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A dental abscess, also referred to as an oral abscess or tooth abscess, is a localized infection that results in a collection of pus. The long-term build-up of pus inside the gums or teeth triggers an abscess, which forms due to a bacterial infection. The infection affects the surrounding structures of teeth and can cause persistent toothaches and other symptoms.
There are three main types of oral abscesses that can form in different regions around a tooth, including:
A gingival abscess, also called a gum abscess, is a painful and rapidly expanding lesion that forms between the gums and teeth due to a bacterial infection. The most common cause of a gingival abscess is from the impact of a foreign object, such as popcorn, a toothpick splinter, or shellfish fragments.
In the beginning stages, a gum abscess appears as a red swelling with a shiny, smooth surface. After about 48 hours, the abscess becomes pointed and has a higher risk of erupting as it progresses.
A periodontal abscess is a localized pocket of pus that forms in the tissues of the periodontium (gums). This abscess appears as a shiny, smooth swelling that protrudes out of the gums and is sensitive to the touch. The tooth or teeth around the abscess may also become sensitive or loosen. This type of abscess typically develops in patients who have periodontal disease, a serious gum disease that results in permanent bone loss.
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The long-term build-up of dental plaque and hardened tartar (calculus) initiates periodontitis. The calculus is located beneath the gums (subgingival), between the gums, and along the gum line. However, the calculus can only be removed with scaling and root planing treatment.
A periapical abscess forms at the root of a tooth and consists of a pocket of pus that develops due to a bacterial infection. Bacteria first enters the innermost part of the tooth (dental pulp) through a cavity, crack, or chip.
The dental pulp contains the nerve, blood vessels, and connective tissues and provides sensory innervation (stimulation) through a tooth’s nerve. Once the bacteria pass through the pulp, it can spread all the way down to the root, creating an abscess. Inflammation, swelling, and pain typically occur at the tip of a tooth’s root where the abscess forms.
The primary cause of dental abscesses is from plaque build-up due to neglected oral care. This includes not brushing, flossing, or using fluoride regularly. Other risk factors associated with abscesses include:
Injuries, dental damage, or deep tooth cracks allow bacteria to spread to deeper parts of the teeth or gums, potentially resulting in an abscess.
People with weaker immune systems or those taking medications for serious health conditions are at a higher risk of developing abscesses. This includes chemotherapy patients, steroids, and people with diabetes.
Depending on the type of dental abscess and how long it has been progressing, common symptoms may include:
If the abscess ruptures, you may notice a foul taste (salty fluid) and smell in your mouth. You will also feel pain relief in the infected tooth. If this occurs, call your dentist immediately.
If you experience severe pain and difficulty breathing, call your local emergency department or 9-1-1.
Depending on the type of abscess and the severity of the infection, there are three treatment options available. They include:
If the abscess is treated early and hasn’t progressed, drainage of the abscess is typically recommended. During the procedure, a dentist will make a small incision into the abscess to drain the pus. A dentist cleans the infected area and prescribes antibiotics post-op.
Root canals are typically necessary when a tooth becomes heavily decayed and the bacteria spreads to the dental pulp and teeth roots. If there is also an abscess at the root of a tooth (periapical abscess), root canal therapy is typically necessary. During the procedure, a dentist removes the infected dental pulp in the patient’s tooth and also drains the abscess. Then the root canal is cleaned, shaped, sealed, and restored with a dental crown.
The root canal procedure itself is typically performed in one to two appointments. If you add the crown on top of that, it can be three to four appointments. However, if you’re seeing an endodontist, it's usually just one visit for the RCT and then two visits with a general dentist for the crown.
Tooth extractions, which is the surgical removal of teeth, might be necessary after teeth are damaged from an injury, disease, or tooth decay. If an abscessed tooth cannot be saved, extraction is necessary. During the procedure, local anesthesia is administered and the tooth is removed using small instruments.
After extraction, the tooth socket is covered with sterile gauze, and pressure should be applied for about 20 minutes. Stitches may also be necessary depending on the patient’s situation. An artificial dental implant can be placed after the extraction site heals.
Commonly prescribed antibiotics for dental abscesses include amoxicillin and penicillin. These antibiotics also treat many other types of general infections and tooth infections. Your dentist may prescribe you metronidazole and penicillin because they are commonly used together to treat bacterial infections.
Antibiotics alone do not cure dental abscesses. Instead, they are taken after the root canal or extraction procedure to help clear up the infection.
Ibuprofen and similar painkillers can help control dental abscess pain before you see your dentist for treatment. Many of these medications can be purchased over-the-counter and do not require a prescription. You can also take them in combination with the antibiotics your dentist prescribes after treatment.
Dental abscesses should be treated promptly or there is a risk for serious complications. If you ignore your tooth infection or wait too long to get treatment, you may experience:
Practicing good oral hygiene is the best way to prevent the development of any oral condition and disease. Dental abscess prevention tips include:
“Abscessed Teeth.” American Association of Endodontists, https://www.aae.org/patients/dental-symptoms/abscessed-teeth/.
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.
NHS Choices, NHS, https://www.nhs.uk/conditions/dental-abscess/.