An Abscess

One of the most painful dental conditions is an abcess. The pain is caused by the pressure build up of pus at the base of the tooth. This pushes the tooth up from the socket and may make the tooth feel high when biting.

How an abcess forms
Our body fights disease with our immune system. The cells which fight bacteria travel around in the blood and use the blood vessels as a type of highway. The problem arises when a tooth becomes infected as the only large blood vessels enter through a small hole at the tip of the root.
When the pulp has died no blood can enter the inside of the tooth, therefore the bodies cells can't enter the tooth and kill any bacteria. The tooth acts as a reservoir of bacteria which breed and leak out of the end of the tooth to produce toothache.

Bacteria

 

For this reason the endodontist must open the tooth and clean the inside with instruments and disinfectants. When the nerve in a tooth becomes infected and dies your endodontist must clean the inside of the tooth to prevent an abcess forming. The endodontist needs to drill a hole in the top of the tooth which will allow him access to the nerve chamber.

A healthy tooth contains a living nerve which is supplied by blood vessels which enter via the apex of the root.

Healthy Tooth

The space between the bone and the tooth is roughly the same along the whole length of the root. The periodontal ligament is found here.

Early Apical Change


Once the bacteria have started to kill the nerve the body reacts with an inflammatory reaction which may extend to the tip of the root.

Granuloma

The body attempts to wall off the bacteria by forming inflammatory tissue at the tip of the root.

 

Abcess Formation

Once the bacteria take hold the body continues to wall them in by forming a capsule around them. This can be extremely painful as then capsule contains pus which is under pressure. This force the tooth up in the socket and the tooth feels high and pain occurs when the patient bites on it.