How to Identify and Treat a Dental Abscess or Tooth Infection


Are you worried you might have a mouth abscess? Perhaps someone you know has one and you want to know what exactly that means, and how you can prevent the same thing from happening to you. In this article we’ll explain what causes abscesses, how to spot the symptoms of a tooth abscess, and what abscess treatment usually involves. We’ll also give you some tips for avoiding them in the first place.

What is a tooth abscess?

parts of the tooth
Different parts of the tooth are susceptible to infection

An abscess is a pocket of pus that accumulates when a bacterial infection breaks down tissue. Abscesses can form in many different parts of the body. They are a natural defense mechanism, the aim being to block the infection from reaching other areas. The resulting build-up of pus is usually very painful.

When it comes to mouth abscesses, both the gums and the teeth themselves are at risk. An abscess in the mouth can erode the periodontal structure (which supports the teeth) and the jaw bone, causing irreparable damage. In some cases, the affected tooth has to be extracted.

By understanding tooth abscess symptoms and seeking professional treatment as soon as you become concerned, you can reduce the chances of further infection and complications.

Types of dental abscess

There are three main types of oral abscess: gingival, periodontal, and periapical. The distinguishing factor for each one is the location where the abscess forms.

Gingival abscess

A gingival abscess, or gum abscess, forms on the surface of the tissue at the gum line of the teeth (gingiva). This is often a result of external damage to the gum, for example from food entering the gumline or penetration from a toothpick.

If caught early, an abscess on the gum is relatively easy to treat and recover from. If left untreated, however, it can progress to a periodontal abscess and cause greater oral damage.

Periodontal abscess

This type of abscess occurs deeper into the gum pockets. Since there is nowhere for pus to drain, the abscess spreads into the surrounding tissue and jaw bone.

tooth decay stages
A periapical abscess begins with tooth decay

Periapical abscess

These begin in the soft tooth pulp, usually as a result of decay deep inside the tooth. Once tooth decay has eroded the protective enamel and dentin of the tooth, bacteria can invade the nerves and tooth pulp (a condition known as pulpitis).

Pus from this infection may appear at the gum line of the tooth, but more commonly it ends up in surrounding tissue which becomes inflamed.

Wisdom tooth abscesses are particularly common in this category since the very back teeth are harder to clean. In addition, it’s harder for your dentist to spot cavities on these teeth and treat them early on.

Causes of abscesses in the mouth

Your mouth naturally contains bacteria, and when not cleaned well, forms plaque on your teeth and gums. Teeth infections develop when the acid produced by plaque starts to decay the teeth or gums.

Abscesses most commonly occur when tooth decay is left to spread. Other possible reasons for infection include:

  • Gum disease (gingivitis)
  • A cracked tooth
  • Trauma
  • Complications from dental surgery such as implants, root canal treatment, and extractions
  • Rough tooth brushing
  • Food stuck between teeth and gums

People with poor dental hygiene are more susceptible to oral abscesses due to an increased build-up of plaque. Any injury or surgery to teeth and gums can increase the chances of infection as delicate parts of the mouth are exposed to bacteria.

In addition, people with a weakened immune system are at greater risk of developing a dental infection. The immune system is affected by certain underlying health conditions, such as diabetes. Some medical treatments, such as chemotherapy, also reduce a patient’s natural immunity.

While none of these things will automatically lead to a tooth or gum abscess, they are all factors that increase the risk of infection.

Symptoms of tooth infection

The first signs of tooth infection are likely to be strong pain and difficulty eating. Specifically, dental abscess symptoms include:

  • Continuous, throbbing pain

    avoid hot drinks with an abscess
    Hot drinks may make tooth abscess pain worse
  • Pain when the tooth is tapped
  • Increased pain when eating hot or cold foods/drinks
  • Greater discomfort when biting teeth together or chewing food
  • A foul, bitter taste in the mouth from draining pus
  • A bad smell in the mouth from the infection
  • Swelling and reddening of the face or gums
  • Bleeding from the gums
  • A tooth that is loose and/or discolored
  • A pea-sized bump inside the mouth

More serious symptoms which may indicate dental abscess complications include:

  • Fever
  • Headache
  • Nausea
  • Diarrhea
  • Swollen lymph glands
  • Pain spreading to the jaw, ear or neck on the same side as the infected tooth
  • Difficulty opening your mouth (trismus)
  • Difficulty breathing or swallowing (dysphagia)
  • General fatigue

These tooth infection symptoms usually come on quite suddenly. Within a few hours, you may find yourself in excruciating pain.

