A tooth abscess, or a dental abscess, is a collection of pus in or around a tooth. Pus is a thick, oozing white or yellow-white liquid that is the result of a bacterial infection.
The body sends an inflammatory response to fight infections, and the buildup of cells leads to increased pressure at the site of infection. This increased pressure typically causes severe pain.
One of the most important things to understand, as we continue undergoing times of quarantine and risk of infection with COVID-19, is what truly constitutes an emergency. For both the safety of the patients and the workload of our overburdened healthcare workers, it’s important to keep non-emergency situations out of the hospitals.
Specific to dental problems, it is essential for patients to seek care for dental emergencies from dentists and not from emergency room providers.
The cause of dental abscesses is always a dental infection. Dental infections can begin inside the tooth or around the tooth. An abscess can also form due to gum disease.
Those inside the tooth are called “endodontic infections”, and they involve the nerves and blood vessels within the tooth. Usually, endodontic infections are caused by large cavities, cracks, or trauma. Eventually, endodontic infections spread out the end of the tooth’s root to infect the bone surrounding the root.
Dental abscesses can also result from infections that begin in the gums and bone surrounding a tooth. These are called periodontal infections. It is important to know the difference when it comes to treatment if you want to save the tooth.
Endodontic infections usually require root canal treatment, and periodontal infections may require gum surgery. If you do not want to save the tooth, the treatment is extraction for either type of infection.
Your dentist is able to readily distinguish between endodontic and periodontal infections because they look quite different on a dental x-ray.
Regardless of where the infection began, when left untreated, it will spread. In many cases, the infection spreads outward in a small pimple-like swelling that can drain and release pressure (called a fistula). This type of abscess may not hurt at all.
In other cases, the infection spreads inward to some deadly areas. If a dental infection spreads to the bloodstream, it leads to a condition called septicemia.
An infection that spreads to the soft tissues under the tongue can block the airway. If an infection from certain upper teeth spreads, it can reach the brain. All of these situations can be deadly.
Because it is difficult to predict how a dental infection will spread, it is best to assume that any 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.
The goal of emergency treatment is to stop the spread of the infection. This will typically involve prescription antibiotics. In severe cases, it can involve intravenous antibiotics and a procedure called an incision and drainage in which a surgeon “opens” the swelling to allow the pus to drain out. This relieves pressure and reduces pain.
You should never attempt to drain an abscess on your own at home. Opening a swelling without sterile instruments and infection control actually worsens the infection by introducing different types of bacteria.
You can visit the Emergency Room (ER) for a dental emergency (such as a tooth abscess). However, the ER will only be able to treat you if the underlying condition is health-related. The ER will bill you through your health insurance, not dental insurance.
If you have a life-threatening abscessed tooth, you will need to visit an emergency dental clinic. ER doctors can prescribe you antibiotics and pain medications until you are able to book an appointment with your dentist for treatment. You can also take over-the-counter pain relievers if you have an extreme toothache.
As soon as you notice any swelling or pain in your mouth, you should seek dental care. The earlier you catch a tooth abscess, the lower the risk for spreading the infection.
Throughout the COVID-19 pandemic, dentists and oral surgeons have remained available for emergency dental treatment. In order to access care, you should call your local dentist or oral surgeon.
Take swellings in the gum seriously. Seek urgent care from a dentist as soon as possible to stop the spread of dental infection. Avoid going to the emergency room if possible.