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Can a dental abscess be treated with antibiotics and draining alone?

A

Axelle

Junior member
Joined
Nov 29, 2022
Messages
1
Location
USA
Hi all,

I was referred to an Endodontist from my regular dentist, after I went in because I was having cold sensitivity and pain in tooth #14, which has an old filling that is around 8 years old. The dentist took X-rays and didn't see anything, and on examination neither did the Endodontist. He then did a CBCT, and found an abscess at the root of the tooth. I asked if he could tell what caused the abscess, since the tooth doesn't have any issues that either the Endodontist or dentist could see, and he said it might be a leaky filling but couldn't say for sure. My questions is this: he wants to do a root canal to take care of the abscess. I'm leery of being stuck in a chair for an hour and a half and going through this entire procedure, and wanted to know why this is the default treatment for a root abscess when there's nothing wrong with the tooth? Honestly I'd prefer to have the dentist redo the filling if it's a problem, and stick a needle into my gum where the abscess is and drain it and give me antibiotics. Why isn't this an option?
 
Gordon

Gordon

Administrator
Staff member
Verified dentist
Joined
Oct 25, 2005
Messages
7,985
I'd prefer to have the dentist redo the filling if it's a problem, and stick a needle into my gum where the abscess is and drain it and give me antibiotics. Why isn't this an option?
Short answer, because it doesn't work.

Long answer. For an abscess to form the "nerve" inside the tooth is dead. This "nerve" is actually a mix of nerve fibres and blood vessels. The blood vessels are the important bit. The proper name for it is the pulp.

After the pulp dies off, for whatever reason, bacteria can get in and set up home, happily munching on all that nice dead bundle.

Without a blood supply your body can't do anything about them, no immune response and no white cells can get in there.
After a while the bacteria start to spill out of the nerve space and into the small gap between the tooth and the bone. At this point your body will throw in a bunch of white cells and attacks the bacteria.

Sometimes the bacteria are too fast growing and sturdy and they overwhelm the defence or else the defending tissues aren't at their best and you get a lot of swelling and pain. An "acute" infection.

Other times the defences can hold things up but they can't actually get to the origin of the bacteria so you get a state of constant low level warfare, kind of like between North and South Korea :) A "chronic" infection. A chronic infection can turn acute if a new more aggressive bacteria move into the pulp space or if the host defences get weakened for some reason.

Antibiotics won't make a long term difference because there's no blood flow to transport them to the infected area. They will help in an acute infection to help tip the balance towards the defence but will simply push things over into a chronic infection for a while.

Root canal treatment attempts to remove the dead pulp tissue, disinfect the root canals and block up the space to prevent new bacteria getting in.
 
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