Abscess Tooth Stages
What You Should Do at Each Stage?

Last Updated: 9.02.2024

Author: George Ghidrai, MD  

A tooth abscess can create significant discomfort and worry, especially in severe cases. In this article, you will learn about the different stages of an abscessed tooth.

You will discover the signs and symptoms you may experience at each stage and what actions you should take. You will also learn about the best treatment options and find answers to other important questions you might have.

Contents [ hide ]

• What is a tooth abscess?
• Abscess Tooth Stages
• 1. Tooth decay
  • What are the signs and symptoms you may experience?
  • What actions should you take at this point?
• 2. Dental pulp infections
  • What are the signs and symptoms you may experience?
  • What actions should you take at this point?
  • What procedures will your dental practitioner perform?
• 3. Abscess formation
  • What are the signs and symptoms you may notice at this stage?
  • What should you do at this stage?
  • What can you do to relieve your symptoms?
  • What can you do to reduce the swelling from an abscessed tooth?
  • What procedures will your dentist or oral surgeon perform?
  • What happens to the abscess after the tooth extraction?
• 4. Sepsis
• 5. Tooth loss
• Conclusions

What is a tooth abscess?

A tooth abscess is a localized collection of pus associated with a tooth. It can form inside the teeth, in the gums, or in the bone that holds the teeth in place.

A tooth abscess is a bacterial infection caused by tooth decay, broken teeth, or gum disease. A failed root canal treatment or a broken dental restoration (filling or crown) may also create a dental abscess.

Abscess Tooth Stages

Five main stages may occur in the case of abscessed teeth. The abscess itself is one of the later stages of this process.

1. Tooth decay

   Tooth decays are the starting point of any dental infection. Dental plaque buildup around your teeth and gums is the main factor that leads to dental cavities.

2. Dental pulp infection

   Dental pulp diseases occur when bacteria from tooth decay reach the dental pulp. Bacteria inside the pulp can cause permanent damage, leading to infections that can eventually spread to the surrounding tissues.

3. Abscess formation

   Most of the time, an abscess is a direct complication of dental pulp decay. Abscess formation is one of the body's natural defense mechanisms. It prevents the infection from reaching other, more vital areas.

4. Sepsis

   Sepsis is when bacteria from the abscess spreads to the bloodstream, potentially causing life-threatening infections. Fortunately, a tooth abscess rarely triggers sepsis, at least when the patient doesn't have some severe medical conditions.

5. Tooth loss

   If left untreated, an abscess can cause advanced bone loss around the tooth, resulting in tooth loss.

Before we detail every stage, here are some important considerations:

• A tooth abscess develops gradually, and the infection may progress undetected for months or even years.
• The abscess phases listed above are not predetermined. For example, dental pulp infections can sometimes lead to other conditions, such as chronic apical periodontitis.
• In the case of proper treatment in the first two stages, tooth abscess progression stops.
• Sepsis is a life-threatening infection that requires immediate attention.

Here is a look at all the abscess stages in more detail:

1. Tooth decay

Dental decay is the most common condition that occurs in humans. Tooth decay and its complications represent the number one cause of tooth loss.

Based on the evolution, there are two types of tooth decays:

• Enamel decay: only damages the enamel, which is the outermost layer of the tooth.
• Dentin decay: when the decay affects both tooth enamel and dentin. Dentin is the second layer of the tooth positioned between the enamel and the dental pulp.

What are the signs and symptoms you may experience?

You may not be aware of the disease in the first stages. However, once the decay passes through the enamel and reaches the dentin, you may feel mild pain. Moreover, tooth sensitivity may temporarily worsen with exposure to heat, cold, or sweet foods and drinks.

As for the clinical signs, the earliest sign is a chalky white spot on the tooth's surface (enamel decay).

As the lesion progresses, it can change its color to brown. The decay will eventually evolve into a cavity, gradually becoming more noticeable (dentin decay).

What actions should you take at this point?

If you notice any of these signs or symptoms, visiting your dentist as soon as possible is best. Once your dental practitioner treats your cavity, the progression stops. The decay can no longer evolve into a tooth abscess.

2. Dental pulp infections

Bacteria from dental cavities can gradually break through the enamel and dentin and reach the pulp. This will determine infections in the dental pulp tissues, known as pulpitis.

What are the signs and symptoms you may experience?

Tooth pain is the most common symptom associated with pulp infections. In addition, you may experience:

• prolonged sensitivity to cold and heat
• increased sensitivity to sweets
• lingering pain after the removal of a stimulus
• referred pain: when you feel the pain in an area near the affected tooth

The bacteria inside the pulp will attack the tooth's nerves, causing them to die. As a result, the damage to the nerve can mean that sometimes, you first feel severe pain, then nothing at all.

What actions should you take at this point?

You can try some over-the-counter pain relievers, but they will only ease your pain for the short term. Make an appointment with your dental care provider. Do not use antibiotics, as they are generally useless at this stage.

What procedures will your dental practitioner perform?

Your dentist will perform root canal therapy on your damaged tooth. During the procedure, he will remove the entire pulp and replace it with a root canal filling.

The root canal will eliminate the infection from the tooth and stop the abscess progression.

