Gum boils may look like an innocent pimple on the gums but they're actually the end of a sinus tract that leads directly to a tooth abscess. It is because they're connected to a dental abscess that they ooze out pus whenever they pop.
Despite being a tell tale sign of a tooth infection, gum boils can present with pain and also without it but it all depends on whether it is actively draining or not. Typically if the boil on the gums is actively draining, you shouldn't feel much pain if there is any at all. Conversely, a non-draining one can be quite painful.
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Why is the gum boil causing you pain?
Gum boils are usually very painful if they haven't popped yet. In other words when they aren't actively draining they can potentially cause you a lot of pain.
In order to understand why they're painful when they haven't popped, we need to go over how they form in the first place. Once again, they're more than a simple pimple on the gums because they're actually the end of a sinus tract that leads to a tooth abscess.
As an infection progresses through the stages of a tooth abscess, the tooth nerve dies first and forms an abscess at the tip of the root. The infection eats through the bone at the root tip and we can see this with a dental x-ray.
Once the abscess forms in the bone, we can detect it with an x-ray. What the infection looks like is a big black circle on the x-ray, which tells us that the bone is becoming less solid. That makes sense since the infection is eating through the bone.
If this is left untreated, the infection will slowly make its way through the gums and form a pimple. Thus, the gum boil (parulis) that we see is actually a tooth abscess trying to make its way out of the bone and into the mouth.
In case you needed some additional persuasion, here is a technique that is used to trace the origin of a gum boil. You basically stick a root canal filling material (gutta percha) straight into the pimple and then take an x-ray to see where it ends up. That will tell you which tooth is the source of the infection.
Video of tracing technique:
Now that you understand how the gum boil forms, we can talk about why it hurts. That pimple on the gums hurt because it is a pus filled ball of infection. It formed that giant pimple because the infection is trying to burst out. The pain that you are feeling is because you're feeling the pressure of all that infection building up with nowhere to go.
Essentially the pain that is coming from a gum boil is all due to the abscess growing in size with no outlet. Since there is no drainage, what you're feeling is the vast amount of pressure building up from within the tooth and jaw bone.
When is the gum boil painless?
Some gum boils can be painless especially if they've already started draining. Once it pops, all of that pressure that was building up from the abscess can finally be released.
You may be surprised because you don't ever recall popping the gum boil so why would it drain all on its own? Well, fortunately for you there are many times where it can just pop all on its own.
Most commonly it can be from when you were eating something hard and it scratches it or if you accidentally nicked it with your toothbrush while you were brushing. Both situations will lead to the parulis having an opening that will allow it to drain all on its own.
This type of drainage is no different than draining a big dental abscess that has facial swelling. Draining the infection will lead to pain relief.
Here is a video showing a big abscess being drained:
Just to remind you that the gum boil is still one of the stages of a tooth abscess. If you leave it untreated it will slowly start to spread and eventually cause your face to swell up.
This is a picture of what the facial swelling can potentially look like:
If your face happens to swell up like the picture above, you will be experiencing a lot of pain. How can swelling of that size not cause you pain in the first place?
Therefore, it is quite interesting in that gum boils go through cycles of pain and no pain. When it first appears it can be painful but once it pops, it'll not be painful. However, if you decide to leave it untreated the infection can spread and cause your face to swell up and then you'll be in pain once again!
The moral of the story is that you should not ignore it nor should you leave it alone. You should seek prompt medical attention even if it does not hurt you at the moment. It can always start to hurt you later on down the road so you might as well have it addressed now while it is not bothering you.
Gum boils are interesting in that they can be painful and also not be painful. It all depends on whether it is draining or not. The pain that stems from it is mostly from feeling the abscess build up and consequently the pressure increases in your jaw with nowhere to go.
If the pimple pops, a lot of that pressure can be relieved, thus offering you momentary pain relief. Nonetheless, it does not mean that you should leave it alone once it does pop on its own because the infection could worsen and cause you pain once again.
Just by having the boil on your gums drained it does not mean that the infection will be cured. The reason is because the infection is coming from a tooth abscess that stems from the infected nerve. In order to treat it permanently, you'll need to remove the infected nerve via a root canal treatment.
The only person who can do that for you is a dentist so what are you waiting for? You should go make an appointment immediately.