What is a Palatal Abscess?

front tooth abscess

This is an abscess – but it’s not on the palate.

Many patients will come to a dental office stating something to the effect of “I have an abscess” or “I have this bump here so it must be an abscess.” But what is an abscess? And more specifically, what is a palatal abscess? In this post, we will not only describe it to you, but we will show you incredibly detailed photos!

An Abscess Defined

Before we talk about a specific type of dental abscess – a palatal – let’s first define what an abscess is:

A circumscribed collection of purulent exudate appearing in an acute or chronic localized infection frequently associated with swelling and other signs of inflammation.

A more simplified definition would be:

A localized collection of pus associated with an infection.

We can further define an abscess based upon the location, consistency of the pus, and other variables. For this post, we are focusing on abscesses located on the palate (the roof of your mouth).

So a Palatal Abscess is Associated with the Palate?

A drawing of a palatal abscess

Diagram of a palatal abscess.

Yes!

A palatal abscess is a collection of pus associated with an infected tooth that drains onto the palate (a.k.a. roof of the mouth).

When an infection with a tooth develops, it most often begins at the tip of the root deep inside the bone. The infection expands within the bone, with pressure building. Ultimately, the infection perforates the bone, and enters the soft tissue, which creates a swelling.

In a palatal abscess, the infection spreads from the tip of the root towards the palate, resulting in swelling on the roof of the mouth near the offending tooth.

Palatal Abscess Photo #1

The photo below was taken in my dental office in Orange, CT. She developed a LARGE swelling on the roof of her mouth on the right hand side:

Upper right molar palatal abscess

Palatal Abscess associated with a fractured upper right molar. Clicking on the photo will show you all the gory details! Photo courtesy Dr. Nicholas Calcaterra.

In the above case, this 70 year old female split her upper right molar in half. This lead to an infection which culminated in a large palatal swelling. The solution was to remove the tooth and drain the abscess – which I did! Within a week, she was back to normal (except she no longer had the tooth).

Palatal Abscess Photo #2

This photo was taken on a mid 20s female. You are looking up at her palate. The infected tooth was #7 – her right maxilary lateral incisor. You notice a LARGE swelling.

Palatal Abscess with a maxillary lateral incisor

Abscess on the palate associated with an infected upper lateral incisor. Clicking on the photo will show you incredible detail. Photo and subsequent treatment by Dr. Nicholas Calcaterra.

Treatment for this patient involved draining the abscess and then performing a root canal. I am pleased to report that the treatment succeeded and that she still has the tooth!

Palatal Abscess Photo #3

This patient in her mid 70s developed swelling in the upper left. She called us but was not able to arrange transportation to see us for approximately 48 hours. In the interim, we prescribed antibiotics for her, which she began taking. When she arrived, she reported that there had been a swelling, but it had suddenty went down rapidly, accompanied by a metallic taste.

Palatal abscess that perforated and drained

Palatal Abscess that grew very large – and then ulcerated and drained. Photo and treatment performed by Dr. Nicholas Calcaterra.

In the above photo, the tissue is only slightly swollen now, but there is now a large ulceration. Treatment involved extracting the offending tooth. She was much happier after the tooth was gone!

I hope you enjoyed this post and the photos. I have dozens more photos. Want to see more? Leave a comment and I’ll post more.

Getting an Infected Tooth Pulled

In 2016, I tackled this very subject as Dental MythBuster #16 – You Shouldn’t Have an Infected Tooth Pulled. In this post, I dispelled the myth that if there is an active abscess or other type of infection with a tooth, it should not be removed. I wrote this Dental MythBuster because I had previously encountered some individuals who believed that you are supposed to give antibiotics ONLY and not treat the infection surgically.

This “no pulling when infected” myth was in full force when I posted this video in February 2019 on our YouTube Channel of me treating a patient with a large, life threatening infection. In spite of this, there were posters who were somehow suggesting that I should not remove the tooth? Huh?

Video of Juicy Pus Explosion from Dental Abscess with Extraction

Let’s look at the video that provoked these comments:

It is a very popular video with over 1.6 million views as of 9/2019. As a result, there are many comments. But if you scroll through them, you will occasionally see commenters assert that removal should not have been done.

