What is a Dental Abscess?
A dental abscess is also called an oral abscess or tooth abscess. It is a localized infection that results in a collection of pus.
According to Dr. Nandita Lilly, one of NewMouth's in-house dentists, "a dental abscess, if not treated accordingly, can lead to hospitalization. In some cases, it can be fatal."
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.
Three main types of oral abscesses can form in different regions around a tooth, including:
Gingival Abscess (Gum Abscess)
A gingival abscess usually develops around the gums near the crown or top part of the tooth. It only affects the gum tissue.
The most common cause of a gingival abscess is the impact of a foreign object. This could be popcorn, a toothpick splinter, or something else.
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 pocket of pus that forms in the gum tissue. It affects both the gums and bone surrounding a tooth.
This type of 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.
A periodontal abscess typically develops in patients who have periodontal disease. This is the advanced stage of 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 during scaling and root planing.
Periapical Abscess
A periapical abscess is located at the root of a tooth and can only be removed through root canal therapy or extraction. It 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. It 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.
Summary
A tooth abscess is a painful pocket of pus that develops from a bacterial infection in the mouth. There are three types: gingival, periodontal, and periapical abscesses.
Pictures of Dental Abscesses
5 Dental Abscess Stages
A tooth abscess is one of the later stages of tooth decay. Tooth abscess stages include:
1. Enamel Decay
The first stage is damage to the first layer of your teeth (enamel). Enamel decay is often caused by plaque build-up on your teeth. Some people may not experience any symptoms. Others may develop tooth sensitivity or decalcified white spots that are more prone to enamel breakdown.
2. Dentin Decay
If you don't treat your enamel decay, it will progress to the next layer of your tooth. Dentin is the yellowish second layer. Many people will experience increased tooth sensitivity in this stage. In others, a small hole in your tooth may develop.
3. Pulp Decay
The soft inner pulp is the deepest layer of your tooth structure. If bacteria reach this layer, they can attack the nerve of the tooth. This often causes severe tooth pain. Eventually, the tooth's nerve dies, which is when the abscess begins to form.
4. Abscess Formation
Once the bacteria makes its way to your pulp, it can start to spread deeper into your gums or jaw bone. Your gums may begin to swell, and you may see a small bump on your gums. This may feel like throbbing pain in your teeth, gums, and surrounding tissue.
5. Serious Complications
If you do not treat your tooth abscess, it could lead to serious symptoms. The most common are:
- Tooth loss — severe tooth decay can cause your tooth to break or fall out
- Sepsis — bacteria can spread to your bloodstream and cause sepsis, which is a life-threatening infection
Summary
The six stages of a dental abscess include enamel decay, dentin decay, pulp decay, abscess formation, and complications. Serious complications like sepsis (a deadly blood infection) and/or tooth loss can occur if left untreated.
What Causes Dental Abscesses?
Bacteria build-up from neglected oral hygiene is the primary cause of dental abscesses. Other risk factors include:
Injuries & Damage
Injuries, dental damage, or deep tooth cracks allow bacteria to spread to deeper parts of the teeth or gums. This can cause an abscess.
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 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.
Summary
Dental abscesses are caused by harmful bacteria due to poor oral hygiene. Risk factors include mouth trauma, weakened immune systems, poor diets, and tooth cracks, among others.
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 that comes and goes spontaneously
- Pain in the gums, roots of the tooth, or referred pain
- 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
- Facial 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 general dentist immediately.
If you experience severe pain and difficulty breathing, call your local emergency department or 9-1-1.
Summary
The primary symptom of a dental abscess is severe pain near the infection site. Swelling, redness, and inflammation around the abscess are also common.
Dental Abscess Treatment
Depending on the type and severity of the infection, there are three treatment options available. They include:
Abscess Draining
If the abscess is treated early and hasn’t progressed, abscess draining 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 Treatment
Root canal treatment is necessary when the bacteria spread to the dental pulp and tooth roots. Or if there is an abscess at the root of a tooth (periapical abscess).
