Short answer: A tooth root infection is when the pulp tissue inside the tooth becomes infected and loses its vitality as a result of deep decay, a crack or trauma, and the infection spreads to the bone at the tip of the root. Pain when chewing, swelling or drainage in the gum and facial swelling may occur. Because antibiotics cannot reach the source, they are usually not enough on their own; the permanent treatment is root canal treatment or extraction of the tooth.
A tooth root infection is a condition that develops when the pulp tissue, which houses the nerves and blood vessels inside the tooth, becomes infected and loses its vitality, and the infection then spreads to the bone at the tip of the root. In everyday language it is also called an "infected tooth", a "tooth abscess" or, more generally, a dental infection. In this article we explain how a tooth root infection develops, its symptoms, why antibiotics are often not enough on their own, the decision between root canal treatment and extraction, and what can happen when an infected tooth is extracted.
What is a tooth root infection?
A tooth root infection is when bacteria reach the pulp chamber of the tooth, kill this tissue and then spread through the root canals to the jawbone at the tip of the root, forming an inflamed focus there. In medical terms this condition is called apical periodontitis; when the pus accumulates and forms a pocket, it is called an abscess.
The process usually progresses in the following order:
- Decay or a crack: A deep cavity that goes through the enamel and dentin layers, or a crack or fracture in the tooth, opens a path for bacteria to the pulp.
- Pulp inflammation: The pulp becomes inflamed; first there may be lingering sensitivity to hot and cold, then pain that starts on its own and gets worse at night.
- The pulp losing its vitality: As the inflammation progresses, the pulp dies. At this stage the pain may ease for a while, creating a misleading sense of relief.
- Infection at the root tip: Bacteria exit the root canals and create an inflamed area in the bone at the tip of the root. This can sometimes remain silent for years, and sometimes it can turn into an acute abscess.
Apart from deep cavities, past blows to the tooth, repeated large fillings and an old or inadequate root canal treatment can also cause an infection to develop at the root tip.
Symptoms
The symptoms of a tooth root infection include pain that increases when chewing or when the tooth is touched, swelling in the gum and a pimple-like bump that drains, facial swelling, a bad taste in the mouth and sometimes fever. However, in some cases it causes no symptoms at all and is noticed by chance on a routine X-ray.
- Sharp pain when biting down on the tooth or when it is tapped lightly
- A feeling that the tooth has become "longer"
- Swelling or redness in the gum at the level of the root, or a small bump (fistula) that drains pus
- Swelling in the cheek, under the jaw or under the eye
- A bad taste and odor in the mouth
- Gray or dark discoloration of the tooth
- Fever, fatigue and tender lymph nodes in the neck
Rapidly growing facial swelling, difficulty swallowing or breathing and a high fever may indicate that the infection is spreading and require urgent assessment.
Infection that does not clear with antibiotics
A tooth root infection usually does not clear with antibiotics alone, because the dead pulp tissue and the bacteria in the root canals, which are the source of the infection, are in an area without blood circulation, and the medication cannot reach this area sufficiently. Antibiotics can temporarily suppress an infection that has spread to the surrounding tissues; swelling and pain may decrease. But because the source has not been cleaned, the infection often flares up again.
For this reason, dental organizations recommend that antibiotics be used only when the infection has spread or affects the patient's general condition, and always together with treatment aimed at the source. Unnecessary and repeated antibiotic use contributes to the development of resistance in bacteria and can reduce the effectiveness of the medication when it is truly needed. Antibiotics should not be taken from leftover old prescriptions or without a dentist's recommendation; the choice of medication and the duration of use are up to the dentist.
Treatment: root canal treatment or extraction
The permanent treatment for a tooth root infection is to eliminate the source of the infection, and this is achieved either through root canal treatment, in which the root canals are cleaned and filled, or by extracting the tooth.
