Periapical Lesions or Draining Sinus Home A-Z Health Information Health Library A-Z Periapical Lesions or Draining Sinus Overview A periapical tooth abscess refers to the formation of a pus-filled pocket of infection around the root of the tooth. The bacterial infection often spreads to the root of the tooth, resulting in inflammation4 Causes and risk factors The invasion of bacteria into the innermost part of the tooth, i.e., the dental pulp (which is rich in blood vessels, connective tissues, and nerves), can result in the formation of periapical abscesses; the bacterial cells often enter the pulp via a cavity or a chip/crack in the tooth and spread to the root, causing inflammation around the root tip (periapical tissue). At advanced stages, an abscess, which may sometimes drain into the oral cavity through a sinus, is formed. One is most likely to develop periapical abscess in the following scenarios:The patient has poor oral hygieneThe patient suffers from dry mouthThe patient consumes a lot of sugary foods and drinks4 Symptoms Severe throbbing toothachePain while chewing and bitingPain radiating to the ears, neck, or jaw Halitosis, i.e., bad breath and/or bad taste in the mouthFacial swellingFever Diagnosis Periapical lesions are usually diagnosed using the following methods:Physical examination: The dentist may examine the oral cavity to check for the following:swellings in the gumstenderness of tooth to percussionpresence of tooth cavityswollen and tender lymph nodesDental X-ray: The infected tooth or swollen region is examined via X-ray imaging to confirm the presence of periapical abscess.If patients experience any of the aforementioned symptoms (especially, when the symptoms are persistent), they are advised to contact their dentist as soon as possible. Treatment In case of a periapical abscess, the tooth may require the following treatments: Root canal treatment: The infected tooth pulp is cleaned and filled with a filling material.Tooth extraction or removal: In severe cases where the tooth cannot be salvaged, it might need to be extracted.Medication: Supportive pain killer and antibiotics may also be prescribed.