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. Then two visits with a general dentist for the crown.
Tooth Extractions
Tooth extractions 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. A dental implant can be placed after the extraction site heals.
Summary
Tooth abscesses must be treated quickly to prevent spreading. Your dentist must drain the infection (never try to do this at home). Root canal treatment and tooth extraction may also be necessary (depending on the severity).
Dental Abscess Healing Time
After an extraction, the infection will drain through the empty socket. Your tooth can take a few weeks to fully heal after a dental abscess treatment.
Your dentist will schedule check-ups with you to make sure that you are healing properly. You may still have an infection if you are experiencing:
- Extreme pain even with painkillers
- You had or have a fever
- You had or have difficulty eating, speaking, or breathing
Best Antibiotics For Dental Abscesses
Antibiotics alone do not cure dental abscesses. They are taken after the root canal or extraction procedure to help clear up the infection.
Commonly prescribed antibiotics for dental abscesses include amoxicillin and penicillin. Other antibiotics prescribed to people with tooth abscesses include:
- Clindamycin
- Ampicillin and sulbactam
- Azithromycin (Zithromax)
- Erythromycin
- Keflex
- Metronidazole
- Ticarcillin and clavulanate
The course of treatment for most antibiotics is 10 to 14 days. They must be taken for the entire course of treatment, even if your symptoms go away.
Most people experience relief after about 48 hours on an antibiotic. Significant improvement occurs within three to five days.
Keep in mind that antibiotics help reduce dental infections but do not eliminate them. The only way to get rid of a tooth abscess infection is to remove the nerve or extract the abscessed tooth.
Tips for Managing Pain
Ibuprofen and similar over-the-counter (OTC) painkillers can help control dental abscess pain. However, they can't treat the condition.
Only use OTC painkillers that are safe for you and do not prolong their use. Long-term use of OTC painkillers damages your organs.
These are good to take while you wait for your treatment. You can also take them with the antibiotics your dentist prescribes afterward.
Summary
Amoxicillin can be used to treat the underlying bacterial infection. However, antibiotics will not cure an abscess. Professional drainage is still necessary. Over-the-counter medications can be used to manage pain before/after your appointment.
Risk Factors of an 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.
Summary
A tooth abscess is serious and can be life-threatening (if left untreated). It can lead to tooth loss, bone/sinus infections, septicemia (a deadly blood infection), or a brain abscess (rare).
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
- Eat a balanced, healthy diet and reduce sugar intake
Summary
Optimal oral hygiene is essential for abscess prevention. Also, make sure you keep up with professional teeth cleanings and dental exams every six months.
Dental Abscess FAQs
Can a tooth abscess go away on its own?
A tooth abscess will not go away on its own. If the abscess is not drained by a dentist, it can spread to other areas of your body, including the jaw, head, or neck.
Can I pop an abscess on my gum?
You should never try to pop or squeeze a dental or gum abscess. Doing so can push the infection into deeper tissues in your mouth.
How can I treat a gum abscess at home?
You cannot drain a gum abscess at home. However, you can minimize the pain by applying a warm compress to the area 4 times a day for 30 minutes at a time.
How do I know if my tooth abscess is spreading?
Symptoms that a tooth abscess has spread to other parts of your body include fever, swelling, dehydration, increased heart rate, increased breathing rate, and stomach pain.
Is a gum abscess an emergency?
It is difficult to predicthowa dental infection will spread, so it is best to assume that a tooth abscess is an emergency. Any visible swelling in the gums, whether it causes pain or not, could be dangerous, and you should seek urgent dental care.
What does a tooth abscess look and feel like?
Most abscesses are warm and soft to the touch. In some cases, they can be firm to the touch.
Will a tooth abscess go away with antibiotics?
Antibiotics alone cannot treat a tooth abscess. An abscess has to be professionally drained by a dentist. Antibiotics may be prescribed if the infection has spread or is very severe.
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