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Dental Abscess

Woman in pain with hand on jaw

What is a dental abscess?

A dental abscess is a pocket of pus that forms around the root of a tooth or inside the gums.

Abscesses that occur at the tip of the root of a tooth are called periapical abscesses, and those that form in the gums at the side of a tooth root are called periodontal abscesses.

A dental abscess may also be called a tooth abscess.

What causes a dental abscess?

A dental abscess usually starts off as a cavity (tooth decay). Cavities are caused by a combination of different factors such as bacteria, frequent snacking or diets high in sugar, genetic reasons, and poor oral hygiene including a build-up of plaque and tartar.

Acids in plaque remove minerals from the hard-outer surface of a tooth which is called the enamel, forming tiny holes. If these holes are not treated, bacteria and acids can progress through them into the dentine, which lies just under the enamel and is softer and less resistant to erosion. Eventually, decay makes its way into the innermost layer of the tooth, called the pulp which contains nerves and blood vessels. Bacteria continue to grow inside the pulp forming pus and causing swelling and irritation and pain. Pus can then spread to the adjacent areas of the tooth, such as the gums or the jaw or facial bones, causing a dental abscess.

Dental abscesses may also form from a facial injury or when old fillings start to break down, allowing bacteria to enter the dentine. They can also form in periodontal pockets; these are spaces in the gums around your teeth which offer an ideal environment for bacteria to grow.

People at higher risk of cavities and therefore dental abscesses include those who:

  • Don’t look after their teeth properly
  • Drink alcohol
  • Have a poor diet
  • Have certain medical conditions or take certain medications likely to cause a dry mouth (such as diuretics, antihistamines, opioids)
  • Smoke

What are the symptoms of a dental abscess?

Symptoms of a dental abscess include:

  • Dental pain, which is often severe, throbbing, and unrelenting and radiates into the jawbone or other facial bones
  • Bad breath
  • Fever, nausea, chills, or sweats
  • Sensitivity to hot and cold temperatures
  • Swelling in the face or cheek that is tender to touch
  • Swollen lymph nodes under the jaw or in the neck

If an abscess ruptures, a person may experience a sudden rush of salty, foul-tasting and foul-smelling fluid into the mouth, but instant pain relief.

How is a dental abscess diagnosed?

See your dentist if you have persistent tooth pain. If you have facial swelling and fever or shortness of breath and can’t reach a dentist, go to an emergency room.

Your dentist will examine your mouth and may take x-rays to determine the extent of the abscess.

How is a dental abscess treated?

Treatment from a dentist is required to resolve a dental abscess.

  • For a periapical abscess, a dentist can drain the pus and may prescribe antibiotics to treat the infection. They may be able to save the tooth with root canal treatment but in some cases, the tooth may need to be pulled.
  • For a periodontal abscess, the abscess will be drained and the dentist may perform scaling and planing below the gum line. Sometimes the gum tissue may need reshaping to remove the periodontal pocket.

Sometimes a dental abscess will rupture on its own, reducing pain levels; however, this does not clear the infection, nor the existing cavity, so further treatment is required.

Without treatment, swelling caused by the abscess can become significant enough to block the airway, causing difficulty breathing and other serious complications, some life-threatening.

While you are waiting for treatment from a dentist, the following may offer some relief:

  • Acetaminophen or NSAIDs (such as ibuprofen or naproxen) for the pain
  • Lignocaine oral gel (to numb the area)
  • Clove oil (may temporarily numb the area although use should be limited)
  • Wet, cool, peppermint tea bags