Tooth Abscess Antibiotics Not Working

What is a Dental Abscess?

A tooth or dental abscess occurs when a bacterial infection forms of a pocket of pus.

Abscesses occur at different locations of the tooth, including:

1. Tip of the tooth root (periapical)
2. Gum at the side of the tooth root (periodontal)

dental abscess

Most periapical abscesses develop from an untreated cavity. Abscesses need draining and infection treatment, usually in the form of antibiotics. Failing to treat an abscess can lead to serious dental issues and other health complications. 

In rare instances, an untreated dental abscess can be life-threatening.

Symptoms of a Dental Abscess

The symptoms of a dental abscess include:

  • Toothache that triggers severe and persistent throbbing pain
  • Pain that radiates into the jaw, neck, or ear
  • Sensitivity to foods and liquids that are cold or hot
  • Painful biting or chewing
  • Fever
  • Facial swelling
  • Swollen or tender lymph nodes
  • A rush of foul-tasting or smelling fluid in the mouth (this indicates a rupture and the pain usually subsides following the flow of liquid)
  • Breathing or swallowing difficulties

Summary

The most common sign of an abscess is a severe, persistent, throbbing toothache.

Using Antibiotics to Treat a Dental Abscess

When are Antibiotics Needed for a Dental Abscess?

Doctors prescribe antibiotics to treat dental abscesses that are causing pain symptoms or swelling. The goal is to get rid of the infection.

If it is only affecting the immediate area of the tooth, you might not need antibiotics. However, antibiotics are necessary if there is any risk of it spreading beyond the affected tooth. Or if you have a weakened immune system for any reason.

Your dentist will also cut and drain the abscess. Then they'll wash it with saline, an antibacterial agent. A root canal can remove the diseased pulp from within the tooth and save it. Sometimes, you need a tooth extraction if it is unsalvageable.

Summary

Antibiotics are only necessary if the abscess is causing pain/swelling or if there is a risk of it spreading.

Which Antibiotics Work Best For a Tooth Infection?

The most effective antibiotic for a tooth infection varies. People are different and react differently to medications.

However, Amoxicillin (Augmentin) is one of the most commonly prescribed antibiotics for tooth abscesses and infections. It also relieves pain. 

Penicillin is an option, but many people are allergic to it. A doctor might prescribe clindamycin for someone allergic to penicillin. Other antibiotics prescribed to people with tooth abscesses include:

  • Ampicillin and sulbactam 
  • Azithromycin (Zithromax)
  • Erythromycin 
  • Keflex
  • Metronidazole 
  • Ticarcillin and clavulanate 

How Long to Take Antibiotics for an Abscess

Antibiotics must be taken for the entire course of treatment, even if your symptoms go away. For example, your tooth might feel better after a day or two, but you’ll need to take an antibiotic for 10 days.

The course of treatment for most antibiotics is 10 to 14 days.

Keep in mind, antibiotics help reduce the dental infection but do not eliminate it. The only way to get rid of a tooth abscess infection is to remove the nerve or extract the abscessed tooth.

Most people experience relief after about 48 hours on an antibiotic. Significant improvement occurs within three to five days.

Summary

In most cases, antibiotics are needed for up to two weeks. If you experience no relief at all within two to three days of beginning antibiotics, contact your dentist. 

What to Do if Antibiotics Don't Fix Your Dental Abscess

If oral antibiotics do not fix your abscess, call your dentist immediately. In some cases, you'll make an appointment to visit your dentist in the coming days.

For others, you’ll need to visit an emergency dentist for treatment of the infected tooth. This is when IV antibiotics or extraction are needed.

This is also the case when you first notice the abscess. An abscess might not seem severe, but it is a serious medical condition. You can ease the pain with over-the-counter pain relief, but you must see a dentist for immediate attention.

The infection causing the abscess can spread and is potentially fatal if not treated. This is true whether you are just experiencing the first symptoms of an abscess or if you’ve been taking antibiotics that have not worked.

In addition to seeking emergency dental treatment, you’ll want to:

  • Avoid hot and cold beverages
  • Avoid high-sugar and high acidity foods and beverages
  • Take an over-the-counter pain reliever that is safe for you
  • Floss between the affected teeth to prevent food particles from further aggravating the problem
  • Sleep with your head elevated
  • Rinse with warm salt water two to three times a day

A visit to an emergency dentist is necessary if you have an abscess and cannot see your regular dentist. An abscess can be fatal if left untreated. It is a dental emergency, even if you think you can deal with the pain.

