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Updated on September 27, 2022

Tooth Abscess Stages, Symptoms & Treatment

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What is a Dental Abscess?

A dental abscess is also called an oral abscess or tooth abscess. It is a localized bacterial infection that results 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."

The long-term build-up of pus inside the gums or teeth triggers an abscess. The infection affects the surrounding structures of teeth and can cause persistent toothaches and other symptoms.

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Types of Dental Abscess

Three main types of dental abscesses can form in different regions around a tooth, including:

  1. Gingival abscess – develops around the gums near the base of the tooth due to the impact 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 root of the tooth due to bacteria entering the dental pulp (innermost layer of the tooth) through a cavity, crack, or chip

Summary

A tooth abscess is a painful pocket of pus that develops from a bacterial infection in the mouth. There are three types: gingival, periodontal, and periapical abscesses.

Pictures of Dental Abscesses

Pictures of Dental Abscesses

Abscess
Periodontal Abscess
Dental Abscess
Tooth Abscess

5 Dental Abscess Stages

A tooth abscess is one of the later stages of tooth decay. Tooth abscess stages include:

1. Enamel Decay

The first stage is enamel damage, the outer layer of teeth. Enamel decay is often caused by plaque build-up on your teeth.

Some people may not experience any symptoms. Others develop tooth sensitivity or decalcified white spots that are more prone to enamel breakdown.

2. Dentin Decay

If you don't treat your enamel decay, it will progress to the next layer of your tooth. Dentin is the yellowish second layer. Many people will experience increased tooth sensitivity in this stage. In others, a small hole in your tooth may develop.

3. Pulp Decay

The soft inner pulp is the deepest layer of your tooth structure. If bacteria reach this layer, they can attack the tooth's nerve.

This often causes severe tooth pain. Eventually, the tooth's nerve dies and the abscess begins to form.

4. Abscess Formation

Once the bacteria makes its way to your pulp, it can start to spread deeper into your gums or jawbone. Your gums may begin to swell, and you may see a small bump on your gums. This may feel like throbbing pain in your teeth, gums, and surrounding tissue.

5. Serious Complications

If you do not treat your tooth abscess, it could lead to serious symptoms. The most common are:

  • Tooth loss — severe tooth decay can cause your tooth to break or fall out
  • Sepsis — bacteria can spread to your bloodstream and cause sepsis, which is a life-threatening infection

Summary

The six stages of a dental abscess include enamel decay, dentin decay, pulp decay, abscess formation, and complications. Serious complications like sepsis (a deadly blood infection) and/or tooth loss can occur if left untreated.

What Causes Dental Abscesses?

Bacteria build-up from neglected oral hygiene is the primary cause of dental abscesses. 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 can cause an abscess.

Underlying Medical Conditions & Medications

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
  • People taking steroids
  • People with diabetes

Poor Diets High in Sugar

Eating sugary and processed foods results in the build-up of dental plaque and calculus. Without proper brushing, cleaning, and flossing, tooth decay may develop. Untreated decay can result in a dental abscess later on.

Summary

Harmful bacteria cause dental abscesses due to poor oral hygiene. Risk factors include mouth trauma, weakened immune systems, poor diets, and tooth cracks, among others.

Prevention Tips

Good oral hygiene is the best way to prevent oral conditions and diseases. 

Dental abscess prevention tips include:

  • Brushing your teeth twice a day with fluoride toothpaste. You can either use a regular or electric toothbrush
  • Replacing your toothbrush or toothbrush head every 3 to 4 months
  • Flossing between your teeth daily with dental floss, floss sticks, or a water flosser
  • Using a fluoride or antiseptic mouth rinse daily to help 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 every six months
  • Eating a balanced, healthy diet
  • Reducing sugar intake

Summary

Optimal oral hygiene is essential for abscess prevention. Also, make sure you keep up with professional teeth cleanings and dental exams every six months.

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
  • Throbbing near the affected tooth that comes and goes spontaneously
  • Pain in the gums, roots of the tooth, or referred pain
  • Painful, swollen lymph nodes in the neck and/or jaw
  • Redness, swelling, and inflammation near the abscess
  • Swollen, inflamed, and shiny gums
  • Pain that worsens when lying down 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
  • Severe ear, neck, and/or jaw pain
  • Pain when biting down or chewing
  • Difficulties swallowing and breathing
  • Facial swelling
  • Fever

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 general dentist immediately.

