Diagnoses

Acute apical abscess

Establishing this diagnosis

The following criteria support this diagnosis:

• The term "phoenix" abscess implies that acute pain has arisen out of a chronic (long-standing) infection. The tooth now hurts when biting, chewing, or tapping on it.
• Swelling may or may not be present, depending on whether the intense pressure from the infection has been able to vent into or through the tooth's bony housing.
• Presence of fever and general malaise (feeling poorly)
• An X-ray image of the tooth may not show changes
• The patient's pain is typically relieved to some extent by application of cold substances to the affected tooth, and they often present to the dentist sipping ice water. Cold temperatures reduce the gas pressure created by bacteria which have infected the inside of the tooth.

A phoenix abscess has all of the same symptoms, but shows a dark area around the root on X-ray images. The term "phoenix" is an older term, and its use is becoming less commonplace in favor of more descriptive terms such as "chronic" (which generally features a lesion that can be seen on X-ray) and "suppurative", which means "draining". Drainage from infections can produce a bad taste and halitosis (bad breath).