A dental abscess is a collection of pus that can form inside the teeth, in the gums, or in the bone that holds the teeth in place. It’s caused by a bacterial infection. A tooth abscess is an infection inside the tooth itself, and an abscess at the end of a tooth, which is more commonly called a periapical abscess. If you think you might have a dental abscess, it’s really important to see your dentist as soon as possible, because abscesses don’t go away by themselves. Not only can they be very painful, but without prompt treatment, you could end up having to have your tooth extracted. Treatment for dental abscesses involves draining the pus from the tooth and filling or removing the tooth to prevent re-infection.
dental abscess types
Each tooth is made up of several layers. The outermost layer is the enamel, which covers a softer layer, the dentin. The dentin and enamel are the tooth’s protective layers. Underneath the dentin is the pulp, where the tooth’s nerves and blood vessels are situated. The pulp runs down the center of the root of the tooth, which connects the tooth to the underlying bone of the upper or lower jaw. Infections in the pulp can therefore easily spread into the bone of the jaw. Likewise, if the gum around the tooth becomes infected, the tooth is at risk of damage as well. Some abscesses affect the pulp first and spread to the bone, while others affect the surrounding tissues of the gum and do not start in the pulp.
There are two major subtypes of dental abscess: periapical and periodontal. A third type, pericoronitis, is much less common. In pericoronitis, the infection affects the gum flap, known as the operculum, which covers a tooth that has not yet erupted through the gum. This article deals with periapical and periodontal abscesses.
Periapical abscesses: affecting the inside of the tooth
Periapical abscesses usually occur near the tip of the root of the tooth. They are more common among children than among adults. Children with poor dental hygiene are particularly at risk of periapical abscesses. Poor dental hygiene, including inadequate brushing or flossing, can cause caries, also known as cavities, which erode the enamel and dentin, admitting bacteria to the pulp. As a result of this, the pulp becomes inflamed, and this can lead to the death of nerves in the tooth. Because dead tissue is more vulnerable to infection, this puts the tooth at high risk of an abscess.
In periapical abscesses, damage to the enamel and dentin, as in the case of later-stage cavities admits bacteria to the pulp, leading to an inflammatory condition known as pulpitis. Periapical abscesses are a common complication of severe, long-term pulpitis. They can cause swelling in the jaw, cheeks and the floor of the mouth.
Periodontal abscesses: affecting the gums
Periodontal abscesses are more common among adults than children and are often a complication of gum disease. They tend to originate in the alveolar bone and periodontium. Gum disease or injury can cause teeth to become loose and/or inflamed, including the surrounding area. The resulting pocket that forms between the tissue and the tooth is vulnerable to infection by bacteria which can then form a periodontal abscess.
Painful, abscessed teeth can be caused by untreated tooth decay, a cracked or broken tooth or filling, or from a gum infection, especially in advanced gum disease.1 Your mouth always has bacteria, but it is kept out of the tooth by the solid tooth enamel. If tooth decay erodes that enamel or you have a cracked tooth, bacteria can get into the living pulp inside the tooth. Your immune system fights back, sending in white blood cells to kill the bacteria. Pus forms from white blood cells, dead tissue, and bacteria.
There isn’t any extra room inside your hard tooth, so it tries to drain out the tip of the tooth root in the jaw. A pocket of pus can form at the root tip. The abscess can appear on a dental X-ray. The pressure and inflammation from this abscess can be very painful.
Signs and symptoms of a dental abscess
Dental abscesses are usually painful. The pain may be situated in the tooth itself, the surrounding gum or be more generalized, including the jaw, cheeks, or even neck or face, depending on the location of the abscess. The affected tooth may:
- Feel tender
- Feel loose in the jaw
- Be sensitive to heat and/or cold in the mouth
- Be sensitive to pressure on the tooth, or to being tapped
- Be slightly raised
People with a dental abscess may experience pain in the affected area.
Other symptoms of dental abscesses include:
- Swelling in the gums or face
- Redness of the skin over the affected part of the gum
- Bleeding in the gums
- Swollen lymph glands in the neck
- Generally feeling unwell (malaise)
- Loss of appetite or inability to eat
Dental examination may also reveal swelling and redness around the tooth in the mouth and a fluctuant (movable/shiftable) mass in the area. Periodontal abscesses may also present with a gum boil. A gum boil, also known as a parulis, is a soft red papule that appears where a sinus or channel from an abscess reaches the outside of the gum, between the gum and the inside of the cheek. It is the result of an abscess, so it is a definite sign that an abscess is present, but it is not itself an abscess.
Rarely, in severe cases of dental abscess, the affected person may also experience:
- Cellulitis, a bacterial infection of skin and subcutaneous tissues
- Lockjaw (trismus)
- Difficulty swallowing, due to pain and swelling
- Difficulty breathing, due to swelling
- Difficulty speaking
Generally, a spreading dental infection as a result of an abscess may cause the affected person to feel very unwell. They may have a fever (a body temperature of 38 C / 100.4 F or higher), swelling in the floor of the mouth, the face or the jaw and severe pain that does not respond to maximum doses of over-the-counter painkillers such as.
Complications of dental abscess
In rare cases, complications do arise. These can include:
- Cellulitis,an infection of the skin and subcutaneous tissues.
- Ludwig’s angina,which occurs when cellulitis spreads into the tissues under the tongue, in the lower jaw and under the chin. It is also known as submandibular cellulitis/submandibular space infection.
- Osteomyelitis,an infection of underlying bone.
- Parapharyngeal abscess,an abscess at the back of the mouth, near the throat. It is caused by staphylococcal and/or streptococcal bacteria. It is most common in children aged five years or younger.