The “You Can’t Have an Infected Tooth Pulled” Myth in Action

Let’s look at one YouTuber who goes by the name rancar29:

Youtube comment on getting an infected tooth pulled

In the above comment, rancar29 claims that removal would cause sepsis, and that surgical intervention should not have been done at that time.  Apparently, he/she feels that a couple of orally administered pills will cure this infection and that the tooth – the root cause of the infection – should stay put.

I could put forth many arguments to refute the assertions of rancar29, too many to list. But the one point worth highlighting is that with an infection of this size and in this area, bacteria are already into flooding the bloodstream. Generally speaking, removal will not “spread” the infection anymore than it is already is spreading.

Would You Still Want the Tooth in your Mouth?

So, let’s say you go to your dentist with massive swelling and pain. The pain is so intense you feel like your vision is being affected. You can barely drive properly. You can’t think straight. You get in the chair. An x-ray is taken. There is a MASSIVE infection present (but you already knew that).

Large Dental Abscess with swelling and pus

If this were you, would you be OK with a couple of antibiotics pills?

The dentist then says – we’ll just give you some pills and hope the infection clears. Would you be OK with that?

Dental Infection = Infection Just Inches From Your Brain

As I outlined in a more recent post – A Toothache Can Kill You – I talked about how dental infections are close to the brain. And that even in recent times, individuals in the United States have died from untreated tooth infections.

Infections such as the one shown in this video need surgical intervention ASAP. So if you are ever in this situation, you need to get treatment quickly.  Relying on a myth that you shouldn’t get an infected tooth pulled could make you end up in the ER, or worse.

Disclaimer: as always, this post is not considered medical or dental advice. Every case is different. If you have an infection like this, seek out the expertise of a dentist or oral surgeon.

 

A Toothache Can Kill You

As a dentist in private practice, I see all types of outlooks and attitudes regarding toothaches and other dental conditions. I see some patients who are deeply concerned to others who say “it’s just a tooth.” Others will state something like “it’s not hurting so why should I do something about it?”

When I see a patient with an obvious infection, I will often times say something like this: “you have an infection with about 100 billion nasty bacteria less than 2 inches from your brain. Are you sure you want to ignore this?”

Let’s look at a recent case I saw in my office.

Large Dental Abscess on the Lower Right

I saw the following patient who showed up in obvious pain:

Toothache abscess with swelling face photo of patient

This patient came to us with a golf ball size swelling on his lower right. The culprit? A tooth!

In the above photo, you can see the obvious swelling. After an exam, it was apparent the serious infection was originating from a tooth. I was very blunt with the patient. Either you get treatment now, or you will likely be in the ER getting ready for emergency surgery in less than 48 hours.

Want to see how it ended? Then watch our YouTube video below:

Infections like this – assuming they are not so advanced so as to require hospitalization with emergency surgery – are nearly always treated using the adage “cold steel and sunshine.” This expression is referring to extraction. The tooth is removed with “cold steel” and then the roots are exposed for the first time to “sunshine”. By removing the tooth, the source of the infection is removed, the pus drains, and in nearly all cases your immune system can fight off the infection.

How an Infected Tooth can Kill You

Many individuals are still skeptical that a tooth infection can kill you. After all, it’s just a tooth some will say. Well, if you read the stories located here, here, and here, you’ll see this is not a myth. It can happen.

So how does it happen? One of the more common causes is that the infection spreads to your brain. See the photo below:

Skull showing the proximity of the upper teeth to the brain.

Skull showing the proximity of the upper teeth to the brain. The roots are embedded in the bones of your skull and very close to your brain.

The above photo is that of a skull (which everyone knows). The bottom arrow points to the approximate location of the roots of an upper back tooth. In most cases, the infection (bacteria, pus, swelling) originates within the tooth but then enters the rest of the body through the tips of the roots. The top arrow points to the approximate location of the base of the brain. Now, this is a two dimensional photo of a three dimensional object (brain and skull). But you should be able to see that an infection with upper teeth roots places nasty, killer bacteria less than 2 inches from you brain!

If the nasty bacteria end up in the brain, it can fatal, and very quickly. It’s that simple. This is likely what happened in the case of Deamonte Driver.

