Understanding Chronic Apical Abscess: Causes, Symptoms, and Treatment

By | September 4, 2023

A 9-year-old presented at the outpatient department of endodontics with a chief complaint of drainage of discharge below the chin area

Clinical examination showed extraoral sinus tract associated with grossly carious left mandibular first molar

The periapical radiograph showed radiolucency invading the mesial pulp horn and open apex


Chronic apical abscess is a dental condition characterized by an infection at the tip of the tooth’s root. It is typically caused by untreated dental decay, trauma, or a failed root canal treatment. In this article, we will explore the causes, symptoms, and available treatment options for chronic apical abscess.

1. Causes of Chronic Apical Abscess:
Chronic apical abscess occurs when bacteria invade the dental pulp, leading to infection and inflammation. The most common causes include untreated dental caries (cavities), cracked or fractured teeth, and failed root canal treatments. Poor oral hygiene practices, such as inadequate brushing and flossing, can also contribute to the development of abscesses.

2. Symptoms and Signs:
Identifying the symptoms of chronic apical abscess is crucial for timely intervention. Common signs include persistent and throbbing toothache, sensitivity to hot or cold temperatures, swelling of the gum or face, a foul taste in the mouth, and in some cases, the presence of a pimple-like bump on the gum near the affected tooth. If you experience any of these symptoms, it is important to seek dental attention promptly.

3. Treatment Options:
Treating chronic apical abscess aims to eliminate the infection and preserve the affected tooth whenever possible. The treatment options include:

a) Root Canal Therapy: This procedure involves removing the infected dental pulp, cleaning the root canal system, and sealing it to prevent reinfection. It is a common and effective treatment for chronic apical abscess, allowing the tooth to be saved.

b) Apicoectomy: In cases where root canal therapy is not successful or feasible, an apicoectomy may be recommended. This surgical procedure involves removing the infected tip of the tooth’s root and sealing the end to prevent further infection.

c) Extraction: In severe cases where the tooth cannot be saved, extraction may be necessary. After the extraction, your dentist may discuss options for tooth replacement, such as dental implants or bridges.

d) Antibiotics: Antibiotics may be prescribed to control the infection and prevent its spread. However, they are typically used as a temporary measure and are not considered a standalone treatment for chronic apical abscess.

Chronic apical abscess requires prompt dental intervention to prevent further complications. By understanding its causes, recognizing the symptoms, and seeking appropriate treatment options like root canal therapy or apicoectomy, you can effectively address this dental condition and restore oral health.