Is your tooth persistently paining and disturbing your sleep? This might be due to a tooth abscess. Learn about its symptoms, causes, risk factors, and treatment.
An infection or collection of pus in a tooth, which has spread to its root or roots and the surrounding areas, is called tooth abscess or dental abscess. The pus is made up of white blood cells, tissues, and bacteria. The infection usually originates from the pulp, which is present in the tooth's innermost chamber. The pulp contains blood vessels and nerves. Infection or bacteria can reach the pulp through tooth decay, fractured tooth, or periodontal disease. When the tooth loses the ability to fight off infection, bacteria enter and multiply in the pulp. This bacterial infection spreads and exits through the tooth root into the surrounding structures.
An abscess can also be caused by bacteria that are present in plaque, which is the thin film that coats the tooth and is the by-product of food, saliva, and bacteria. This plaque can damage the gums and has to be removed with proper brushing and flossing. A failure to do this can result in bacteria spreading to the tooth or gums and an abscess. A tooth abscess can result in moderate to severe pain. This pain can also radiate to the ear or neck.
Abscesses do not tend to go away on their own, and you need to consult a dentist as soon as possible. Your dentist will drain the abscess and might perform root canal treatment to save the tooth. But in some cases, the tooth has to be extracted. If left untreated, a tooth abscess can spread and turn into a serious and life-threatening condition.
The common types of dental abscess are:
Periapical Abscess - An abscess that surrounds the tip or apex of the tooth’s root.
Gingival Abscess - An abscess on the gums.
Periodontal Abscess - The abscess spreads to the tissue and bone surrounding the tooth.
Combined Periodontic-Endodontic Abscess - A combination of periodontal and periapical abscess.
Pericoronal Abscess - It is an abscess in the tissue that encompasses or surrounds a tooth that has not fully erupted.
Tooth or gum abscess can result in the following symptoms:
Intense throbbing pain in the tooth or gums.
The pain can start suddenly and worsen gradually.
The pain can radiate to the jaw, ear, and neck.
The pain increases on lying down.
Pain while chewing.
Face or cheek swelling and redness.
The tooth might turn blackish and become tender or loose.
The gums turn red, swollen, and shiny.
The tooth is sensitive to cold and hot food items.
Unpleasant taste in the mouth.
The lymph nodes in the neck get swollen or tender.
You might also experience fever and malaise if the infection spreads too much. And in severe cases, swelling can restrict mouth opening and make swallowing and breathing difficult. Always consult a dentist before the infection spreads out of control, as it can result in life-threatening complications.
An abscess usually results from bacteria getting inside the tooth or gums. Depending on the type of abscess, the causes are:
Periapical abscess - Bacteria enters the tooth through tooth decay or fracture and reaches the pulp. From the pulp, the infection spreads and exits through the apex or tip of the tooth root.
Gingival abscess - Bacteria present on the tooth surface (plaque) and gums can enter the gums through injury.
Periodontal abscess - Gum abscess can spread and affect the surrounding tissue and bone.
Peicoronal abscess - Due to poor oral hygiene and the impaction of food in the space between the erupting tooth and surrounding gums, bacteria multiplies and results in an abscess.
The following are some factors that can increase the risk of dental abscess are:
Poor oral hygiene.
Consuming a diet rich in sugar.
Frequent snacking and eating between meals.
Drinking aerated drinks and other sugary beverages.
Having a dry mouth. This is because saliva flushes out food debris and bacteria.
Bruxism (grinding or clenching teeth).
Other dental or tooth injuries.
A dentist can determine the presence of a dental abscess based on:
The patient’s signs and symptoms.
Examining the tooth by tapping on it. An abscessed tooth will pain on touch and pressure. The dentist will also check if the tooth is mobile or not.
Dental X-rays - The dentist might suggest getting an IOPA (intraoral periapical radiograph), which will help identify an abscess. He or she might also suggest an OPG (orthopantomogram) to check how much the infection has spread.
CT scan - In case there is swelling in the neck, a CT might be needed to determine the extent of infection.
The treatment options include:
1) Home Remedies:
Try the following tips to reduce pain:
Avoid drinking too hot or too cold food and drink.
Do not chew on the side of the abscessed tooth.
Avoid flossing around the infected area.
Brush with an ultra-soft toothbrush.
Use lukewarm saline (salt) water to rinse your mouth.
These remedies will only provide temporary relief. Getting an abscess treated by a dental professional is important.
2) Incision and Drainage - The dentist will open up the abscess by making small incisions on the surface. This will drain the pus. Then the area is washed with saline water. In severe cases, a rubber is placed inside the incision to drain pus and reduce swelling.
3) Root Canal Treatment - The infected tooth is saved with the help of root canal treatment. The dentist drills a hole on the tooth to access the pulp. The infected and necrosed tissue in the pulp is removed, and the pus is drained (periapical pus). Then the pulp chamber is filled with a biocompatible material, and the tooth is covered with a crown.
