Tooth Abscess Stages, Symptoms & Treatment

What is a Dental Abscess?

A dental abscess, also known as an oral or tooth abscess, is a localized bacterial infection resulting in a collection of pus.

According to Dr. Nandita Lilly, one of NewMouth's in-house dentists, "A dental abscess, if not treated accordingly, can lead to hospitalization. In some cases, it can be fatal."

A long-term buildup of pus inside the gums or in the bone surrounding the teeth triggers an abscess. The infection can affect the surrounding structures and cause persistent toothaches and uncomfortable symptoms.

Types of Dental Abscess

Three main types of dental abscesses form in different regions around a tooth. They are:

1. Gingival abscess – develops around the gums near the tooth base due to the impaction of a foreign object.
2. Periodontal abscess – develops inside the gum tissue and can affect the gums and bone surrounding the tooth.
3. Periapical abscess – develops in the tooth’s root due to bacteria entering the dental pulp (innermost layer of the tooth) through a cavity, crack, or chip in the tooth.

Gum boil seen as lump hidden behind the upper lip

Close-up shot of a developed inflammation of the gums with abscess.

Inflammation of the gums or a tooth abscess

Inflammation of the gums or a tooth abscess

Inflammation of the gums or a tooth abscess

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Symptoms of a Dental Abscess

Depending on the type of dental abscess and how long it has been progressing, common symptoms may include:

• Severe toothache
• Intermittent throbbing near the affected tooth 
• Painful, swollen lymph nodes in the neck or jaw
• Severe ear, neck, or jaw pain
• Redness, swelling, and inflammation near the abscess
• Pain that worsens when lying down (especially for upper teeth) and interrupts sleep
• Tooth sensitivity to cold, sweet, or hot substances
• Consistent bad breath, even after brushing or rinsing the mouth
• A loose tooth or multiple loose teeth near the infection site
• Pain when biting down or chewing
• Difficulties with swallowing and breathing
• Facial swelling
• Fever

If the abscess ruptures, you may notice a foul taste (salty fluid) and smell in your mouth. You may also experience pain relief in the infected tooth. If this occurs, call your general dentist immediately.

If you experience spreading facial swelling or difficulty breathing, call your local emergency department or 911.

5 Dental Abscess Stages

A tooth abscess is one of the later stages of tooth decay. The infection commonly starts as decay, dental trauma, leakage from previous dental work, or a broken tooth. It evolves into an abscess when left untreated. The stages of abscess formation may include:

1. Enamel Decay

The first stage is damage to the enamel or outer layer of the tooth. Plaque buildup on a tooth can often lead to enamel decay.

Some people may not experience symptoms. This is because the decay is far from the nerve inside the tooth. Others develop tooth sensitivity or decalcified white spots prone to enamel breakdown.

2. Dentin Decay

If you don't treat your enamel decay, it will progress to the dentin layer of your tooth. Dentin is a bone-like, yellow-hued structure under the tooth's enamel layer. Many people experience increased tooth sensitivity in this stage of decay. For others, a small hole in the tooth may develop.

3. Pulp Decay

If untreated, the decay will progress to the pulp, the innermost layer of your tooth. This layer contains nerves, blood vessels, specialized cells, and connective tissues. 

If bacteria reach this layer, they can attack the tooth's nerve, causing severe pain. Eventually, the tooth's nerve dies, and an abscess forms.

4. Abscess Formation

Once the bacteria reach your pulp, they can spread deeper into your gums or jawbone. Your gums may begin to swell, and you may notice a pimple-like bump on your gums. The abscess formation may cause throbbing pain in your teeth, gums, and surrounding tissues.

5. Serious Complications

Leaving your tooth abscess untreated could lead to serious complications, including: 

• Tooth loss — severe tooth decay can cause your tooth to break and require extraction.
• Sepsis — bacteria can spread to your bloodstream and cause sepsis, a life-threatening infection.

Prevention Tips

Good oral hygiene is the best way to prevent most oral conditions and diseases. The best means of avoiding an abscess include:

• Brushing your teeth twice daily with fluoridated toothpaste and a regular or electric toothbrush
• Replacing your toothbrush or toothbrush head every 3 to 4 months
• Flossing your teeth daily with dental floss, floss sticks, or a water flosser
• Using a fluoridated or antiseptic mouth rinse daily to prevent plaque buildup and tooth decay
• Keeping up with professional dental care. This includes visiting your dentist for routine teeth cleanings, X-rays, and dental exams at least every 6 months
• Eating a balanced, healthy diet
• Reducing sugar intake

What Causes Dental Abscesses?

