Tooth Abscess Stages, Symptoms, and Treatment

What is a Dental Abscess?

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:

Gingival Abscess (Gum Abscess)

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.

Periodontal Abscess

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.


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A periodontal abscess typically develops in patients who have periodontal disease, a serious gum disease that results in permanent bone loss.

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. The calculus can only be removed with scaling and root planing treatment.

Periapical Abscess

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.

What Causes Dental Abscesses?

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 tooth abscesses include:

trauma

Injuries & Damage

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

medications

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, steroids, and people with diabetes.

poor diet

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.

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 and throbbing near the affected tooth. This can include the gums, tooth root, or the tooth directly. The pain typically comes and goes suddenly
  • 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
  • Face 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 dentist immediately.

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

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Dental Abscess Treatment

Depending on the type of abscess and the severity of the infection, there are three treatment options available. They include:

tooth

Abscess Draining

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 canal

Root Canal Treatment

Root canal treatment is 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 root canal treatment and then two visits with a general dentist for the crown.

tooth

Tooth Extractions

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.

Best Antibiotics For Dental Abscesses

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.

Tips for Managing Pain

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.

Risk Factors of Untreated Dental Abscess

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:

  • 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 develop as well.
  • 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.

Prevention Tips

Practicing good oral hygiene is the best way to prevent the development of any oral condition and disease. Dental abscess prevention tips include:

  • Brush your teeth twice a day with fluoride toothpaste. You can either use a regular or electric toothbrush
  • Replace your toothbrush or toothbrush head every 3 to 4 months
  • Floss between your teeth daily with dental floss, floss sticks, or a water flosser
  • Use a fluoride or antiseptic mouth rinse daily to help prevent plaque buildup and tooth decay
  • Keep up with professional dental care. This includes visiting your dentist for routine teeth cleanings, x-rays, and dental exams every six months
  • Drink fluoridated water often
  • Eat a balanced, healthy diet and reduce sugar intake

Resources

“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/.

Updated on: June 29, 2020
Author
Alyssa Hill
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Medically Reviewed: October 30, 2019
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Lara Coseo
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