Dear Dr. Reznik Thanks for this very informative and helpful format. I am a medical student and poz for two years. Over the last six months I have noticed a small localized swelling over my right front tooth. It is fluctuant at times and when I press it hard I can express some pus-y discharge and blood. Thereafter it seems to subside but only to recur. There is some erythema over that area as well. The only work I have had on my teeth is scaling over a year ago and some veneer work in the same area. I am scared of going to the dentist but would like your opinion. Thanks again and waiting to hear your thoughts.

What you have described sounds very much like the clinical results of an abscessed tooth. Many times a history of trauma to a tooth in the past can lead to the vital parts of the tooth (pulp tissue) dying, hence the abscess which would explain why this may be happening in the absence of any invasive dental work. You may or may not be in pain as the discharge you mention should relieve the pressure build-up.

My advice: Have a dentist x-ray the tooth in question. If there is an abscess it will be very visible on x-ray. If you do have an abscess the treatment would be a root canal, which is not as bad as it sounds. Since this tooth is already non-vital you should not have to worry about the pain people usually associate with root canals. A personal note: due to a car accident several years ago where I was hit head-on by a drunk driver I had to have 6 root canals, none of which were painful. There are more horror stories about root canal therapy than any other dental treatment, most of which are unfounded.

Take care and get to a dentist soon!

DR