The first thing to clarify is what a dental abscess is: a dead tooth with a bacterial infection in its root canal system. This bacterial infection spreads to the root tip and forms a chronic inflammation, or nodule. From this nodule, as a dental nodule, bacteria flow out through the interstitial fluid into the blood vessels, spreading to other areas and organs of the body. In other organs, such as the skin or joints, secondary disease, i.e. symptoms of the nodule, appear, for example in the form of skin disease or arthritis.

The treatment of a dental abscess is therefore primarily aimed at eliminating the existing infection. Root canal treatment offers the possibility of doing this. If this is not an option, removal of the infected tooth may be necessary. The treatment of dental abscess can be based on an accurate diagnosis.

Not necessarily! If the tooth is alive, and most crowded teeth are alive, then the tooth is not a dental calculus. A tooth becomes a pulp when it is dead, i.e. there is no living blood vessel or nerve tissue in the root canal system. However, bacteria can enter the cavity canal system and maintain infection. If the infection gets through to the tip of the root, it can cause tissue inflammation there, and then the infection escapes to other areas of the body in the bloodstream. This is called a secondary nodular disease and the tooth is now a dental nodule.

No! We distinguish between several categories, and we also have to consider the severity of the symptoms caused by the infection, whether there may be a focus elsewhere in the body, or whether we should only look for the problem in the mouth. For example, if the cardiologist asks for a so-called "decontamination" before a serious heart operation, the procedure is quite different, since a so-called "survivor", i.e. a tooth that is free of symptoms but still visibly infected on X-ray, can be life-threatening.

So, if there is time for treatment and there is no serious, life-threatening pathology, it may be worthwhile to have the tooth root canaled or revisited, i.e. to have the root canal done again if it has been done in the past. However, we cannot expect an immediate result here. On the one hand, the treatment itself is long and, on the other hand, it takes months after the root canal or re-root canal to demonstrate that the inflammation of the root canal has disappeared.

No. X-rays are an essential part of the dental gum examination, as they help you to "see inside" the bone. We mainly take panoramic X-rays. In fact, modern imaging tools such as 3D CBCT X-rays can help to determine with even greater accuracy whether or not a tooth is decayed. In some cases, a lesion seen on a panoramic X-ray can give a false positive or false negative result. So a tooth may be alive, even though the x-ray shows a dark lesion, or it may be dead, even though the panoramic x-ray shows nothing. So the panoramic X-ray should in most cases be complemented by an intraoral X-ray or a 3 D CBCT scan and of course the combination of the oral examination and the X-ray analysis will give the final diagnosis.

If left untreated, nodular inflammation in the bone will further destroy the periodontium. This means localised bone loss. In the long term, this is not beneficial - even if it is often painless - because valuable bone tissue around the nodulated tooth is destroyed. If this tooth is extracted over time, much less bone remains in its place. This, in turn, limits the options for further tooth replacement, which may not be possible or may require bone grafting.

In some cases, inflammation around a previously chronic, silent nodular tooth can become acute, causing the patient severe pain and inflammation. Such a flare-up often requires antibiotics and, in the case of an immune deficiency, can even lead to sepsis, a serious infection in the tissues.

At an organ level, there is also no benefit from an untreated tooth. In fact, from a nodular infection, bacteria are constantly flooding the blood vessels and spreading to other tissues, skin, joints, heart valves, etc. This may not be a problem for a while, as it is an invisible burden on the immune system. But in the long term, the damage causes serious organ problems.

A nodulated tooth should therefore be treated:

• close, six-monthly x-ray monitoring in the case of a symptom-free, well-functioning, well-closed, so-called surviving tooth
• in the case of a tooth with a complaint, root canal treatment, if possible, or re-root canal treatment
• in the case of an unsalvageable tooth - for example, due to severe coronal damage or other anatomical complications - tooth extraction