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Dental and Oral Health Center

Jaw pain, abscess treatment

08/03/2007

Question:

I had some left upper gum pain near the cheekbone. The dentist told me he saw a small abscess on the root. This molar is already crowned. He suggested that I have the crown drilled and a root canal done, and then fill the crown. This is about $850.00, but if the crown is damaged in the process, it would be another $800.

I don`t have extra money! I took Keflex for 7 days (500mg qid), but now I feel a little buldging (abcess?) high up on the left upper gum line. I have some discomfort when applying pressure to my cheekbone. Can this possibly be drained without going through the cap? It it possible that the root of the tooth is not involved, but it`s localized in the upper gum line? It would be more cost effective if I just have the tooth pulled, instead of possibly spending $1650, after already spending $800 for the original crown! Please advise. Thank you very much.

Answer:

When a tooth has a periapical abscess, such as you have described, the recommended treatment is to have a root canal done. In most cases, this will solve the problem.

The infection has started in the soft pulpal tissue of the tooth and has progressed out the apex of the root into the periodontal space and bone surrounding the root. This infected soft tissue must be removed and the canals cleaned and sealed or the infection will remain and slowly destroy bone around the tooth.

A root canal is accomplished by accessing the pulpal area of the tooth by preparing an access opening through the occlusal or biting surface of the tooth. If the crown you have on the tooth has a metal occlusal surface, there is little danger of damaging the crown except for the access opening which is easily filled with a permanent filling material after the root canal is finished. In the cases of all ceramic crowns or ceramic fused to metal crowns, there is the danger of ceramic chipping or breaking during the preparation of the access opening. It is possible that this would necessitate the making of a new crown.

You did not state how long the crown had been on the tooth. If the crown has been in place a long time, it is also possible that it could have recurrent decay. This would also necessitate a new crown.

As far as having the tooth removed, it is generally more expensive to replace an extracted tooth than it is to save it. If it is not replaced, there is a danger that teeth behind it could tilt forward and eventually be lost or teeth in the opposing arch can super-erupt causing chewing difficulties and even TMJ problems. It is best to either keep the tooth or replace it after the extraction site has healed.

As far as accessing the abscess through the gum tissue, that is not an option. You can not gain access to the pulpal tissue which must be removed and to the canals which must be filled and sealed unless you access through the occlusal surface.

As far as the infection not being in the tooth but only in the gums, it is not possible. If there is a periapical lesion on the radiograph, the pulpal tissue of the tooth was infected before the gum tissue. The tooth was the source of the soft tissue or gum infection. That is why it is necessary to remove this pulpal tissue from the tooth. Even if you treat this infection with antibiotics like Keflex and the pain and swelling go away, the infection is still present in the pulpal tissue of the tooth and the infection will return to the bone and soft tissue surrounding the tooth as soon as the effects of the antibiotics wear off. This usually occurs in a month or two.

Therefore, your best solution is to have the tooth treated endodontically and a permanent restoration placed in the access opening. I hope this has answered all of your questions.

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Response by:

D Stanley Sharples, DDS
Clinical Assistant Professor of Primary Care Dentistry
College of Dentistry
The Ohio State University