What is a tooth abscess?

A tooth abscess is a pocket of pus from a bacterial infection under your gums. An abscess usually looks like a red or purple, swollen bump, boil or pimple, but some abscesses are deep within the bone and not visible in the mouth. An abscess can start from a tooth or gum infection, but can also spread to surrounding bone and neighboring teeth. Abscesses can occur in different places in the mouth for different reasons.

Three types of tooth infections can cause abscesses:

1. Gingival: This infection develops in your gums. It may not affect your tooth or supporting structures, but can after prolonged infection.

2. Periapical: A periapical abscess is an infection that forms at the tip of root of your tooth. If you have a tooth that’s fractured or decayed, bacteria can enter your tooth and spread throughout your tooth and into the pulp. (The pulp is the innermost part of the tooth that contains nerves and blood vessels.) When bacteria infiltrate the pulp, infection can spread to the tip of your tooth’s root, then, eventually to the surrounding bone, causing the formation of an abscess.

3. Periodontal: This infection starts in the tissues and bone that support your teeth. A periodontal abscess usually results from gum disease and is more common amongst adults.

How does a tooth abscess affect my oral and overall health?

When left untreated, a tooth abscess can spread to your jawbone, the soft tissues of your face and neck, and beyond. In extremely rare cases, the infection can travel to your heart (endocarditis) and brain (bacterial meningitis).

Who gets abscessed teeth?

You’re more likely to develop an abscessed tooth if you:

• Have dry mouth (xerostomia): Bacteria thrive in a mouth with a low amount of saliva. This is very common for patients taking certain medications, diseases, and as patients age.

• Smoke: People who smoke are about twice as likely to get tooth abscesses as people who don’t.

• Have poor oral hygiene: Regular brushing, flossing and dental cleanings can reduce bacteria.

• Have a weakened immune system: Diseases or medications can lower your immune response, making it harder to fight off germs.

Symptoms and Causes

What are the symptoms of an abscessed tooth?

If you have a tooth abscess, you might describe your pain as:

• Aching or throbbing.

• Sharp or shooting.

• Continuous or only when chewing.

• Radiating to your jawbone, neck or ear.

• Having pain that comes and goes.

Other tooth abscess symptoms may include:

• Tooth sensitivity to hot or cold temperatures.

• Bad taste in your mouth.

• Bad breath (halitosis).

• Gum redness and swelling.

• Loosening of the affected tooth or associated fillings/crowns.

• Swollen area in your upper or lower jaw.

• Open, draining sore on the side of your gums.

In addition, you may experience more generalized symptoms like:

• Fever.

• Swollen lymph nodes.

• General discomfort, uneasiness or ill feeling.

What causes a tooth abscess?

Anything that creates an access or opening for bacteria to get into your tooth or surrounding tissues can lead to an abscessed tooth. Causes include:

• Severe cavities: A cavity (tooth decay) is the destruction of your tooth’s hard surface. This occurs when bacteria break down sugars in food and drink, creating acid that breaks down enamel.

• Broken, cracked, or chipped fillings, crowns, or teeth: Bacteria can seep into any opening in a tooth and spread to the pulp.

• Gum (periodontal) disease: Gum disease is an infection and inflammation of the tissues around the teeth. As gum disease progresses, the bacteria can access deeper tissues.

• Injury to the tooth: Trauma to a tooth can injure the inner pulp even if there’s no visible crack. The injury makes it susceptible to infection.

Diagnosis and Tests

How is an abscessed tooth diagnosed?

In addition to examining the tooth and surrounding tissue for signs of infection, your dentist may:

• Recommend a dental X-ray: This can help identify sources of dental disease that may have led to the infected tooth. Your dentist can also use X-rays to determine if the infection has spread and may be affecting other areas.

• Recommend a CBCT scan: If the infection has spread to other areas within your neck, this will help to identify the extent of the infection.

• Tap and press on your teeth: A tooth with an abscess is often sensitive to touch or pressure.

• Thermal tests: These tests will help your dentist determine the health of your tooth pulp.

Management and Treatment

How do you treat a tooth abscess?

Goals of treatment are to eliminate the infection and prevent complications. Tooth abscess treatment options include:

• Incision and drainage: Your dentist makes a small incision (cut) in the abscess to drain the pus. They may also place a small rubber drain. This helps keep the area open so the rest of the infection can drain out.

• Root canal: This helps eliminate infection and save your tooth. This common procedure removes your tooth’s infected pulp, and fills the space with material to prevent another infection. The pulp is important when the tooth is growing, but once it’s mature, the tooth can survive without the pulp. After the procedure, your tooth should be back to normal, though you may need a dental crown to protect the root canal. If you care for the restored tooth properly, it can last a lifetime.

• Tooth extraction: Sometimes, an abscessed tooth becomes damaged beyond repair. In these cases, your dentist may need to extract (pull) your tooth.

• Antibiotics: Your dentist may recommend antibiotics to help with your treatment. It’s important to know that while this medication may help fight off remaining bacteria, it won’t get rid of the cause of the infection, which is the affected tooth.

How soon after tooth abscess treatment will I feel better?

A tooth abscess should clear up after treatment. Temporary sensitivity is common, and it may take a few days to feel completely back to normal. As every case is unique, healing times can vary. Ask your dentist what to expect after your tooth abscess treatment.

Can a tooth abscess go away by itself?

A tooth abscess won’t go away on its own. Pain may stop if an infection causes the nerve inside your tooth to die. The pain stops because the nerve isn’t functioning anymore, so you may not be able to feel it. However, the bacteria will continue to spread and destroy surrounding tissue. If you have tooth abscess symptoms, see your dentist even if you no longer have pain.

How long can a dental abscess go untreated?

Left untreated, a tooth abscess will eventually spread to the surrounding tissues and beyond, wreaking havoc on your oral and overall health. It can take weeks or months for the infection to spread — and it’s impossible to know exactly how long that will take. Because tooth abscesses don’t go away on their own, it’s crucial that you see a dentist as soon as possible.

Prevention

How can I reduce my risk for tooth abscesses?

You can reduce the risk of developing a tooth abscess by seeing your dentist routinely and getting regular dental check-ups and cleanings. It’s also important to see your dentist if a tooth becomes loose or chipped. Proper oral hygiene is essential for dental health. At home, brush your teeth twice a day and floss once a day.

How can I relieve the pain of a tooth abscess?

Tooth pain is a sign that you should see your dentist. While you wait for your appointment, warm saltwater rinses and over-the-counter pain relievers (such as acetaminophen, naproxen or ibuprofen) can ease discomfort. It’s important to note that there is no home remedy that can permanently solve a tooth abscess.

Outlook / Prognosis

When should I see a dentist?

If you develop mouth pain, a toothache or a red, swollen bump on your gums, schedule an appointment with a dentist as soon as possible. The sooner you get treatment, the less likely it is that the infection will spread beyond your tooth.

When should I go to the ER?

You should head to the emergency room if you have a tooth abscess accompanied by:

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.

• Trouble swallowing.

• Trouble Breathing

• Facial or jaw swelling.

• Mental confusion.

• Elevated heart rate.

What questions should I ask my dentist?

• Are my symptoms caused by an abscess?

• What tests will I need to be evaluated?

• How can we best address my problem?

• Are there any alternative treatment options?

A tooth abscess is an area of bacterial infection that can damage oral tissues and spread to other areas of your body. It is important to see your dentist routinely and avoid putting off regular check-ups, as prevention is of utmost importance. Regular visits give your dentist a chance to spot issues early, when they may be simpler to treat. If you’re experiencing pain, it’s important to see your dentist to get the care you need.