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Periapical Lesions

Overview

A periapical tooth abscess is a painful condition associated with the formation of a pus-filled pocket of bacterial infection around the root of the tooth. This usually happens when bacteria reach the innermost part of the tooth (the dental pulp), which contains nerves and blood vessels, due to tooth decay, cracks, or trauma. The infection often spreads to the root of the tooth, resulting in inflammation.

Typical symptoms of a periapical lesion include:

  • Severe throbbing toothache
  • Pain while chewing and biting
  • Pain radiating to the ears, neck, or jaw
  • Halitosis, i.e., bad breath and/or foul taste in the mouth
  • Facial swelling
  • Fever
     

A periapical abscess typically develops due to

  • Tooth decay (cavities)
  • Fractured or chipped tooth
  • Failed or incomplete dental treatment
  • Severe gum disease

Certain conditions increase the risk of developing an abscess:

  • Poor oral hygiene
  • Dry mouth (due to certain medications or conditions)
  • High intake of sugary foods and drinks

If patients experience any of the aforementioned symptoms (especially when persistent), they are advised to contact their dentist as soon as possible.

Periapical lesions are usually diagnosed using the following methods:

  • Physical examination: The dentist may examine the oral cavity to check for the following:
    • Swellings in the gums
    • Tenderness of tooth to percussion
    • Presence of tooth cavity
    • Swollen and tender lymph nodes
  • Dental X-ray: The infected tooth or swollen region is examined via X-ray imaging to confirm the presence of a periapical abscess. 

In case of a periapical abscess, the tooth may require the following treatments:

  • Root canal treatment: The infected tooth pulp is removed, thoroughly cleaned, and sealed with a filling material.
  • Tooth extraction: In severe cases where the tooth cannot be salvaged, it might need to be removed.
  • Medication: Supportive pain-relief medications and antibiotics may be prescribed to control infection and reduce discomfort.

Seek prompt dental care if you experience persistent toothache, swelling in the face or jaw, fever, or spreading pain. Early intervention prevents complications such as spread of infection to other body parts.

Although not all cases can be prevented, maintaining good oral health significantly lowers the risk of abscess formation. Additional measures include:

  • Brushing twice daily
  • Limiting sugary foods and drinks
  • Visiting the dentist regularly for check-ups and cleanings
  • Seeking early treatment for cavities or gum problems

Patients with suspected or confirmed periapical abscesses should consult a:

  • General dentist (first point of care for diagnosis and treatment)
  • Endodontist (specialist in root canal treatments)
  • Oral and maxillofacial surgeon (if extraction or surgical drainage is required)

Disclaimer:

The information in this Health Library is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any questions about a medical condition or before starting any treatment. Use of this site and its content does not establish a doctor–patient relationship. In case of a medical emergency, call your local emergency number or visit the nearest emergency facility immediately.