Tooth Abscess

Types of tooth abscess

• Periapical abscess: forms at the tip of the root after bacteria enter the pulp (the nerve and blood vessels inside the tooth), usually through deep decay or a crack. The most common type.
• Periodontal abscess: forms in the gum and bone beside the root, usually from gum disease (periodontitis).
• Pericoronal abscess: forms in the gum flap over a partly erupted wisdom tooth (pericoronitis).

Causes

• untreated tooth decay: the most common cause. Decay reaches the pulp, causing pulpitis, and the pulp dies and becomes infected
• cracked or broken teeth, letting bacteria in
• failed fillings, crowns or root canals
• gum disease with deep pockets
• trauma to a tooth, which can kill the pulp, sometimes years later
• impacted wisdom teeth

Risk factors

• poor oral hygiene and infrequent dental visits
• high-sugar diet
• dry mouth
• smoking
• diabetes and weakened immunity

Symptoms

• severe, persistent, throbbing toothache that may spread to the ear, jaw or neck
• pain when biting or chewing
• sensitivity to hot and cold
• swelling of the gum, cheek, jaw or face
• a small pimple or bump on the gum (a sinus tract) that may leak pus, often easing the pain
• a bad taste or bad breath
• fever and feeling unwell
• swollen, tender lymph nodes under the jaw or in the neck
• a loose or darkened tooth

Sometimes the pain suddenly stops. This can mean the nerve has died or the abscess has drained, but the infection is still present and needs treatment.

How a tooth infection can spread

Untreated, the infection can spread through the jawbone and into soft tissues:

• facial cellulitis: spreading redness and swelling of the face
• Ludwig angina: swelling of the floor of the mouth and neck that can block the airway
• deep neck infections and spread into the chest
• osteomyelitis: infection of the jawbone
• sinusitis from upper tooth infections
• cavernous sinus thrombosis: a rare, life-threatening clot behind the eyes from upper face infections
• sepsis: a body-wide reaction to infection

Diagnosis

A dentist will:

• examine and tap on the teeth to find the painful one
• test the tooth's response to cold
• take dental X-rays to show decay, bone loss around the root and the abscess
• use a CT scan in the hospital if a deep or spreading infection is suspected

Treatment

Dental treatment

• drainage: the dentist makes a small cut in the abscess or opens the tooth to let pus drain
• root canal treatment: removes the infected pulp, cleans and seals the canals, saving the tooth. A crown often follows
• extraction: removing the tooth if it cannot be saved
• periodontal treatment: deep cleaning for gum abscesses

Antibiotics

Antibiotics are not a substitute for dental treatment. According to American Dental Association guidance, they are used when infection is spreading (facial swelling, fever, swollen glands), when treatment must be delayed, or in people with weakened immunity. Penicillin-type antibiotics such as amoxicillin are common choices.

Hospital treatment

Severe or spreading infections need IV antibiotics, surgical drainage, and airway monitoring.

Home relief while waiting for the dentist

• pain relief: ibuprofen, alone or alternating with acetaminophen (paracetamol), at the label dose, is effective for dental pain. Avoid NSAIDs if you have kidney disease, stomach ulcers or take blood thinners
• warm salt-water rinses several times a day
• chew on the other side and avoid very hot, cold or sugary foods
• sleep with your head raised
• do not put aspirin directly on the gum, which burns the tissue
• do not try to pop the abscess yourself

Prevention

• brush twice a day with fluoride toothpaste and clean between teeth daily
• limit sugary foods and drinks
• see a dentist regularly, and treat cavities and cracked teeth early
• wear a mouthguard for contact sports
• do not smoke

Frequently asked questions

What are the signs of a tooth abscess?

Signs include severe throbbing toothache, pain when biting, sensitivity to hot and cold, swelling of the gum or face, a pimple on the gum that may drain pus, a bad taste, and sometimes fever and swollen neck glands.

Can a tooth abscess go away on its own?

No. The pain may ease if the abscess drains or the nerve dies, but the infection remains and can spread. A dentist must drain the abscess and treat the tooth with a root canal or extraction.

When is a tooth abscess an emergency?

Go to the ER for trouble breathing or swallowing, swelling under the tongue or in the neck, swelling spreading to the eye, high fever or confusion. These suggest a spreading infection that can be life-threatening.

Will antibiotics cure a tooth abscess?

Not on their own. Antibiotics can control spreading infection but cannot reach the source inside the tooth. The abscess comes back unless the tooth is treated with drainage, root canal treatment or extraction.