Chronic Periapical Abscess

March 19, 2013 | Posted in General Information

An abscess is a collection of pus that is produced following an inflammatory response. The cells that are activated as part of our immune response are so destructive that they not only destroy (or attempt to destroy) the source of the inflammation/ irritation, but they also destroy our own normal cells in the surrounding area. The collection of these cells and their destructive byproducts is 'pus' and is often contained in an epitheial lined sac known as an abscess, cyst or granuloma.

In this radiograph, tooth #26 has a large radiolucency extending around the roots (outlined in blue). The patient indicated the tooth was restored about 4 years ago with a very deep filling due to a very deep cavity. Over time, the insult of the deep cavity (and subsequent restoration) caused a chronic inflammatory response in the pulp of the tooth leading to eventual pulp necrosis. The necrotic pulp tissue is attacked by the immune system creating the abscess visible on the radiograph.

The patient had been experiencing intermittent periods of swelling and discomfort over the past 4 years, but did not seek dental treatment.  The chronic condition resulted in advanced destruction of the tooth's supporting structures.  The treatment options were reviewed and the patient decided to have the tooth extracted.

 

 

 

 

 

 

 

In the extracted views, the abscess is clearly visible and outlined in blue. As described above, it is a pus filled sac resulting from a chronic inflammatory insult. In this case, the condition is formally known as a "chronic periapical abscess".  Delay in treatment of these conditions is not recommended and can be potentially life threatening. The close proximity of these infections to vital structures and vessels can allow the infection to spread freely throughout the body. There have been documented cases of dental lesions spreading through sinus vessels to the cavernous sinus of the brain resulting in death!