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Why can you have an abscess without symptoms of infection?

M

MountainMama

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Joined
Jul 1, 2018
Messages
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Sorry of this is an obvious question, but it has been keeping me up at night.

Since I discovered that I had this huge abscess that has been likely brewing for up to 2 years, according to the endodontist, why did I have no symptoms until recently?

With that, now that I have had an apicoectomy to get rid of lingering infection, how will I know if the infection is gone, or if it returns? I had no symptoms until it got huge. I even had two blood tests done this summer and fall, to check for infection and nothing was abnormal.

My endodontist did not prescribe antibiotics, because I have had so many this year, but she said to call if I have swelling or fever. I never had those the first time, so how will I know?

Sorry, having a bit of a panic attack that the infection isn't gone, and second guessing turning down the antibiotics.
 
Hi MountainMama,

It is possible to have abscesses for years without having any symptoms. Your immune system tries to contain the infection, and if it is winning, you have no symptoms. If something changes, say you get run down, stressed or get some other illness that suppresses your immune system, then the infection gets the upper hand and you start to get symptoms.
If the apicectomy fails, you may or may not get symptoms just like with the original infection. However, now that your dentist is aware of the problem, he or she may well take an x-ray every now and again to monitor the situation.
Don't worry about the antibiotics, they should not be needed if the apicectomy has worked.

Hope that helps a bit

Lincoln
 
Hi MountainMama,

It is possible to have abscesses for years without having any symptoms. Your immune system tries to contain the infection, and if it is winning, you have no symptoms. If something changes, say you get run down, stressed or get some other illness that suppresses your immune system, then the infection gets the upper hand and you start to get symptoms.
If the apicectomy fails, you may or may not get symptoms just like with the original infection. However, now that your dentist is aware of the problem, he or she may well take an x-ray every now and again to monitor the situation.
Don't worry about the antibiotics, they should not be needed if the apicectomy has worked.

Hope that helps a bit

Lincoln

Yes, thank you! That helps a lot to know the antibiotics are not needed. I am in the midst of changing dentists, as my dentist left the practice before I had the apicoectomy. So I have not yet visited with the new dentist. I have met him, as he was the partner in the practice, but he hasn't treated me. So I am somewhat anxious about finishing treatment with him as well.

Sounds like I need to make sure I do my best to keep my immune system healthy as well.
 
Great question and answer. I’ve wondered and worry as well. I do know, as you do, that it will become obvious if the infection flares and your immune system looses ? bit unsettling to know this happens though
 
Great question and answer. I’ve wondered and worry as well. I do know, as you do, that it will become obvious if the infection flares and your immune system looses ? bit unsettling to know this happens though

Yes, I do not want it to get to the point where it has spread! That is a scary prospect. It is scary enough knowing that it is there, and that it may not be gone with treatment, as you well know. The next step for me would be losing my front tooth.
 
I’m keeping my fingers crossed for you that all will heal well and the infection is gone! I understand how stressful it feels though to wonder how you will know if it’s worked or not. And it’s curious that it didn’t show up on an xray. That makes me nervous that all kinds of things could be going wrong with my teeth and not be seen by the dentist with xrays and then not treated! I have had several cone beam scans - the endodontist never went over them in depth with me (which I wish he had), but he did say no signs of infection were seen. Glad your apico went better this time! :)
 
I’m keeping my fingers crossed for you that all will heal well and the infection is gone! I understand how stressful it feels though to wonder how you will know if it’s worked or not. And it’s curious that it didn’t show up on an xray. That makes me nervous that all kinds of things could be going wrong with my teeth and not be seen by the dentist with xrays and then not treated! I have had several cone beam scans - the endodontist never went over them in depth with me (which I wish he had), but he did say no signs of infection were seen. Glad your apico went better this time! :)

Thanks! I realized this morning that they never scheduled a follow-up appointment, and I would feel better with one, so I am going to call today and see about scheduling one. I am healing well, but last night I had pain behind the tooth again, and even though the swelling has gone away at the surgery site, there is swelling that comes and goes right behind both front teeth...just a small amount but it is sore when it swells.

I do want to clarify that the abscess itself showed up on the x ray, just not that it tunneled behind my tooth, so it appeared smaller on the x ray than it actually was.
 
Yes, I do not want it to get to the point where it has spread! That is a scary prospect. It is scary enough knowing that it is there, and that it may not be gone with treatment, as you well know. The next step for me would be losing my front tooth.
Logic says that the treatment will have reduced the infection and hopefully cured it. So I think a spread at this point unlikely ??
 
Logic says that the treatment will have reduced the infection and hopefully cured it. So I think a spread at this point unlikely ??
I hope so. So far my teeth have gone against all logic and have perplexed my dentist and endodontist with the way they have reacted to things. The endodontist seemed very confident though, which helps.

