Periapical abscess (price and dangers of draining?)

[bGlitter]

I have a deep cavity (with a filling) that developed an abscess 8 months ago. Although there was a bit of pain when it first appeared, I took antibiotics from a dentist. The pain went away but the abscess remained. I know it is recommended to get this drained much earlier.

I am still trying to preserve my tooth without root canal or extraction (although I recognize that could be a possibility). One thing I am worried about is if the draining itself could kill my tooth (assuming it is still alive). I live in California and plan to consult a dental practice in the area. The tooth is my upper second premolar tooth, which I have read can have 1 or 2 roots, each of which can have two "canals". My questions are:

1) What dangers are present in the draining of a tooth abscess? Specifically, can the draining procedure itself kill the tooth (assuming it is still alive)? Worries to come to my mind are the practitioner being too aggressive around the tooth nerve, etc.?

2) Can this tooth (upper second premolar) theoretically still be alive if one of its roots is dead (and it happens to have two roots)? If that is a possibility, how can I ensure the dentist does not interfere with a root is not even infected?

3) What is the price of this procedure in my area (for someone without health insurance). For some reason, I cannot even find this basic information online.

I have been putting draining it off for a long time because I just worry that sometimes treatments can cause more problems if done in incompetent (or overly aggressive) manners. This is why I appreciate any ideas so I can be armed with a wider net of knowledge to choose the correct practitioner and be active in the process to protect myself.

 

[honestdoc]

I think you are missing the point. Instead of treating the symptom (draining the abscess), you are ignoring what is causing the abscess. Without x-rays, I'm guessing the the tooth is necrotic (causing the abscess). The tooth needs a root canal or extraction. Even if the tooth is multi-rooted and partially necrotic, the tooth will never recover (the vital part will eventually die). Partially necrotic tooth will not abscess since it has some vital vasculature which means your abscess came from a fully necrotic tooth.

I would not waste any efforts in draining the abscess. Instead, I would focus on saving the tooth with root canal, core build up and crown or extraction and possible implant if appropriate for your oral condition and budget.

 

[bGlitter]

Thanks for your response.

I should be more careful with my wording. I do not know if I really have an abscess yet. 14 months ago, I had severe pain in the tooth. My dentist discovered that its filling was too large and was the only point of contact on that side of the mouth - so it was taking all the blunt force each time I chewed. She shaved down the filling and the intense pain stopped. She took an x-ray and checked that there was no black dot by the top of the root (in order to, I believe, check for an abscess or loss of bone structure). I was told my tooth was likely just bruised. 8 month ago, a tender bump formed above the tooth, which I suspect may be pus. I took antibiotics and still do not have any intense pain, other than very mild pain that comes and goes at times.

1) Is it possible that I have a pus-filled region but the X-ray will show no black dots (loss of bone structure). In other words, is it possible to have pus (from an infection) without an abscess? I intend to get an X-ray to check for loss of bone structure (abscess) and, if present, will be more inclined toward serious procedures (like root canal and extraction). However, I do not want to undergo serious procedures prematurely should there not actually be an abscess and this pus infection can simply be removed.

2) What is the general price of pus draining at a dental practice without health insurance in North America?

 

[MattKW]

1. Xrays do not always show abscesses, and most dead teeth are diagnosed by other tests, e.g. cold sensitivity, tenderness, history of signs and symptoms. Did your dentist do cold tests?
2. You don't drain pus by an incision in the gums except in cases of large, soft swellings. You can clean out the root canal for lesser abscesses and start some healing that way. that's really starting a root canal treatment.
3. If you do have an abscess, then using antibiotics should only be for emergencies, otherwise repeated use risks the development of resistance and a dangerous infection.

 

[bGlitter]

1. Xrays do not always show abscesses, and most dead teeth are diagnosed by other tests, e.g. cold sensitivity, tenderness, history of signs and symptoms. Did your dentist do cold tests?
2. You don't drain pus by an incision in the gums except in cases of large, soft swellings. You can clean out the root canal for lesser abscesses and start some healing that way. that's really starting a root canal treatment.
3. If you do have an abscess, then using antibiotics should only be for emergencies, otherwise repeated use risks the development of resistance and a dangerous infection.

Thanks for your helpful response!

1. I did a cold sensitivity test (where the dentist put a cold object on the tooth) and I felt the coldness. It was less strong than other teeth and a bit slower. I just repeated it at home with an ice cube and sometimes I do not really feel it but other times I almost certainly feel it. Some of my other teeth also seem to sometimes feel it and sometimes not. However, I do certainly feel the coldness in that tooth sometimes. The percussion test shows that tooth to be quite a bit more sensitive than other teeth. The tooth did experience trauma (constant biting pressure and deep feeling).

2. The pus is large and soft (as far as I know as a layperson). It is not a concentrated point. Would cleaning the pus out through the root canal kill the pulp and tooth and/or weaken these structures? If so, I really hope to avoid it (at least initially) and simply drain through the gum incision. Is this ever done at the dentist and could draining through gum incision itself kill or weaken my tooth (i.e. removal of too much tissue that may or may even be dead)? What is the price for gum incision and pus draining?

3. Thank you for this information about antibiotics. I have been doing massive research on this topic and I did not think about (come across) this danger yet. Fortunately, I have only used the treatment regime once (when the pus first appeared 8 months ago).

 

[honestdoc]

In my location on the Pacific NW, the full fees for Incision and Drainage code D7510 is $387.00. In California could be more. Call and ask for the fees to code D7510. What did your dentist diagnose your problem with? I still believe it is best to resolve the cause of the swelling & pus and not drainage. If you were to come in to my practice, I would diagnose your problem and not do that procedure.

 

[Sonia Salamuri]

Root Canal therapy or Endodontic Therapy developed a lot, and I think that in USA even more, because it's the home of some well known endodontists, at least, it's what I think. I believe it's expensive, but a good root canal therapy can save your tooth.