Phoenix abscess

Phoenix abscesses are believed to be due to a changing internal environment of the root canal system during the instrumentation stage of root canal treatment, causing a sudden worsening of the symptoms of chronic periradicular periodontitis. This instrumentation is thought to stimulate the residual microbes in the root canal space to cause an inflammatory reaction. These microbes are predominantly facultative anaerobic gram-positive bacteria, such as Streptococcus, Enterococcus and Actinomyces species.{{Cite journal|last1=Sakko|first1=Marjut|last2=Tjäderhane|first2=Leo|last3=Rautemaa-Richardson|first3=Riina|date=2016-05-01|title=Microbiology of Root Canal Infections|journal=Primary Dental Journal|volume=5|issue=2|pages=84–89|doi=10.1308/205016816819304231|issn=2050-1684|pmid=28826437|s2cid=21567336}} Another cause of a phoenix abscess is a decrease in a patient's resistance to these bacteria and their products.

• Pain

A common clinical feature is exacerbated and exaggerated pain. There may or may not be associated with pus & suppuration. The signs & symptoms are similar to that of an acute periradicular abscess, but with a periradicular radiolucency present as well.{{Cite journal|last=McClanahan|first=Scott B|date=2002|title=Pulpal and Periradicular Diagnostic Terminology|url=http://www.wrnmmc.capmed.mil/ResearchEducation/NPDS/Shared%20Documents/Clinical_Updates/2002/02_-_001%20Pulpal%20and%20periradicular%20diagnostic%20terminology.pdf|journal=Clinical Update|volume=24}}{{Cite journal|last=Shetty|first=Neeta|title=Mid Treatment Flareups in Endodontics|url=http://medind.nic.in/eaa/t05/i2/eaat05i2p20.pdf|journal=Endodontology}}

• Loss of Vitality

The problematic tooth will have a non-vital pulp with no previous symptoms.{{Cite web|url=http://www.ada.org/~/media/jcnde/pdfs/nbde_endo_note_dec12.ashx|title=NBDE Part II Endodontics Terminology|date=2012}} Vitality of teeth can be assessed through various means. Common tests would include ethyl chloride test or electric pulp test. Other examples of tests would be laser doppler flowmetry (LDF), pulse oximetry etc.

• Tender to Touch

The tooth is extremely tender to touch, and it may be high on occlusion as it may be extruded from the socket.

• Mobile

Mobility may be observed.

Radiographically, there will be a periapical lesion associated with the tooth. This lesion is normally existent prior to this episode. Widened periodontal ligament (PDL) space is visible.

For most situations urgent treatment is required to eliminate the pain and swelling.{{Cite news|url=https://www.toothiq.com/dental-diagnosis/phoenix-abscess/|title=Phoenix Abscess - ToothIQ|work=ToothIQ|access-date=2018-11-19|language=en-US}}

Further root canal treatment is often the best option. Firstly, the tooth should be accessed and thoroughly irrigated using sodium hypochlorite. Following this the canals should be dried using paper points.{{Cite journal|last=Carrotte|first=P|date=September 2004|title=Endodontics: Part 3 Treatment of endodontic emergencies|url=http://www.endoexperience.com/documents/EndodonticsPart3treatmentofendodonticemergencies.pdf|journal=British Dental Journal|volume=197|issue=6|pages=299–305|doi=10.1038/sj.bdj.4811641|pmid=15454989|s2cid=205672369|doi-access=free}} The tooth should then be debrided, and drainage established.

In certain circumstances it may be necessary to provide an antibiotic. These circumstances include the presence of a diffuse swelling or cellulitis, when immediate drainage cannot be achieved, or the patient has systemic involvement.{{Cite web|url=http://www.sdcep.org.uk/wp-content/uploads/2016/03/SDCEP-Drug-Prescribing-for-Dentistry-3rd-edition.pdf|title=SDCEP-Drug Prescribing for Dentistry 3rd edition|website=SDCEP}}

Analgesics may also be advised for pain control.

If the tooth is unrestorable then extraction may also be an option.

Adjusting the bite may provide some relief but this will not be a permanent solution to the problem.  

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Category:Acquired tooth disorders