What is phoenix dental abscess?

February 28, 2016

  

Endodontic emergencies account for a major portion of unscheduled visits to the dentists. Conditions causing severe dental pain could stem from pulpitis, periodontitis, abscess, or a cracked tooth. The first step in determining proper treatment is to provide a swift and correct diagnosis. Then the dentist can relieve pain, control inflammation and infection, remove damaged tissues, and restore the structure of a tooth.

Understanding abscessed tooth

Dentists call a localized collection of pus in the alveolar bone at the apex (tip) of a tooth root an abscess. The infection extends from the apex of the tooth root up to the periradicular tissue through the apical foramen (small opening at the apex of a tooth root). It can be asymptomatic, or cause severe pain and swelling. There can be numerous factors in cases of abscess, but the leading causes are dental caries (cavities). Other common causes include tooth trauma or periodontal infection. Some differentn classifications of an abscessed tooth include: periodontal, gingival, apical, pericoronal, or phoenix abscesses.

Phoenix abscess

The older term “phoenix,” is becoming less common. Modern dentists favor more descriptive terms such as, “chronic” (long lasting or visible on an x-ray) and “supportive” (drainage from infections). A phoenix abscess is a painful condition due to the exacerbation of an existing lesion, like a cyst or granuloma, around the apex (tip) of a tooth’s root. A phoenix abscess can occur immediately following a root canal therapy or as the result of inadequate debridement during other endodontic treatments. It can also come from untreated necrotic (dead) pulp. It can even come from an increase in the virulence of bacteria and a decrease of the patient’s immunity. However, most often, a phoenix abscess is a secondary condition of chronic apical periodontitis. Initially the apical lesions are asymptomatic, but because of changes in the internal environment due to instrumentation, endodontic treatment exacerbates a chronic lesion and results in an abscess. This is often why a phoenix abscess can be one of the most troublesome.

Symptoms of phoenix abscess

The signs and symptoms of this condition mimic those of acute periapical abscess. Symptoms include a rapid onset of:

• Inflammation
• Pus formation
• Sour or metallic taste
• Halitosis (bad breath)
• Spontaneous pain
• Sensitivity to percussion
• Discomfort when biting or chewing
• Swelling of associated tissues

Questions the dentist will often ask

To make a proper diagnosis the dentist will want to know several details. Here are some questions you can expect:

• Where is the pain?
• When did the pain first start?
• Describe the pain.
• Under what circumstances does pain occur?
• Had anything helped relieve pain?
• Do you have associated tenderness or swelling?
• Have you had any recent endodontic or periodontal treatment?
• Have you experienced any dental trauma?

Treatment for phoenix abscess

This condition is difficult to correct. Often the dentist must re-perform root canal therapy on the tooth. This consists of irrigation, improved debridement of the root canal, and drainage through the canal or a surgical trephination (a puncture through soft tissue and bone over the root apex).  In severe cases the dentist will prescribe antibiotics to eradicate infection. If infection is too severe or the tooth does not have enough remaining natural structure to undergo another root canal treatment, the dentist must perform an extraction of the entire tooth.

Reduce the risk of tooth abscesses

Dental professionals work tirelessly to bring patients the utmost in endodontic dentistry. Many professionals use multi-visit treatments for symptomatic apical periodontitis or abscess to make sure they fully resolve symptoms before finishing off a case. They use calcium hydroxide to disinfect the root canal system. Also, advances in irrigation help tin increase the efficacy of disinfecting the canals. These improved debridement procedures reduce a patients risk of developing a phoenix abscess. Patients can help reduce their risk of this problem by brushing, flossing, and maintaining regular dental exams to prevent decay and infection. Also, patients should get early treatment for cavities and prevent the formation of an abscess.

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