When the tooth is severely damaged and can no longer be restored, your doctor will remove the tooth.

3. Abscess formation

The abscess formation is one of the later stages of the tooth decay evolution. The process begins when the germs have entered the pulp or moved deeper into the jawbone or the tissues that support the tooth.

What are the signs and symptoms you may notice at this stage?

When an abscess develops inside your mouth, the symptoms you may notice include:

• An intense, throbbing pain near the tooth that may get gradually worse
• Pain that spreads to the ear, jaw, face, and neck on the same side as the affected tooth
• Pain can get worse:
  • when chewing on the side of the affected tooth
  • when lying down, which may disturb your sleep
  • when touching the tooth
  • when putting pressure or warmth on the tooth
• Bad breath and an unpleasant taste in your mouth
• In some cases, you may find it hard to open your mouth fully and have difficulty swallowing
• Shiny, red gums and swelling in the face
• The swelling that you may often see as a "bump" on your gums
  • An abscess can form relatively quickly – it can take as little as one to three days after you observe your first signs of infection
• Fever, in case of severe abscesses

What should you do at this stage?

Patients with tooth abscesses should see a dentist as soon as possible. Dental abscesses never go away on their own.

Moreover, they can spread to other parts of the body and create serious complications. The infection can also become chronic, lasting for months or even years.

Avoid visiting a General Practitioner, as they can do little to help (maybe prescribe you some painkillers).

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What can you do to relieve your symptoms?

While you're waiting to see your dental care provider, some actions may help in relieving your symptoms:

• Painkillers can help control your pain. Ibuprofen proved to be an effective painkiller for dental abscesses, but some patients are unable to take it for medical reasons.

  If this is the case, you can take Acetaminophen instead. Avoid giving Aspirin to children under 16.

  Alternative analgesics are accessible. If you are uncertain about which medication to take, consult your physician. You should always check the medicine leaflet before.

• Avoid hot or cold food and drink, which will worsen the pain.

• Attempt to consume soft foods using the opposite side of your mouth.

• Use a soft toothbrush and temporarily avoid flossing around the affected tooth.

• You can rinse your mouth several times daily with a mild salt-water solution. Combine one-half teaspoon of salt with water in a glass. This may help draw the pus out and relieve pressure.

These measures can help relieve your symptoms temporarily, but you shouldn't use them to delay getting help from a dentist.

What can you do to reduce the swelling from an abscessed tooth?

Try placing a cold compress on the outside of your cheek. You may also use ice, but keep a small towel between it and your skin to prevent injury. Do this for 10-20 minutes at a time.

What procedures will your dentist or oral surgeon perform?

a. Drain the abscess

The first goal of professional treatment is relieving the symptoms and reducing the risk of spreading the infection. The area is thoroughly cleaned, and the trapped pus must be allowed to escape.

The dentist makes a small cut (incision) in the gum to let the pus drain. Sometimes, he places a small drain to facilitate drainage and reduce swelling.

Your doctor may prescribe antibiotics to help the abscess heal and keep the infection from spreading. Antibiotics may not be necessary if the infection is limited and your overall health is good.

b. Root canal treatment

After the symptoms are relieved, you will need root canal therapy to save the tooth. A root canal treatment can take several appointments to be completed.

Once the treatment is successful, the tooth will be restored with a filling or a dental crown.

c. Tooth extraction

If the tooth cannot be saved, your dentist or oral surgeon will extract it and drain the abscess to eliminate the infection.

What happens to the abscess after the tooth extraction?

Following the removal of your tooth, the abscess begins to heal. Your body will naturally fight off the infection, gradually eliminating the pus pocket.

Depending on the size and severity of the abscess, the healing process might take a few days or weeks.

4. Sepsis

Without treatment, the infection can sometimes spread to other body parts. This condition is called sepsis and requires immediate attention.

How can I tell if my tooth abscess is spreading?

An abscessed tooth rarely triggers sepsis, particularly when your health is good. People suffering from severe diseases affecting their immune system are at a higher risk.

However, sepsis can cause life-threatening infections when it does occur, and it is an immediate emergency.

As a result, if you notice any of these symptoms, it is crucial to make an appointment with your dentist or oral surgeon. In case of severe symptoms, call 911.

• High fever or chills
• Severe headache
• Difficulty breathing
• Fast breathing
• Fast heartbeat
• Swelling of the neck, cheeks, or face
• Painful mouth and tongue
• Severe muscle pain
• Nausea or vomiting
• Double vision or loss of vision
• Drooping eyelids
• Feeling dizzy or faint
• Confusion
• Loss of consciousness

5. Tooth loss

An untreated dental abscess can gradually affect the bone and the tooth's supporting tissues, eventually leading to tooth loss.

Conclusions

A tooth abscess is definitely something you want to avoid. If it does happen, you want to keep it under control and prevent damage to other parts of your body.

The best way to do this is to take the proper steps to prevent dental abscesses:

• Maintaining regular and proper oral hygiene is the most efficient way to avoid any type of tooth abscess
• Schedule periodic dental appointments with your dentist
• Treat your cavities as soon as possible, before the bacteria penetrates the dental pulp, to limit the complications