Alternative Treatment Options

Alternative treatments ease the discomfort of an abscess and help it heal faster. However, it should never be the only approach to dealing with an abscess.

Alternative treatments and home remedies for abscesses include:

  • Warm salt water and baking soda mouthwash 
  • Apply clove oil or oregano oil to the affected area using a cotton swab
  • Apply thyme oil to reduce swelling
  • Swish a tablespoon of coconut oil in your mouth for 20 minutes and then spit it out

Take Over-The-Counter Pain Relievers

Over-the-counter pain relievers such as ibuprofen are effective for easing the pain that comes from a tooth abscess. However, they should NEVER be the only treatment for tooth pain.

You should visit a dentist as soon as possible, even if that means seeking emergency dental treatment.

Make sure you only use OTC painkillers that are safe for you and that you do not use them for extended periods. Long-term use of OTC pain relief damages your organs.

Summary

Visit your dentist immediately if oral antiobiotics do not fix your abscess, as this condition can be life-threatening. Make an appointment with an emergency dentist if you cannot get a hold of your normal dentist. Additional treatment will be necessary.

Dangers of an Unresolved Dental Abscesses

Leaving an abscess untreated will lead to serious medical complications in addition to severe pain. The infection will spread to other parts of your body, including your brain and nearby organs.

A dental abscess infection that travels to the brain is very difficult to treat because of the blood-brain barrier. It’s also common for infections to spread into the sinuses.

An infection in your teeth or gums might indicate that you have heart health problems. Researchers believe gum disease is linked to heart disease and heart attack risk. 

The infection can also spread to the surrounding bones. Facial bones are especially intolerant to infection. There is a high risk that bone removal will be needed to stop the further spread of the infection.

Even if you have a mild abscess, it can spread and weaken the bones, which creates problems in the future for your teeth.

An untreated abscess also poses a risk for tooth loss. Usually, a root canal and crown are enough to save the affected tooth. However, left untreated, there’s a high likelihood your dentist will need to pull the tooth.

One of the most serious issues linked to untreated dental abscesses is septicemia. This is an infection in the bloodstream and it puts your entire body at risk.

If the abscess is not treated in time and it ruptures, the infection can spill into your blood and circulate throughout your body. Sepsis is life-threatening and requires IV antibiotic treatment and long-term hospitalization.

Summary

Serious infections can develop if an abscess is left untreated, including septicemia, a life-threatening condition that requires intensive treatment.

How to Prevent a Tooth Abscess

Practicing excellent oral hygiene is the best way to prevent a tooth abscess and other oral conditions like cavities and gum disease.

Here are some best practices:

  • Brush your teeth twice a day with an electric toothbrush. Don't use hard-bristled toothbrushes because they can harm your gums
  • Replace your toothbrush head every 3 months
  • Floss every day before bed to remove food, debris, and plaque
  • Use an antiseptic mouth rinse daily (or fluoride) to help prevent plaque and bacteria buildup
  • Visit your dentist for professional teeth cleanings twice a year
  • Drink fluoridated water
  • Eat a healthy diet and reduce sugar intake

Summary

Optimal oral hygiene is essential for dental abscess prevention.

Tooth Abscess: Common Questions and Answers

Is a tooth abscess an emergency?

It is difficult to predict how a dental infection will spread, so it is best to assume that a tooth abscess is an emergency. Any visible swelling in the gums, whether it causes pain or not, could be dangerous, and you should seek urgent dental care. 

Can a tooth abscess go away on its own?

A tooth abscess will not go away on its own. If the abscess is not drained by a dentist, it can spread to other areas of your body, including the jaw, head, or neck.

How do I know if my tooth abscess is spreading?

Symptoms that a tooth abscess has spread to other parts of your body include fever, swelling, dehydration, increased heart rate, increased breathing rate, and stomach pain.

Is a tooth abscess hard or soft?

Most abscesses are soft and warm to the touch. However, they can be firm in some cases.

Resources

Tooth Abscess - Symptoms and Causes.” Mayo Clinic, 2019.

Hidden Tooth Infections May Be a Warning Sign of Heart Disease.” Harvard University.

Abscessed Teeth.” American Association of Endodontists, 29 Nov. 2017.

Signs of Tooth Abscess.” Ada.

Hupp, James R., and Elie M. Ferneini. Head, Neck, and Orofacial Infections: an Interdisciplinary Approach. Elsevier, 2016.

King, Christopher. Textbook of Pediatric Emergency Procedures. Kluwer, Lippincott, Williams and Wilkins, 2008.

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