Things to Know About a Dental Abscess
A dental abscess is an infection of the root canal of a tooth.
A dental abscess is an infection of the mouth, face, jaw, or throat that begins as a tooth infection. The original cause may be from a deep cavity, periodontal (gum) disease, a cracked tooth, trauma, or sometimes even due to recent dental procedures such as extractions and implants. Most infections are more likely to have been caused by poor dental health and can result from a lack of proper and timely dental care. They can also occur from previously performed dental procedures as they get older and start to leak and fail. People with underlying medical conditions such as autoimmune disorders (Sjögren's syndrome and similar conditions) or conditions that weaken the immune system (diabetes, post-radiation/chemotherapy cancer care, or people taking immunosuppressive therapy) may be more susceptible to developing a dental abscess.
- In an abscess, bacteria from the tooth can extend into the gums, the cheek, the throat, the tissues beneath the tongue, or even into the jaw or facial bones. A dental abscess can become very painful when tissues become inflamed or due to the pressure within the abscess. A gum or gingival abscess is the result of infection or trauma to the surface of the gum tissue. Periodontal abscesses are the result of an infection that has moved deeper into gum areas (on the outside surfaces of a tooth), and a periapical abscess refers to a tooth with an infection of the dental pulp (starting inside a tooth).
- Pus often collects at the site of the infection as the immune system tries to keep the infection from spreading. Pain may not always be present. The condition will often become progressively more painful until the abscess either ruptures and drains on its own or is drained surgically.
- In extreme cases, a dental abscess can result in death if it spreads to the brain, causes septicemia (infection of the bloodstream), or if swelling obstructs the airway and compromises breathing. Dental abscesses can also make one generally ill, with nausea, vomiting, fevers, chills, and sweats.
What Are the Symptoms and Signs of a Dental Abscess?
Symptoms of a dental abscess typically include
- redness of the mouth and face.
Often one or more teeth will be very sensitive to pressure. With an advanced infection, one can experience other complications such as:
- chills, and
- difficulty swallowing, opening the mouth, or breathing.
If it remains untreated long enough, the infection can spread through the bone and damage adjacent teeth, which would require additional treatment.
The signs often found in conjunction with a dental abscess may include, but are not limited to:
- deep cavities,
- gum inflammation,
- oral or facial swelling,
- tenderness with touch,
- pus drainage, and
- sometimes limited ability to open the mouth (difficulty or pain upon opening the mouth very wide or when swallowing).
If the abscess has spread to a superficial area, there is typically tenderness to palpation (touch) of the infected area. Dental abscesses may range from mild to severe. They may be associated with no symptoms or with severe symptoms. Depending on a number of factors, the abscess may range from chronic to acute, and stable (not changing) to rapidly spreading. The infection can in some cases spread beyond the teeth and bone through the bloodstream to other areas of the body where it can damage organs and even be life-threatening.
What Causes a Dental Abscess?
The cause of these infections is a direct growth of bacteria from within the pulp spaces of a tooth (endodontic) or on the deep root surfaces of a tooth (periodontal) into the supporting soft tissues and bones of the face and neck.
When Is an Abscessed Tooth an Emergency?
- If someone thinks he or she has an abscess, call a dentist. If someone is experiencing significant signs or symptoms and is unable to reach a dentist, go to a physician or a hospital's emergency department for evaluation, especially if feeling sick.
- If an infection becomes so painful that it cannot be managed by nonprescription medicines, see a doctor or dentist immediately. Drainage might be required. If someone develops fever, chills, nausea, or vomiting as a result of a dental abscess, see a doctor.
- If one has intolerable pain, difficulty breathing or swallowing, any of the symptoms of a dental abscess, or someone cannot reach a doctor or dentist during off hours, go to a hospital's emergency department for evaluation and treatment. By seeking treatment before the symptoms progress to this stage, one can avoid emergency department visits.
What Tests Diagnose a Dental Abscess?
- A doctor or dentist can determine by physical examination if there is a drainable abscess.
- X-rays of the mouth may be necessary to show small abscesses that are located at the deepest part of the tooth.
What Are the Treatment Guidelines or a Dental Abscess?
- For an acute dental abscess that causes substantial pain or swelling, the doctor may incise and drain the abscess and/or try therapy with antibiotics.
- Abscesses that are eminently life-threatening may require hospital admission.
- Pain medication is commonly prescribed until the symptoms can be controlled.
- These initial measures are often necessary to temporarily relieve the signs and symptoms of an acute abscess; however, further treatment directed at eliminating the primary source of the infection is necessary to prevent recurrence. The location of this primary source determines the "definitive" treatment options, which may include root canal treatment, periodontal treatment, or extraction of the tooth.
What Natural Home Remedies Relieve Pain from a Dental Abscess?
There are no home remedies for a dental infection once it is present, but it is possible to manage the symptoms of the discomfort and swelling.
- People who have cavities or toothaches can take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve), as needed for relief of pain and inflammation. As an alternative to or in addition to NSAIDs, acetaminophen (Tylenol) may be also taken. These medications may help the pain, but they will not treat the infection. Follow-up with a health care professional is always indicated.
- If an abscess ruptures by itself, warm-water rinses will help cleanse the mouth and encourage drainage. Even then, a follow-up visit to a dentist is important.
- Infectious swelling accompanying a dental abscess is different than inflammatory swelling, and application of ice or cold packs to the area is not recommended.
What Is the Management for a Dental Abscess?
- With a dental abscess, as with each and every illness, it is important to comply with a doctor's instructions for follow-up care.
- Proper treatment often means reassessment, multiple visits, or referral to a specialist.
- Cooperate with doctors by following instructions carefully to ensure the best possible outcome.
What Is the Prognosis for a Dental Abscess?
The prognosis is good for resolution of a small dental abscess once it has ruptured or been drained. If the symptoms are improving, it is unlikely that the infection is getting worse. Larger abscesses need immediate medical care, often requiring drainage and antibiotics. Proper follow-up care with a dentist is mandatory for the reassessment of the infection and for taking care of the problem tooth.
- Care might include pulling the tooth or having a root canal performed on it.
- Dental abscesses that have extended to the floor of the mouth or to the neck can threaten a person's airway and ability to breathe and may be life-threatening unless they are properly drained.
How Do You Prevent a Dental Abscess?
Prevention plays a major role in maintaining good dental health. Daily brushing and flossing along with regular dental checkups can prevent tooth decay and dental abscess. Anyone who suffers from frequent dental abscesses needs to be evaluated by a healthcare professional to determine if an underlying medical condition is responsible. Remember there are no home remedies once one develops an abscess, so prevention is the best practice.
- Remember to brush and floss after every meal and at bedtime.
- If tooth decay is discovered early and treated promptly, cavities that could develop into abscesses can usually be corrected.
- Avoidance of tobacco (chewing as well as smoking) use can help as well.
Reviewed on 7/12/2022
Laskin, D. "Anatomic Considerations in the Diagnosis and Management of Odontogenic Infections."
JADA 69 (1964): 308-316.