Note that patients can experience an initial toothache which then fades away. It’s easy to assume that the problem is fixed, but this is not the case. Your tooth pulp cannot heal itself, but once the nerve is destroyed you won’t experience any pain. It’s only once the infection has spread through the dead tooth into the surrounding gums and tissue that symptoms will re-appear. At this point, far more extensive damage has been done.

To avoid tooth abscess complications, you should visit a dentist as soon as you notice any tooth infection symptoms, even if they disappear by themselves.

Acute vs. chronic abscess

lump from abscess
An abscess may appear as a pea-sized lump in the mouth

The above symptoms are all characteristic of what is called an acute abscess. This spreads fast and usually causes great discomfort and pain for the patient.

A chronic abscess, on the other hand, grows slowly and may cause no pain whatsoever. The patient is therefore unaware of the presence of the abscess, and only a dental x-ray will be able to identify it. This is usually a periapical abscess, spreading gradually through the tooth root and into the surrounding tissue.

Eventually, the pus may create a tunnel through the bone and tissue, known as a ‘fistula’ or ‘sinus tract’. This allows the pus to drain, and looks like a pimple inside your mouth. If you see or feel something like this in your mouth, even if you haven’t experienced any other tooth abscess symptoms, you should consult your dentist. If pus starts to drain through the fistula, you’ll know about it from the foul taste.

What does an abscessed tooth look like?

If you think you may have an abscess, you might be wondering what to look for. Keep in mind that not all abscesses are externally visible, so don’t put off visiting your dentist just because you can’t see any outward signs of infection.

While some abscesses may appear as a small lump inside the mouth (as in the image above), they may also result in much greater swelling either in the mouth or on the face.

These tooth abscess pictures show some different aspects of what a mouth abscess looks like:

External symptomsInternal symptoms
Facial swelling Swelling around a molar
Swollen lymph nodes Hole in the roof of the mouth

Tooth abscess treatment

Dental abscess pain can be intense and prevent the patient from eating properly. In this case it may be appropriate to seek emergency treatment. Even if the pain is bearable, you should visit a dentist as soon as possible to avoid further damage and complications.

If you’re having difficulty breathing or swallowing, or have a fever or facial swelling, call 911 or get straight to an emergency room. These are signs that the infection has spread further into your jaw and you need urgent treatment.

The first priority with any dental abscess treatment is to drain the pus that has built up and remove the source of the infection. The method for doing this will depend on the type of abscess.

Your dentist may begin by taking an x-ray to determine how far the abscess has spread and what kind of treatment is needed.

Gum abscess treatment is relatively straightforward. It may be possible to release the pus by applying gentle pressure, just as you would with a pimple on your skin. The dentist will then use a small probe to scrape the remaining infected material from inside the abscess.

In other cases, the dentist may have to make a small incision in the gum tissue to access the infected area.

Provided the infection hasn’t spread into the periodontal structure, no further treatment will be required although antibiotic treatment may aid recovery.

If you have a gum abscess which ruptures by itself, you may find that the pain subsides significantly when the pressure is released. However, this doesn’t mean the infection has cleared. You should still visit your dentist to have the area cleaned properly.

Where a fistula has formed on the gum because of a periodontal abscess, the dentist will insert a thin probe into the hole. They will then take an x-ray (with the probe still in place), and from this, they can see the original source of the infection.

Root canal treatment for abscessed teeth

Periapical abscesses can often be treated with a root canal. This involves drilling down through the crown of the tooth to access the infected pulp chamber. The pus is drained and the cavity is cleaned and disinfected.

process for root canal
A root canal can effectively treat a periapical abscess

The dentist often widens each root canal using small files. This makes them easier to fill but is a delicate process which takes some time.

Root canal treatment may require several visits, especially if the affected tooth is a premolar or molar (rear chewing tooth) since these have two or three roots which may contain one or two root canals.

Between visits, the dentist coats the cavity with an antibiotic paste and applies a temporary filling.

At the final visit, the dentist will remove the temporary filling and check that there is no trace of infection remaining. Provided the infection has cleared, the dentist will apply a permanent filling. Depending on the amount of damage to the tooth, a dental crown may also be needed.

Most dentists will use a cofferdam during root canal treatment to isolate the tooth being treated. This rubber sheet is fitted around the tooth to keep it dry. It also stops any chemicals from entering your mouth while you’re receiving treatment.