Root canal treatment
In root canal treatment, under local anesthesia, an access opening is made in the tooth, the dead or inflamed pulp tissue is removed, the root canals are shaped with special instruments and cleaned with antiseptic solutions, and they are then filled with a sealing filling material. In acute abscesses, the pus can be drained and the treatment may be spread over more than one session. After root canal treatment, the tooth is usually strengthened with a large filling or a crown to protect it from fracturing. Healing of the bone at the root tip takes place over months, and the dentist monitors this with follow-up X-rays.
Root canal retreatment and surgical options
If the infection persists in a tooth that has already had root canal treatment, retreatment of the root canal can be considered. In some cases, an apicoectomy, in which the root tip is cleaned with a small surgical procedure, may be an option.
Extraction
If the tooth has extensive loss of structure, a root fracture, a large loss of supporting bone or cannot be restored, extraction may be recommended. Implant, bridge or denture options to replace the extracted tooth are planned separately. Whenever possible, preserving the natural tooth is preferred; the decision is made by evaluating the condition of the tooth, the X-ray findings and the patient's preferences together.
What happens if an infected tooth is extracted?
In most cases, extracting an infected tooth eliminates the source of the infection and starts the healing process; the belief that an infected tooth cannot be extracted is not a general rule. The dentist decides on the timing of the extraction according to the state of the infection.
- Effect of the anesthesia: In heavily inflamed tissues, the effect of local anesthesia may be reduced. For this reason, if there is widespread swelling and acute infection, the dentist may prefer to drain the pus first or to give a short course of medication.
- Spreading infection: If there is marked facial swelling and fever, additional treatments the dentist considers appropriate are planned together with the extraction.
- Healing: Mild pain and swelling are expected in the first days after the extraction. Because the source of infection has been removed, in many patients the throbbing pain they had before the extraction decreases significantly.
- Dry socket: Increasing pain may occur on days 2–4 due to early loss of the blood clot in the extraction socket. Not smoking and following the dentist's instructions reduce the risk; if this happens, see your dentist.
- Bone loss: A long-standing infection may have caused bone loss in the jaw. If an implant is being considered for the future, placing a graft during the extraction may come into consideration.
Prevention
The most effective way to prevent a tooth root infection is to have cavities treated at an early stage, before they reach the pulp, and to keep up with regular dental check-ups.
- Brush your teeth twice a day with fluoride toothpaste and clean between your teeth every day.
- Limit how often you have sugary foods and drinks.
- Do not put off symptoms such as sensitivity to hot and cold, pain when chewing or discoloration of a tooth.
- If you have a habit of clenching or grinding your teeth, talk to your dentist about a night guard to reduce the risk of cracks and fractures.
- Wear a mouthguard if there is a risk of trauma during sports.
- Have the final restorations of root canal-treated teeth completed on time; staying with a temporary filling for a long time can lead to leakage.
For other topics you may be curious about, you can also visit our frequently asked questions page.
Getting care for an infected tooth in Ankara
If you have a tooth that hurts when chewing, causes swelling or drainage in the gum, or shows an infection at the root tip on an X-ray, planning the appropriate treatment in time increases the chance of saving the tooth. At our polyclinic in Park Oran Ofis on Kudüs Cd. in Çankaya, root canal treatment or other options are explained to you in detail after the examination and imaging. To make an appointment, you can contact us.
Frequently asked questions
Does a tooth root infection go away on its own?
No. The pain may ease for a while or stop completely, but as long as the dead pulp tissue that is the source of the infection remains in place, the infection usually continues and can flare up again over time. The permanent solution is treatment aimed at the source.
Can an infected tooth be extracted?
In most cases, yes. Extraction eliminates the source of the infection. However, if there is widespread swelling and acute infection, the dentist may prefer to drain the pus first or give a short course of medication; the dentist decides on the timing.
Can a tooth that has had root canal treatment become infected again?
It can. Incomplete cleaning of the canals, leakage from the final filling or a new cavity can cause the infection to develop again in a root canal-treated tooth. In this case, root canal retreatment or surgical options are considered.
When should I go to the emergency department for a tooth infection?
If there is rapidly growing facial swelling, swelling that spreads to the eyelid or neck, difficulty swallowing or breathing, or a high fever, go to the emergency department without delay.
