Content Reviewers:Rishi Desai, MD, MPH
In a healthy mouth, normal or commensal bacteria thrive but don’t cause disease.
However, any cut or break in the mucosa is an invitation for bacteria to dive in and multiply, causing an infection.
When that happens, the immune system typically responds and a battle ensues with the result being pus - a mixture of bacteria, immune cells, and dead tissue.
So, in response to an injury, cells release small chemicals called cytokines, like tumor necrosis factor, interleukin-1, interleukin-6, interleukin-8, and interleukin-17, and these attract nearby immune cells.
It’s kinda like yelling for help and being heard by the nearby police.
In addition, the cytokines also dilate nearby capillaries and make them leaky - which brings more blood to the site, and allows immune cells that do show up, to easily slip out of the blood and into the tissue.
This is a specific type of acute inflammatory response called suppurative inflammation, which simply means that pus is created in the process.
From a macroscopic view, this is sometimes referred to a liquefactive necrosis, because the area of dead tissue turns to liquid.
Initially the dead tissue is intermixed with healthy tissue, but over time it can coalesce into a single area.
And around this pool of pus, a wall of fibrinogen - starts to harden into a barrier.
Even though the pus is largely dead material, there are still plenty of live bacteria within the pus, which makes it highly infectious if it gets spread from one place to another.
There are a few different types of dental abscesses.
The inflammation then spreads and causes necrosis or tissue death throughout the entire length of the dental pulp.
And if it goes on without treatment - like a root canal, then the infection ultimately reaches the apical foramen of the tooth.
Subsequently, the infection reaches the periapical tissues and at that point, it’s considered apical periodontitis, which is inflammation of the periapical tissues which secure the tooth in its socket.
In that situation, it’s called chronic inflammation, and it’s where a periapical granuloma forms from this walled-off area.
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