When a tooth persistently throbs and keeps you up at night with pain, it could be something more worrisome than a simple toothache. An abscessed tooth is an infection within a tooth that has spread to the root tip or around the root. This infection originates from the tooth’s inner chamber, which is called the “pulp chamber.” Contained within the pulp chamber are blood vessels and nerves, collectively called the “pulp.”

Prior to the formation of an abscess, the tooth has essentially lost its ability to fight off infection, and bacteria are able to invade the pulp chamber and multiply. As the bacteria multiply, the infection usually spreads from the pulp chamber and exits through the bottom of the root into the bone. The abscess is a collection of pus that is made up of dead white blood cells, tissue debris, and bacteria.

A tooth abscess differs from a gum abscess by the source of the original infection. The tooth abscess (or “periapical abscess”) originates from the pulp of the tooth and exits out the tooth’s apex at the bottom of the root. A gum abscess (or “periodontal abscess”) starts in a gum pocket outside of the tooth next to the root. Treatment will depend on where the infection originates.

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.

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.

Symptoms of tooth infection

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

• 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 discoloured
• 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.

• Symptoms
• Signs and symptoms of a tooth abscess include:

Severe, persistent, throbbing toothache that can radiate to the jawbone, neck or ear

• Sensitivity to hot and cold temperatures
• Sensitivity to the pressure of chewing or biting
• Fever
• Swelling in your face or cheek
• Tender, swollen lymph nodes under your jaw or in your neck

Sudden rush of foul-smelling and foul-tasting, salty fluid in your mouth and pain relief if the abscess ruptures

When to see a doctor

See your dentist promptly if you have any signs or symptoms of a tooth abscess.

If you have a fever and swelling in your face and you can’t reach your dentist, go to an emergency room. Also go to the emergency room if you have trouble breathing or swallowing. These symptoms may indicate that the infection has spread deeper into your jaw and surrounding tissue or even to other areas of your body.

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 be 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:

• Facial swelling
• Swelling around a molar
• Swollen lymph nodes
• Hole in the roof of the mouth

Treatment

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 999 or get straight to A&E. 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.

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.

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 anaesthetic. If extensive treatment is needed, a general anaesthetic 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.

Complications

A tooth abscess won’t go away without treatment. If the abscess ruptures, the pain may decrease significantly — but you still need dental treatment. If the abscess doesn’t drain, the infection may spread to your jaw and to other areas of your head and neck. You might even develop sepsis — a life-threatening infection that spreads throughout your body.

If you have a weakened immune system and you leave a tooth abscess untreated, your risk of a spreading infection increases even more.

Prevention

Avoiding tooth decay is essential to preventing a tooth abscess.

Take good care of your teeth to avoid tooth decay:

• Use fluoridated drinking water.
• Brush your teeth at least twice a day with a fluoride toothpaste.
• Use dental floss or an interdental cleaner to clean between your teeth on a daily basis.
• Replace your toothbrush every three or four months, or whenever the bristles are frayed.
• Eat healthy food, limiting sugary items and between-meal snacks.
• Visit your dentist for regular checkups and professional cleanings.
• Consider using an antiseptic or a fluoride mouth rinse to add an extra layer of protection against tooth decay.

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