Is it OK if an abscess does not completely go down after a root canal, and is it OK to leave the abscess in there?

[Annie364]

I had a large undiscovered abscess tucked away around the roots of the molar UR6 for over 10 years, and then it was found and the tooth was root canalled.

The abscess has been very slow to go down, maybe because of how long the infection had been in there before discovery.

I had a scan in 2021 before the root canal was done by a good endo, then another scan a year after the root canal in 2022, and another scan 4 years after the root canal in 2025.

This image shows the slow healing with comparisons between the CBCT scans done in 2021-2022, 2022-2025, and two images just of 2025. The tooth causing the issue is UR6 and I marked it with a red dot:

Tooth3 hosted at ImgBB

Image Tooth3 in Mi-6-omni's images album

ibb.co

My new dentist said that the reduction in the radiotranslucency from 2022 to 2025 is likely to be bone remodelling rather than the chronic infection going down. We recently did a partial retreatment on just one section of the root canal (and no missed canal was found) and we are waiting before re-scanning it, and there is an option for an apicectomy in the future, but if I hadn't asked for a scan in 2025, the abscess would have been left as-is.

I'm really unsure about what is considered OK by dentists in terms of abscesses. I hear that tooth infections can result in bacterial endocarditis to the heart for example.

Is it generally considered safe or OK in terms of whole body health to leave an abscess around a root canalled tooth like it is in my 2025 scan images forever, as long as the patient is not in pain?

I don't know if the abscess in the 2025 scan could be impacting my overall health, or if the bacteria from it could cause a problem elsewhere in my body in the future - is this generally thought to be a concern?

Thank you very much.

 

[Gordon]

I'm really unsure about what is considered OK by dentists in terms of abscesses. I hear that tooth infections can result in bacterial endocarditis to the heart for example.

It's a judgement call. There's always the risk that the abscess will "blow up" and cause a bit of pain and or swelling at some undetermined and usually extremely inconvenient time in the future.

Bacterial endocarditis is a problem for somebody with pre-existing heart valve damage. If this isn't you then it's not an issue.

Is it generally considered safe or OK in terms of whole body health to leave an abscess around a root canalled tooth like it is in my 2025 scan images forever, as long as the patient is not in pain?

Same question. It's a judgement call.

I don't know if the abscess in the 2025 scan could be impacting my overall health, or if the bacteria from it could cause a problem elsewhere in my body in the future - is this generally thought to be a concern?

Not really; oral bacteria are fairly delicate wee beasties and easy prey for a functional immune system. They don't cause wider issues unless the host's immune system is compromised.

From those films this looks like it might be a perio-endo lesion, where there's a connection between a periodontal pocket and the abscess, so the area keeps getting re-infected from the oral cavity.

Hard to tell without some more x-rays though so don't take my word for it! Has a periodontist had a look?

 

[Annie364]

OK thank you ever so much Gordon, that does set my mind at rest a lot.

I don't have any pre-exisiting heart valve damage or heart problems.

My main concern was that if this chronic infection is in there potentially forever, it could then result in ongoing health problems like feeling unwell/low energy/malaise but without knowing that the actual cause is the chronic infection around the root canal. I was imagining it would be like having say a chronically infected boil on your leg or something and if it couldn't be resolved and was left there, it could well output bacterial endotoxin or actual bacteria and affect someone's health. Or like a bone infection elsewhere in the body like osteonecrosis which would have to be treated and got rid of. So my ongoing gum/bone abscess is not something I need to be concerned about like that?

And from what you are saying, the judgement call is just in terms of the local area? ie. that in the future it could blow up locally around that tooth and cause pain/swelling in that area. That doesn't concern me as much, because at least it would be obvious from the pain/swelling if that problem appeared and action could then be taken to resolve that issue.

A periodontist hasn't had a look but my endodontist did look at the gum. I don't think it's a perio-endo lesion because it's always been fine on the outside over the years during the slow healing. Only in the past 6 months the gum is a bit sore at times but the endo thought this was due to the infection from the inside spreading outwards through the gum a bit, and he said if the infection inside clears up, the occasional gum soreness will also go away. I do keep my oral cavity really clean as well.

Do you think I can have a hope that this abscess still might carry on healing and eventually resolve itself completely?

 

[Gordon]

So my ongoing gum/bone abscess is not something I need to be concerned about like that?

No. Bacterial infections elsewhere on your body would likely not contain oral bacteria.

That doesn't concern me as much, because at least it would be obvious from the pain/swelling if that problem appeared and action could then be taken to resolve that issue.

Yes. It's just a question of how inconvenient it would be if it flared up badly. Xmas morning for instance. Or on a flight to Uzbekistan (I've no personal knowledge of the state of dentistry in Uzbekistan, just a handy example)

Do you think I can have a hope that this abscess still might carry on healing and eventually resolve itself completely?

There's always hope