- Cavernous sinus thrombosis,which can occur when the infection spreads into the blood vessels in the sinuses of the head.
These conditions require very urgent medical attention and are best evaluated via a hospital emergency department.
When to see a dentist
You should see a dentist regularly for check-ups. If you suspect you have a tooth abscess, or you have a toothache, see your dentist as soon as possible. A tooth abscess won’t get better on its own; in fact, an untreated abscess might get worse and lead to life-threatening complications if the infection spreads to other parts of the body.
You should also see a dentist for a check-up as soon as you can if you have chipped or broken teeth.
At the first sign of pain from a suspected abscessed tooth, call your dentist to make an urgent appointment. You need to get treatment before complications can arise. You might get some relief from the pain if the abscess ruptures, but whether it does or not, the infection can spread to your jaw.
Your dentist will examine your teeth and locate the abscess. You may need an X-ray or even a CT scan to see the exact location of the abscess and whether the infection has spread.
Pain Relief for an Abscessed Tooth at home
A toothache that is caused by an abscess may come and go, but don’t be fooled if it does subside. The longer you wait to have the abscess treated, the more the chances of a serious complication rise. You may lose a tooth that could have been saved and you risk getting an advanced infection.
But until you are able to get to the dentist, here are some ways to relieve a toothache caused by an abscessed tooth or dental infection:
- Avoid foods and beverages that are very cold or very hot.Since the dentin layer of the tooth has likely been invaded by tooth decay, extremes in temperature may cause pain. Avoid foods like cold drinks, juices, ice creams, coffee, tea, or hot soups as they may trigger the exposed dentin and cause extreme pain.
- Avoid foods and beverages that are very high in sugar, or are very acidic. Common acidic foods are soft drinks or juices. These reduce the pH in your mouth and put the tooth at risk of further pain due to demineralization. Teeth with dental abscesses are extremely sensitive so any changes in pH should be avoided.
- Use an over-the-counter pain relief medicine. Speak to your doctor or pharmacist about dosages, side effects, and interactions that can lead to further complications. Never exceed the recommended dose, and check to make sure you are able to take pain relief medications with any of the other medications you currently take. Most toothaches are caused by inflammation, so a pain reliever that reduces inflammation is usually the best choice. Never put pain relief medication on the tooth or gum tissue, as this could burn the tissue.
- Floss between the teeth that are painful.Removing the food particles and plaque may help reduce the pain from a toothache. It might help reduce inflammation in the periodontal area which can transmit pain to the rest of the infected tooth.
- Seal a hole in the tooth temporarily.Some pharmacies have over-the-counter temporary filling material that may be used to seal the hole created by decay or a cracked tooth temporarily.
- Sleep with your head elevated.If you elevate your head when resting, some of the pressure in the area of a toothache may diminish.
- Rinse with warm salt water.Rinsing with warm salt water two to three times a day may help to relieve a toothache if the abscess was caused by a gum infection. Salt water works as an antiseptic to remove bacteria from the infected area.
Pain killer and antibiotic medicine
See a dentist as soon as possible. A dentist will normally drain the pus and this often gives great relief of symptoms. This is done either by piercing (lancing) the abscess or by drilling a small hole in the tooth to let the pus escape. Sometimes, if the infection is not contained, an antibiotic medicine is prescribed for a few days after draining the pus to clear any remaining infection. However, in most cases an antibiotic is probably not needed once the pus is drained.
Your doctor cannot do a lot to help apart from recommend and prescribe painkillers. Some doctors may choose to prescribe an antibiotic to help relieve the symptoms, but only when the diagnosis is clear and there is facial swelling. (doctors are advised they should not treat dental problems, as it is outside their area of expertise.) However, an antibiotic will not clear the pus and cure the abscess and you must see a dentist soon. You may need painkillers such as paracetamol or ibuprofen until the abscess is drained and treated. These are both available over the counter. (Note: paracetamol and ibuprofen can be taken together if pain relief with either alone is not enough. Some people require stronger painkillers prescribed by a doctor.)
For a periapical abscess
The treatment for this type of abscess is normally root canal treatment. This treatment aims to save and restore the damaged or dead inner part of a tooth (the pulp). Briefly – a dentist will drill into the dead tooth and allow pus to escape through the tooth, and then remove the dead pulpal tissue. A root filling is then placed into the tooth to fill the space and prevent further infection. (Note: even if pain has gone with an initial emergency drainage of the pus, you are still likely to need root canal treatment. This is because the infection and abscess will almost certainly return unless the dead pulp tissue is dealt with.)
If the infection persists despite root canal treatment, the dentist may have to remove (extract) the tooth.
For a periodontal abscess
Once the pus has been drained, a dentist may clean the pocket where the abscess had formed. Following this a dentist may smooth out the root surfaces of the tooth to encourage the gum to close back on to the tooth and for any pocket to disappear. This helps to prevent a recurrence of infection. If you develop repeated periodontal abscesses you may be referred to an oral surgeon. The oral surgeon may carry out a procedure to reshape the gum tissue.
What is the outlook?
If treated, the outlook (prognosis) is good. The pus can usually be drained and the tooth can be saved if it is not badly broken down.
How do you avoid getting an abscess?
- Visit your dentist regularly for check-ups
- See your hygienistas often as your dentist recommends, to make sure your teeth get a regular deep clean and to follow oral hygiene tips and advice at home
- Before you brush your teeth, clean between them with floss or inter-dental brushes
- Brush your teeth twice a day at home, for two minutes each time
- Try not to rinse your teeth after brushing because it washes away any fluoride in your toothpaste
- Use an antibacterial mouthwash 30 minutes after brushing