Other Ways a Tooth Infection Can Kill You

There are other ways in which an infections associated with a tooth can be fatal:

  • Suffocation – no, I’m not joking. Infections associated with lower molars can lead to swelling of the throat, leading to collapse of your airway. You are simply unable to breath. This is most commonly seen in Ludwig’s Angina.
  • Heart Failure – I’m not joking with this either. The bacteria from a lower tooth can quite easily travel downward through the neck and set up around the heart. This can lead to issues with the heart and ultimately cause the heart to fail. An example of a case is located here.
  • And many other ways. Remember, teeth are part of your body too…
Ludwigs Angina

Photo of a case of Ludwig’s Angina. The swelling will literally cause your airway to close. Photo courtesy of wikipedia.

In summary, it’s important to not ignore a tooth infection, even if it does not hurt. You don’t want to be like the guy in our YouTube video!

 

Can You Do a Root Canal Through a Crown?

As a busy dentist in private practice, I get some variation of the “can I get a root canal on a tooth with a crown” question quite frequently. The question comes in various forms, but the general summary is something like this:

“I got a crown done about three years ago. Everything was fine until a week ago, and now it feels like it is on fire. I think I need a root canal. Can you do a root canal through a crown?”

The answer to this question is yes (most of the time).

Why Teeth Need Root Canals

Before we describe why/how a root canal is done through a crown, it is important to know why teeth sometimes need root canals.

tooth with cavity needing a root canal

This tooth had a large cavity. The brown spot visible in the photo is the decay. On subsequent removal of the decay, the nerve became inflamed, and the tooth needed a root canal.

A tooth needs a root canal when the nerve inside the tooth becomes inflamed or infected. This can be due to several reasons, including:

  1. Dental decay (a.k.a. cavity) that either comes close to or enters the nerve of the tooth.
  2. A crack or fracture of the tooth where the nerve become exposed.
  3. A large restoration (filling) placed very close to the nerve. The filling is done due to the presence of decay and/or cracks (as talked about in points 1 and 2 above). Note it is not the filling that causes the need for the root canal, but rather the decay and/or fracture.
  4. Trauma to a tooth in which the nerve is injured.
  5. Other more infrequent causes (internal resorption, external resorption, jaw cysts, metastatic malignancies which enter the jawbone, etc.)

Generally speaking, reasons 1, 2, and 3 are the causes for 99% of all root canals.

What is a Root Canal?

Describing a root canal is not the point of this post. But a general summary can be presented.

Root canal access cavity

View of a cleaned out nerve chamber of a lower tooth as seen from directly above the chewing surface. The 3 holes are entry points to 3 separate canls.

In a root canal, the infected and/or inflamed nerve tissue inside the tooth is cleaned out and then filled with a special filling material. We do this by drilling a hole from the top of the chewing surface of the tooth into the nerve chamber. In the photo above, you can see the large hole in the tooth which leads down and exposes 3 smaller openings or orifices. These are the openings to the canals of the tooth.

In a root canal, the roots of the tooth remain. They are not removed. By having a root canal done, you are able to keep a tooth that might otherwise have to be extracted.

How a Root Canal is Done Through a Crown

A crown, often called a cap, is a custom fabricated restoration comprised of metal and/or ceramic that covers the top of portion of the tooth. Crowns are done for many reasons, but they are mostly done to protect a tooth that has been compromised by decay and/or fractures.

When a tooth with a crown needs a root canal, you can expect the following sequence:

  1. You will be given local anesthetic so that your tooth is totally numb (and other parts of your mouth too).
  2. A rubber dam will be placed over the tooth.
  3. A small hole will be drilled through the crown into the tooth and into the nerve chamber.
  4. Then the dentist is ready to begin cleaning out the infected and/or inflammed nerve.

Before and after photos showing a root canal through a crown. In the left photo, you see the procedure in process with the rubber dam and access into the nerve chamber. The right photo shows the completed procedure with a filling sealing the access hole. The crown is saved! Photos and dentistry Dr. Nicholas Calcaterra.

In nearly all cases, the root canal is done through the crown, the access is sealed, and then everything goes back to normal.

When Saving the Crown is not Possible

In some cases, doing a root canal through a crown and keeping that crown is not possible. This can happen for a variety of reasons. Some of them include:

  • The decay – which caused the need for a root canal – is so advanced that a new crown is needed.
  • A large piece of porcelain broke off during the procedure so that the crown is no longer functional.
  • A root fracture of the tooth was discovered during the procedure and the tooth must be extracted.

The above list is not comprehensive but covers many of these situations.

In all cases, your dentist or endodontist should discuss with you the likelihood of you keeping the same crown after the root canal procedure.