Short Root Maxillary Dental Infections
Below you can see the stages of a dental infection of a tooth with a short root. This tooth infection can have two presentations: as a buccal abscess or a palatal abscess. The buccal abscess is more common.
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Buccal space: The buccal space is the space between dentition and the lip.
Palatal space: The palatal space is the space between the tongue and dentition.
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(Reneee1137, 2006)
Buccal/Palatal Abscess Infection Pathway
Stage 1: Healthy cross section
In a healthy tooth crown is made up of the dense mineralised outside layer of enamel, supported by the sensate less well mineralised layer that is dentine which contains dental tubules which connect to the pulp chamber in the middle of the tooth. The vital part of the tooth which is not mineralised is call the pulp chamber contains the blood vessels and nerves which supply the tooth and this vital material extends into the roots of the tooth as the root canal. The nerves and vessel exit the tooth via the apex of the tooth and join the structures within the periodontal ligament that surrounds the tooth and anchors it to the alveolar bone of the socket.
Stage 2: Bacterial degradation of the tooth
During a maxillary tooth infection, the healthy tooth gets invaded by bacteria contained in plaque, which thrive off the carbohydrates in the mouth and produce acid, which slowly destroys the enamel layer.
Stage 3: Dead Pulp
When the bacteria gain access to the dentine, they invade the dentinal tubules and in this way gain access to the pulp chamber in the middle of the tooth. Within the pulp chamber, the bacteria incite an acute inflammatory reaction which causes an increase in the hydrostatic pressure within the tooth and leads to hypoxia and this leads to destruction of the contents of the pulp and roots canal system, effectively killing the tooth.
Stage Four: Bone Resorption
It is here, within the pulp chamber, that most of the bacteria will reside, and having destroyed any access for white blood cells normally carried in the blood vessels, makes eradicating the bacteria difficult without either extracting the tooth itself or at least removing the dead contents of the pulp and root canal system and sterilising this area to kill the bacteria. The presence of bacteria means that their by-products/ toxins can leak out of the apex of the tooth, where the nerve would normally exit, and these insight an inflammatory response in the body, which causes a build-up of pressure within the apical tissues of the periodontal ligament, instigating bone resorption and so a widening the periodontal ligament. The causes the formation of pus (consisting of dead and dying white blood cell and bacteria) which is an abscess.
Stage Six: Buccal abscess swelling
In teeth with short roots close to the buccal plate, which is relatively thin, the acute inflammatory response will incite bone resorption of the buccal plate and as the apex is below the muscle attachments this will allow spread through the buccal plate due to bone resorption and present as a swelling inside the mouth. Thus eventually pus can be seen discharging through gum. For the infection to be cleared, the pus has to be drained and the focus of the infection treated by either removing the dead tissue from the pulp chambre and root canals by starting an endodontic root treatment or alternatively extracting the tooth.
In multirooted tooth, where there is one palatal root and 2 buccal roots, the same process can spreads from the palatal root and the infection will instead present as a palatal abscess, but using the same general progression.