Here is a short video explaining how root canal treatment is conducted:

Complications leading to extraction

In the case of periapical and periodontal abscess treatment, if the infection has spread into the jaw bone or periodontal ligament it may be necessary to extract one or more teeth. Extraction is a last resort, though, and will only be done if the dentist judges the bone to be too far eroded to support the teeth.

With periodontal abscess treatment, the dentist will first carry out a deep cleaning of the gum pocket. He or she can then assess the extent of the infection. Oral x-rays will also reveal how far the infection has spread.

The abscess may have caused the tooth to become loose, and in this case, an extraction may be the only solution.

Extraction may also be necessary in cases where re-infection occurs after abscess removal, or when infection occurs in a tooth that has already undergone root canal treatment.

Mouth abscess treatment is usually carried out under local anesthetic. If extensive treatment is needed, a general anesthetic may be administered.

Medication for dental abscess treatment

Depending on the severity of the abscess, the dentist may prescribe antibiotics for the tooth infection. Dental abscess antibiotics are usually only issued when the patient has a fever or the infection is particularly widespread.

Following tooth or gum abscess treatment, patients can usually manage any residual pain with over-the-counter painkillers such as ibuprofen and paracetamol. Dentists may also advise patients to rest and only eat soft foods for a while after their surgery.

How much does it cost to treat an abscess in the mouth?

root canal treatment
A dentist using a cofferdam to perform a root canal

There is no fixed cost for mouth abscess treatment. Not only do charges vary from one dentist to another and between regions, but the type of treatment required for a dental infection will differ for each patient. Many dental insurance policies will reimburse some or all of the costs incurred for tooth infection treatment.

Questions to ask your dentist

If you suspect you have a mouth abscess, here are some questions you may wish to ask your dentist at your appointment:

  • Which type of oral abscess do I have?
  • What treatment do you recommend?
  • Are there any other options for treatment of the infection?
  • How long will treatment take, and how many visits will I need?

    single tooth discoloured
    A tooth may become discolored from an abscess
  • Will I need to take time off work to recover?
  • How often should I come for check-ups in the future?
  • What oral care products do you recommend?

In some cases, damaged teeth become discolored over time. You may want to ask your dentist how likely this is in your case, and what tooth whitening options may be available if you do experience tooth discoloration.

How to treat a tooth abscess at home

Although the only way to be sure of effective treatment is with a visit to the dentist, there are some home treatments which can help alleviate the pain and stop infection from spreading further while you wait for your appointment.

The best form of tooth abscess pain relief is ibuprofen, but paracetamol is second best. If you find just one of these ineffective, you may take both ibuprofen and paracetamol up to the maximum doses shown on the packets.

Other ways to relieve tooth infection pain include:

  • Rinsing and gargling with warm salt water
  • Avoiding hot or cold food and drink
  • Eating only soft foods
  • Avoiding flossing around the affected area
  • Using a soft toothbrush

Read more about ways to relieve tooth pain at home.

Antibiotics for tooth infection must be prescribed by a dentist. If you don’t seek professional treatment for your abscess, it is likely the infection will keep spreading. This can lead to serious damage to your teeth, periodontal ligament, and jaw bone. The infection might spread to other parts of your body if left long enough.

Remember that just because an abscess has drained and the pain has subsided, this doesn’t mean the infection is gone. You still need to visit a dentist.

How to prevent tooth and gum abscesses

visiting the dentist
Regular dental checkups will reduce your risk of developing an abscess in your mouth

Maintaining good oral health will minimize your chances of developing an abscess in your tooth or gum. There are many steps you can take to keep your teeth and gums as healthy as possible:

  • Brush twice a day with fluoride toothpaste and floss or use an interdental brush at least once a day
  • Avoid consuming sugary drinks and foods as snacks between meals or just before going to bed
  • Where possible, brush soon after consuming foods and drinks with a high sugar or starch content
  • Regularly visit your dentist to have oral check-ups

Even if you do develop dental cavities because of tooth decay, the affected tooth or teeth can be treated with a filling before the tooth pulp becomes infected. This is far preferable to undergoing root canal treatment or an extraction for an abscessed tooth, so regular trips to the dentist are very important.

If you still have your wisdom teeth, especially if they haven’t emerged properly, speak to your dentist about whether it would be wise to have them removed. Since wisdom tooth abscesses are relatively common, having the teeth removed is often the best way to prevent infections and other complications.

Finally, you should seek dental care if you experience any trauma to your teeth, for example chipping or cracking. Even if there is no immediate pain, bacteria can invade the tooth immediately and a dental infection may develop within days.

How to Identify and Treat a Dental Abscess or Tooth Infection
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