In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect additional canals that were not adequately treated and can clear up the infection by doing a second root canal procedure, thus avoiding the need for an apicoectomy.

An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

An apicoectomy may be needed when an infection develops or persists after root canal treatment,or retreatment. During root canal treatment, the canals are cleaned, and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.

An apicoectomy is sometimes called endodontic microsurgery because the procedure is done under an operating microscope.

Fluoride  strengthens teeth by penetrating the tooth structure and replacing lost minerals to repair acid damage. Everyone should brush with a fluoride toothpaste every day. Dental offices sometimes recommend additional toothpastes, gels and mouthrinses for both children and adults. Sealants are protective coatings placed over the tops of chewing teeth — molars and premolars. They block bacteria and acids from sticking in the tiny grooves on the chewing surfaces of these teeth. Children should get sealants soon after their teeth erupt into the mouth.

Although you can never get rid of all the bacteria in your mouth, you can control bacteria by brushing regularly and flossing daily, seeing your dentist and dental hygienist regularly for a thorough cleaning and check-up, and reducing the number of times each day that you consume fermentable carbohydrates.
Some prescription mouthwashes (those that contain chlorhexidine) can help prevent decay by reducing the number of bacteria in the mouth. Chewing sugarless gums, especially those with xylitol, can help reduce decay and increase the flow of saliva.

In young children, teeth that have recently emerged have weak enamel and are highly susceptible to acid decay. A type of decay called baby bottle tooth decay or early childhood caries destroys enamel quickly and is common in children. This type of decay can eat through enamel and leave a large cavity in a matter of months.

Older adults sometimes have chronic caries: cavities that don’t seem to get any worse or do so at a very slow rate. Teeth with chronic caries will tend to be darker in color because the edges of the cavities become stained from normal eating and drinking.

Root caries (decay in the roots of the teeth) is more common in older adults. Older adults are more likely to have gums that have receded from years of hard brushing or periodontal disease. They also are more likely to have dry mouth (xerostomia), which increases the risk of decay. Dry mouth is caused by many common medicines. Be sure to ask the doctor or pharmacist if any of your medicines cause dry mouth.

Decay can form beneath fillings or other restorations, such as crowns. Sometimes, bacteria and food particles can slip into a tooth if a filling hasn’t been placed properly or if the filling cracks or pulls away from the tooth, leaving a gap.

It’s not just candy and ice cream we’re talking about. All carbohydrate foods, as they are digested, eventually break down into simple sugars, such as glucose and fructose. Some of this digestion begins in the mouth. Foods that break down into simple sugars in the mouth are called fermentable carbohydrates. These include the obvious sugary foods, such as cookies, cakes, soft drinks and candy, but also pretzels, crackers, bananas, potato chips and breakfast cereals. The sugars in these foods combine with the bacteria normally in the mouth to form acids. These acids cause the mineral crystals inside the teeth to begin to dissolve.

The dental caries lesion forms when these acids start to dissolve a tooth’s outer protective layer, the enamel. A cavity forms when the tooth decay breaks through the enamel to the underlying layers of the tooth. You can reverse a caries lesion (before it becomes a cavity) by using a variety of fluoride products. These include fluoridated water, fluoride rinses for use at home, and, of course, any commonly used fluoridated toothpaste.

Every time you eat, the bacteria in your mouth produce acid. Therefore, the more times you eat the more times your teeth are exposed to an acid attack.

- Saliva: Your mouth and teeth are constantly bathed in saliva. Although we never give much thought to our spit, this simple fluid is remarkable for what it does to help protect our oral health. Saliva keeps teeth and other oral tissues moist and lubricated, washes away some of the food particles left behind after we eat, keeps acid levels in the mouth low, and protects against some viruses and bacteria.

- Plaque: Plaque appears as a soft, gooey substance that sticks to the teeth a bit like jam sticks to a spoon. It is, in fact, colonies of bacteria, protozoa, mycoplasmas, yeasts and viruses clumping together in a gel-like organic material. Also in the mix are bacteria byproducts, white blood cells, food debris and body tissue. Plaque grows when bacteria attach to the tooth and begin multiplying. Plaque starts forming immediately after a tooth is cleaned; it takes about an hour for plaque to build up to measurable levels. As time goes on, different types of microorganisms appear, and the plaque thickens.

- Calculus: If left alone long enough, plaque begins to mineralize and harden into calculus or tartar because the plaque absorbs calcium, phosphorus and other minerals from saliva. These minerals form crystals and harden the plaque structure. New plaque forms on top of existing calculus, and this new layer can also become calcified.

- Bacteria: We have many different strains of bacteria in our mouths. Some bacteria are good; they help control destructive bacteria. When it comes to decay, Streptococcus mutans is the bacterial strain that does the most damage. It attaches easily to teeth and produces acid.

Prognosis
The outlook is excellent if detected promptly and treated appropriately.

Once the abscess is drained, most symptoms go away immediately or within a few days, but the abscess will not be cured unless the cause is eliminated.

Prevention

Good oral hygiene can help prevent abscesses by keeping teeth and gums free of food and debris. Regular dental checkups are also important. If you have a weakened immune system because of medication or another condition, let your dentist know before every appointment. You may receive antibiotics before the appointment to reduce the risk of infection.

Treatment

Saving an abscessed tooth begins with draining the infection, which usually relieves pain and removes much of the infection. Root canal treatment may be necessary and should be started as soon as possible to remove diseased tissue.
If the abscess involves gum tissue, your dentist may suggest that you rinse with warm salt water (1/8 of a teaspoon of salt in 8 ounces of water) a few times a day for several days. You may be prescribed antibiotics to help make sure the infection has been eliminated. Have dental X-rays performed six months later to confirm if healthy bone and tissue are filling the area of the abscess. If the bone does not fill in after the treatment, you may need to visit a periodontist who can surgically reshape the gum so that it is easier to keep clean, or an endodontist who can surgically remove a persistent abscess.

The main symptom is persistent, throbbing pain. At first, the tooth will be sensitive to heat and pressure while chewing. Later, you may develop a fever. Swollen lymph nodes under the jaw or in the neck can be tender and you may feel pain in the sinus area. If the abscess ruptures, a sudden rush of foul-smelling and foul-tasting fluid will spill into the mouth.

Diagnosis

Usually, your dentist can diagnose a tooth abscess by examining your mouth. He or she may push on the swollen area of the gum and do a pulp test on the affected tooth to see if it is still alive. A pulp test can involve:

- Gentle tapping (percussion) on the tooth
- Temperature testing
- Using an electric tester on the tooth

Your dentist also may take an X-ray to look for bone erosion around the tip of the tooth’s root.

Abscesses can form in almost every part of the body. In the mouth, abscesses form in gum tissue or in the roots of teeth and in the surrounding areas of the tooth. They can be caused by trauma (food or debris embedded deep in the gum), by bacteria that enters through a cavity and gets into the dental pulp, or from a deep periodontal pocket. People with a lowered resistance to infection are at increased risk of developing an abscess. At first, the abscess may cause a toothache, which can be severe. The tooth’s nerve can become infected and the infection can burrow through to the gum, forming a visible boil that can rupture in the mouth. Once the abscess ruptures, the pain often decreases significantly, but dental treatment is still necessary. If the abscess does not drain, the infection can spread to other areas of the head and neck and can become life threatening.