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Dentistry/Root canal/abscess


My dentist says I need a root canal for an abscess. I had an abscess some years ago and know the pain and swelling symptoms of which I currently have NONE. Is it really possible to diagnose an abscess based solely on an x-ray with no symptoms?

Hi Frank and thanks for your question.

In reality, yes it is, especially if the problem has existed for some time and turned into a low grade chronic infection.  This type of infection we usually see with a tooth that has become non-vital or where the nerve has died - for whatever reason. The fact that the nerve has died within the tooth and the blood supply compromised, terminates all life and growth within that tooth and in time, the body will recognize the tooth as 'alien', hosting an immune response against it in a bid to keep the supposed antigens localized without spreading to further areas - hence the development of an abscess, usually at the tips of the roots or sometimes on the lateral aspect of a root.  Depending on the rate of development of this abscess, its size, proximity to vital structures and other teeth and ability to find a local drainage route for the accumulated pus, you may or may not experience related symptoms. Often, pus finds its way either via the ligament space between the tooth and bony socket or via a drainage sinus in the gum, which prevents any pressure build up at the site of the infection and therefore not much or no pain - remember that a non-vital tooth's nerve is dead, so you wont have any "classic tooth ache symptoms". To confirm the diagnosis, vitality tests can be performed on the suspected tooth - hot, cold and electrical to evaluate its response to stimuli. All 3 tests should be done on the same tooth and the results interpreted against a vital or control tooth in your mouth.  But as the evidence is clear on xray and a viable cause for the abscess has been determined, such as a large or deep filling, decay, fracture, trauma, perio disease, etc - I don't see any problem with what is proposed.  you can of course get another opinion to put your mind at rest.

I hope this helps and wish you all the best further, take care.

Kind regards
Dr Craig Peck


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Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)


I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.


I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

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