraction and Implant Options

In recent days, a pus-filled abscess has developed behind my upper right lateral incisor. The tooth itself does not hurt, but touching the abscess causes sharp pain. The lateral incisor had previously been treated for cavities. The dentist indicated that an X-ray shows a large da...

Dr. Huang Tingfang reply Dentistry
Dear Ms. Yu, Hello! I apologize for the late response. Essentially, the tumor is too large and requires surgical excision. If we extract and immediately implant, the risks are higher, and the chance of infection increases. It is safer to wait for bone healing before proceeding w...