I did call this morning just to confirm that the things I have been feeling are normal, and was reassured that they are. She said to call back in a week if the swelling behind my tooth is still there, or if the pain gets worse.
 
@drhirst As an addition to this question. I wonder if all infection is seen on standard X-rays? My dentist used bitewing I think, digital onto his computer. I go every six months but X-rays usually only every two years.

The very large infection I am hopefully coming to the end of resolving didn't show up on the first xray he took when I first had symptoms, he took a second at a different angle and there it was, looking like it came from one tooth up above the roots of two and lots of bone loss between them. He did offer a more expensive xray at one point but we didn't do that and still says the xray was misleading,

I guess I might fear something being missed again because I lost a tooth in the end and maybe another one, but hopefully not. This infection could have been there years..... or just bad luck and a virulent infection. One tooth was root filled and frowned many years ago and in the past had gum pockets, so not in tip top condition.

I'm curious. Maybe X-rays don't show infection that well and symptoms are what guides you mostly. I do know he's seen very small amounts of black at roots in the past and mentions that.
 
Sally, you know I had the same issue, with infection going on for years, and forming an abscess undetected. This is a great question and I am curious about the answer as well. I got x rays once a year, and I noticed that on my x rays (bite wing and panoramic) my front teeth do not show up. There are streaks of shadowing on them, obscuring the front four teeth. I am guessing that is why mine went undetected.
I know the angle makes a huge difference. With the typical x ray, my dentist thought the abscess was mostly right over the tooth and encroaching on the incisor. The endodontist was originally just going to take a regular x ray, but then decided to do the CBCT (the more expensive one). It showed that the abscess was more behind the tooth than above and much, much bigger! The endodontist said she was glad she took the CBCT because she wouldn't have gone in so deep, and hadn't planned to numb the palate. So the type of x ray can make a big difference.
 
@drhirst As an addition to this question. I wonder if all infection is seen on standard X-rays? My dentist used bitewing I think, digital onto his computer. I go every six months but X-rays usually only every two years.


I'm curious. Maybe X-rays don't show infection that well and symptoms are what guides you mostly. I do know he's seen very small amounts of black at roots in the past and mentions that.


Hi SallyUK,
X-rays do not always show infection. Sometimes, it is the angle the x-ray is taken at that allows it to hide. Also, sometimes the infection has not yet softened enough of the bone to make a darkening on the x-ray. So, they are just another part of the jig saw and the diagnosis of infection is made by a combination of x-ray appearance, signs, symptoms, visual appearance of the area, vitality tests, mobility tests and the patients description.
It is important to consider the risks of a tiny dose of radiation against the benefits of more precise diagnosis when considering how often to take x-rays. I would say your dentist has got it about right.

Lincoln
 
Sorry of this is an obvious question, but it has been keeping me up at night.

Since I discovered that I had this huge abscess that has been likely brewing for up to 2 years, according to the endodontist, why did I have no symptoms until recently?

With that, now that I have had an apicoectomy to get rid of lingering infection, how will I know if the infection is gone, or if it returns? I had no symptoms until it got huge. I even had two blood tests done this summer and fall, to check for infection and nothing was abnormal.

My endodontist did not prescribe antibiotics, because I have had so many this year, but she said to call if I have swelling or fever. I never had those the first time, so how will I know?

Sorry, having a bit of a panic attack that the infection isn't gone, and second guessing turning down the antibiotics.
Hi! So this actually happened to me. I had a front tooth that was damaged in a childhood accident. It was root canalled and crowned. Over time I developed a bubble over the tooth. No pain just the bubble. Oral Surgeon said it was infection and did apicoectomy. Bubble ended up coming back and then eventually turned into a hard lump. Oral Surgeon had to extract the tooth as he said the infection came back. So in my case, yes there was an abscess without pain.
 
Hi! So this actually happened to me. I had a front tooth that was damaged in a childhood accident. It was root canalled and crowned. Over time I developed a bubble over the tooth. No pain just the bubble. Oral Surgeon said it was infection and did apicoectomy. Bubble ended up coming back and then eventually turned into a hard lump. Oral Surgeon had to extract the tooth as he said the infection came back. So in my case, yes there was an abscess without pain.

Yikes! Very similar story. Mine was damaged as a child, but never treated. It apparently died without any pain or symptoms, and developed an enormous infection and abscess. I don't know how I went 30 years with a dead or dying tooth, and had no symptoms, and no discoloration of my tooth. It is just so strange. I still have my tooth in, and recently had a round of clindamycin, which took away the pressure pain. I still have pain in the gums, though.
 
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