If you experience severe pain and difficulty breathing, call your local emergency department or 9-1-1.

Summary

The primary symptom of a dental abscess is severe pain near the infection site. Swelling, redness, and inflammation around the abscess are also common.

Dental Abscess Treatment

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

Abscess Draining

Abscess draining is typically recommended if the abscess is treated early and hasn’t progressed. 

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 Canal Treatment

Root canal treatment is necessary when the bacteria spread to the dental pulp and tooth roots. It is also necessary 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 patient’s tooth and also drains the abscess. Then the root canal is cleaned, shaped, sealed, and restored with a dental crown.

Tooth Extractions

Tooth extractions 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.

Summary

Tooth abscesses must be treated quickly to prevent spreading. Your dentist must drain the infection (never try to do this at home). Root canal treatment and tooth extraction may also be necessary (depending on the severity).

Dental Abscess Healing Time

After an extraction, the infection will drain through the empty socket. Your tooth can take a few weeks to fully heal after a dental abscess treatment.

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

  • Extreme pain even with painkillers
  • You had or have a fever
  • You had or have difficulty eating, speaking, or breathing

Best Antibiotics For Dental Abscesses

Antibiotics are taken after the root canal or extraction procedure to help clear up the infection. Taking it 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
  • Ampicillin and sulbactam 
  • Azithromycin (Zithromax)
  • Erythromycin 
  • Keflex
  • Metronidazole 
  • Ticarcillin and clavulanate

The course of treatment for most antibiotics is 10 to 14 days. They must be taken for the entire course of treatment, even if your symptoms disappear.

Tips for Managing Pain

Ibuprofen and similar over-the-counter (OTC) painkillers can help control dental abscess pain. However, they can't treat the condition.

Only use OTC painkillers that are safe for you and do not prolong their use. Long-term use of OTC painkillers damages your organs.

These are good to take while you wait for your treatment. You can also take them with the antibiotics your dentist prescribes afterward.

Summary

Amoxicillin can be used to treat the underlying bacterial infection. However, antibiotics will not cure an abscess. Professional drainage is still necessary. Over-the-counter medications can be used to manage pain before/after your appointment.

Risk Factors of an Untreated Dental Abscess

Dental abscesses should be treated promptly to avoid the risk of serious complications. These complications include:

  • Tooth loss — if the abscessed tooth becomes severely infected or weak, a root canal will not be able to save it. If this is the case, you must get the tooth removed and replaced with a dental implant and dental crown (artificial tooth).
  • Bone infection — leaving the tooth untreated can result in an infection that affects the surrounding facial bones.
  • Sinus infections — frequent and painful sinus infections and/or oral soft tissue infections can also develop.
  • Septicemia — this 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 another abscess. This is relatively rare but can occur if the infection becomes severe enough. A brain abscess is dangerous and requires a visit to the emergency room or hospital for treatment.

Summary

A tooth abscess is serious and can be life-threatening (if left untreated). It can lead to tooth loss, bone/sinus infections, septicemia (a deadly blood infection), or a brain abscess (rare).

Dental Abscess FAQs

Can a tooth abscess go away on its own?

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

Can I pop an abscess on my gum?

You should never try to pop or squeeze a dental or gum abscess. Doing so can push the infection into deeper tissues in your mouth.

How can I treat a gum abscess at home?

You cannot drain a gum abscess at home. However, you can minimize the pain by applying a warm compress to the area 4 times a day for 30 minutes at a time.

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 gum abscess an emergency?

Predicting how a dental infection will spread is difficult, 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.

What does a tooth abscess look and feel like?

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

Will a tooth abscess go away with antibiotics?

Antibiotics alone cannot treat a tooth abscess. An abscess has to be professionally drained by a dentist. Antibiotics may be prescribed if the infection has spread or is very severe.

4 Sources Cited
Last updated on September 27, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Abscessed Teeth.” American Association of Endodontists.
  2. Hupp, James R., and Elie M. Ferneini. “Head, Neck, and Orofacial Infections: an Interdisciplinary Approach.” Elsevier, 2016.
  3. King, Christopher. “Textbook of Pediatric Emergency Procedures.” Kluwer, Lippincott, Williams and Wilkins, 2008.
  4. Dental abscess.” NHS Choices, NHS.
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