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; it has the origin in a bacterial infection.
A tooth abscess can be caused by tooth decay, broken teeth or extensive periodontal disease (or combinations of these factors). A failed root canal treatment or a broken dental work (filling, crown etc) may also create a dental abscess.
It is important that patients get professional help as soon as possible because abscesses don't go away on their own. Moreover, they can sometimes spread to other parts of the body and create some serious complications.
Types of tooth abscesses
The most common type of dental abscess is a periapical abscess (also known as tooth-related abscess), and the second most common is a periodontal abscess (or gum abscess). The main difference between the two is the origin of the infection.
Gum abscess or periodontal abscess
The gum abscess is caused by an infection in the space between the tooth and gum. The infection may occur after food gets trapped between the gum and tooth.
People with poor oral hygiene or gum disease have a higher risk of developing such an abscess because a large number of bacteria can build up under the gum and in the bone.
Most times, the gum abscess forms on the side of the tooth and closer to the gingival margin.
The periapical abscess is caused by an infection inside the tooth. Bacteria from inside a tooth decay can penetrate the enamel and dentin to reach the dental pulp (or the tooth's nerve).
If the pulp infection is not properly treated, it can spread through the root canal from the pulp to the periapical tissue, which is located around the apex of the tooth's root.
The periapical abscess shows up at the tip of the tooth's root and spreads to the surrounding bone.
Signs and symptoms
Tooth abscesses can form very quickly. Most abscesses are painful but this is not always the case. In some cases, abscesses may be painless (or cause little pain) but still have a swelling present on the gum. It is important to get anything that shows like this checked by a dental professional to avoid any complications.
Symptoms of an abscess in your tooth or gum may include:
- an intense, throbbing pain in the affected tooth or gum that may come on suddenly and gets 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 affected tooth
- when putting pressure or warmth on the tooth
- bad breath and/or an unpleasant taste in your mouth
- in some cases, you may find it hard to fully open your mouth and have difficulty swallowing
- the swelling (which is the collection of pus) may be present at either the base of the tooth, the gum, and/or the cheek
- shiny, red and swollen gums
- the affected tooth can change color and become loose
- if the infection spreads, you may also develop a high temperature (fever), a bad migraine and feel generally unwell
- the lymph glands in the neck may become swollen and tender in response to the infection
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 or become chronic, where the infection can last for months or even years.
Avoid visiting a General Practitioner, as there is little they can do to help (maybe prescribe you some painkillers).
What can you do to relieve your symptoms ?
While you're waiting to see a dentist, 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 Paracetamol instead. Avoid giving Aspirin to children under 16.
There are other painkillers available. If you are unsure what to take, try asking your GP. You should always check the medicine leaflet before.
Avoid hot or cold food and drink as they will make the pain worse.
Try eating cool, soft foods if possible, using the opposite side of your mouth.
Use a soft toothbrush and temporarily avoid flossing around the affected tooth.
You can also rinse your mouth several times a day with a mild salt-water solution. Use 1/2 teaspoon of salt in a glass of water. 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 your dentist will do
The first goal of the professional treatment is relieving the symptoms and reducing the risk of further spread of the infection. For that, the area is thoroughly cleaned and the trapped pus must be allowed to escape.
If the infection started inside a tooth, the dentist will make a small hole in the tooth. This allows the abscess to drain. The tooth will then need root canal treatment, followed by a filling or a crown.
When the abscess is larger, the drainage through the tooth is not sufficient. In this case, the dentist makes a small cut (incision) in the gum to drain the abscess.
The dentist may prescribe antibiotics and/or painkillers. These drugs will help the abscess heal and keep the infection from spreading.
Depending on the location of the abscess and how severe the infection is, there are two possible treatment approaches:
Root canal treatment
If the tooth can be restored, root canal therapy is needed to save the tooth. A root canal treatment can take several appointments to be completed.
Once the treatment is successfully completed, the tooth will be restored with a filling or a dental crown.
If the tooth cannot be restored or root canal treatment is not possible, an extraction is performed followed by curettage of all apical soft tissue.
In most cases, a gum or a periodontal abscess occurs in people with periodontal disease. Draining the abscess helps the immediate problem. However, the periodontal disease needs to be treated to prevent another infection (see gum disease and periodontitis).
Preventing tooth abscesses
You can reduce the risk of developing dental abscesses by keeping your teeth and gums as healthy as possible. Check out our preventive dentistry page to see how to accomplish that.
Another important aspect is to treat your tooth decays as soon as you (or your dentist) notice them before the infection can spread to the pulp. Remember that dental caries can be stopped by treatment.
Last review and update: February 2019