4) Extraction - In case the dentist cannot save the affected tooth, it has to be pulled out, and then the abscess is drained.
5) Antibiotics - After the abscess has been drained, the dentist will prescribe antibiotics if the infection has spread to the nearby teeth and bone. The commonly prescribed antibiotics are Amoxicillin and Metronidazole.
6) Foreign Object Removal - If the cause is a foreign object in the gums, the dentist will remove it and clean the area with saline.
Some of the possible complications, if a dental abscess is not treated, are:
Dental Cysts - It is a fluid-filled cavity that may develop at the apex of the tooth’s root. This cyst can get infected, and you might need surgery.
Ludwig’s Angina - Intense swelling and pain in the neck and under the tongue due to the spread of infection on the floor of the mouth. In severe cases, the airway can swell and cause breathing difficulties and death.
Maxillary Sinusitis - Infection of the small spaces called the maxillary sinuses that are present behind the cheekbones.
Osteomyelitis - The infection spreads to the bone near the site of the abscess. It results in fever, severe pain, and nausea. The infection can also spread to the bloodstream and affect any bone in the body.
Cavernous Sinus Thrombosis - Infection results in a blood clot at the large vein present at the base of the skull called the cavernous sinus. It is a very rare complication and can be fatal.
Most dental infections can be prevented with good dental habits, which include:
Brush your teeth using a soft brush and fluoridated toothpaste for 2 minutes, twice a day.
Using dental floss, clean the spaces between all your teeth at least once daily.
Avoid snacking in between meals and do not drink sugary and aerated drinks.
Consult your dentist and get your teeth cleaned every 6 months.
To know more, consult a dentist online!
The presence of intraoral swelling (also extraoral swelling) around the affected tooth, pus discharge from the affected tooth and its nearby structures, and erythema are certain signs to look for to identify dental abscess in the mouth.
Dental abscess presents with,
- Throbbing, intense pain.
- Extraoral and/or intraoral swelling in relation to the affected tooth.
- An increased temperature at the site of extraoral swelling.
- Palpable and tender localized lymph nodes.
- Localized erythema.
- Pus discharge.
- Difficulty opening mouth.
- Bad breath.
- Sensitivity of the affected tooth and region to hot or cold foods.
- Facultative anaerobes →Viridans group streptococci.
→Streptococcus anginosus group.
- Strict anaerobes →Prevotella species.
Dental abscesses do not heal on their own until the root of infection is eliminated and treated.
Antibiotics and drainage of the abscess help reduce the swelling temporarily. Still, permanent treatment must be sought to get rid of swelling permanently.
While waiting to get a dentist’s appointment, you can manage your tooth abscess pain with painkillers like Ibuprofen and Paracetamol. Do not floss the affected teeth and avoid hot or cold foods and drinks. Also, avoid chewing with the affected side.
Untreated abscesses causing fever, enlarged and painful lymph nodes, difficulty swallowing and opening mouth, breathing difficulties, large swelling, drooling mouth, and severe uncontrollable pain need immediate medical attention.
Yes. If a dental abscess is left untreated, it causes potentially life-threatening events like septicemia or sepsis, cellulitis, cavernous sinus thrombosis, brain abscess, and death.
Ignoring a tooth abscess can eventually lead to sepsis. Localized dental infection upon left untreated spreads to the nearby structures and into the bloodstream leading to sepsis.
Removing the source of infection is the primary aim of treatment. Abscessed teeth have infections in the tooth apex (periapical) and in the structures supporting the teeth (periodontal). Hence root canal therapy and deep scaling and root planing are the preferred choices of treatment. But if the tooth is loosely moving and mobile, tooth extraction is the only treatment option.
Antibiotics are not given to cure dental abscesses. Your dentist may prescribe antibiotics alone or in adjunct to drainage to prevent the spread of the infection to its nearby structures. Your dentist will decide the duration and dosage of antibiotics based on your health and abscess condition.
Antibiotics like Amoxicillin, Metronidazole, and Clindamycin help prevent infection spread. However, these are not permanent solutions, and eliminating the source of infection is of prime concern.
Dental abscesses tend to burst at times. If it happens, allow the pus from it to drain and rinse your mouth with warm water. Consult your dentist for complete drainage and management as the infection is still present.
- If immediate treatment of the abscess is not possible at the dentist, they might perform drainage of the abscess.
- Root canal treatments.
- Deep scaling and root planing.
- Teeth extraction.
- Painkillers and antibiotics.
Draining of dental abscesses must be carried out in a hospital setting. For abscesses that have not reached the external skin surface, a small cut is made intraorally near the affected tooth on the fluctuant portion of the swelling after the region is numbed with a local anesthetic solution. For large infections, drains are secured into the abscess space with sutures to drain. The pus is allowed to drain and copiously irrigated with sterile saline.
Dental abscesses need immediate treatment. If they go untreated, the risk of the infection spreading to the nearby areas is high, thereby leading to complications.
Last reviewed at:
24 Nov 2022 - 6 min read
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