Bacteria buildup from neglected oral hygiene is the primary cause of a dental abscess. 

Other risk factors include:

Injuries & Damage

Injuries, dental damage, or deep tooth cracks allow bacteria to spread to deeper parts of the teeth or gums. This leads to an abscess.

Underlying Medical Conditions & Medications

People with weaker immune systems or those taking medications for severe health conditions are at a higher risk of developing abscesses. This includes people:

• Undergoing chemotherapy
• Taking steroids
• With diabetes

Long-term use of antibiotics, a dry mouth, and a weakened immune system can all upset the healthy balance of bacteria in the mouth. They can also lead to mouth sores, infections, decay, and, eventually, abscesses. 

Poor Diets High in Sugar

Eating sugary and processed foods results in the buildup of dental plaque. Plaque eventually hardens into calculus. Without proper brushing and flossing, gum disease and tooth decay may develop. If left untreated, this can eventually evolve into an abscess. 

Watch Our Video Podcast About Tooth Abscess

Dental Abscess Treatment

Three treatment options are available, depending on the type and severity of the infection. They are:

Incision and Drainage 

Incision and drainage is typically recommended if the abscess is treated early and hasn’t progressed. A dentist will make a small incision to drain the pus from the abscess during the procedure before cleaning the infected area and prescribing antibiotics.

Root Canal Treatment

Root canal treatment is necessary when the bacteria spread to the dental pulp and tooth roots. It is also required if there is an abscess at the root of a tooth (periapical abscess).

During the procedure, a dentist removes the infected dental pulp in the person’s tooth. They then clean, shape, and seal the root canal system. Finally, they cover the tooth with a dental crown.

Tooth Extractions

Tooth extractions may be necessary after a tooth gets damaged from an injury, disease, or decay. If an abscessed tooth cannot be saved, extraction is necessary.

Local anesthesia is administered during the procedure, and the tooth is removed using surgical instruments. After extraction, the tooth socket is covered with sterile gauze, and pressure is applied for about 30 minutes.

Dental Abscess Healing Time

After an extraction, the infection will drain through the empty socket. The area can take ten days to a few weeks to fully recover after treatment.

Your dentist will schedule check-ups with you to ensure proper recovery. You may still have an infection if you are experiencing:

• Extreme pain, even with painkillers
• A fever
• Difficulty eating, speaking, or breathing

Best Antibiotics For Dental Abscesses

Occasionally, antibiotics are recommended after the root canal or extraction is complete. This is to clear the infection. Taking antibiotics without removing the infected tooth will not cure a dental abscess.

Commonly prescribed antibiotics for dental abscesses include amoxicillin and penicillin. Other antibiotics prescribed to people with tooth abscesses include:

• Clindamycin
• Azithromycin (Zithromax)
• Erythromycin 
• Keflex
• Metronidazole 
• Augmentin 

The course of treatment for most antibiotics is 7 to 10 days. Antibiotics must be taken for the entire treatment duration to ensure complete recovery, even if your symptoms disappear sooner.

Tips for Managing Pain

While Ibuprofen and similar over-the-counter (OTC) painkillers cannot treat a dental abscess, they help control pain related to the infection. Only use OTC medications as necessary. Long-term use of OTC painkillers can lead to organ damage. 

Many dentists recommend taking OTC painkillers while you wait for treatment. You can also take them after treatment alongside the antibiotics your dentist may prescribe.

Risk Factors for Untreated Dental Abscesses

Dental abscesses should be treated promptly to avoid the risk of serious complications. If left untreated, serious complications include:

• Tooth loss — if the abscessed tooth becomes severely infected or weak, a root canal cannot save it. If this is the case, a dentist will remove the tooth and, if desired, replace it with a dental implant and crown, bridge, or partial denture.
• Bone infection — leaving the tooth untreated can result in an infection that affects surrounding facial bones.
• Sinus infections — frequent, painful sinus infections or oral soft tissue infections can develop due to an untreated abscess.
• Septicemia — septicemia is a life-threatening condition that occurs when your entire bloodstream becomes infected. A dental abscess can trigger septicemia if left untreated long-term.
• Brain abscess — a dental abscess infection can travel to the brain, resulting in a brain abscess. This is relatively rare but can occur if the infection becomes severe. A brain abscess is life-threatening and requires a visit to the emergency room or hospital for treatment.

Common Questions About Dental Abscesses