Tooth Abscess Still Swollen After Antibiotics

Updated: Oct 14

Your tooth abscess has been causing you pain for days and you've finally taken your first dose of antibiotic but why don't you feel any different? Is it working or did your dentist prescribe you the wrong medication? This article will cover when antibiotics start working and what to do if the tooth infection does not subside.


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Table of Contents:


Overview

The most common antibiotic for a dental abscess is amoxicillin. It may be extremely effective for all types of tooth infections but the effects aren't instantaneously perceived. The reason is because the antibiotic is manufactured in a pill form and must be taken by mouth. The pill must work its way through your digestive system to get broken down and absorbed by the body. That entire process does not happen within a minute of taking it because it takes time to digest and absorb it.


Therefore, you won't feel any of the beneficial effects of the antibiotic until much later. In fact, it may even feel like it didn't have any effects on the tooth abscess at all while you're waiting for the pill to be absorbed in the digestive tract. Please rest assured, it will work because the process just takes time.


How long after starting antibiotics will tooth pain go away?

If you wait long enough for the antibiotics to take effect, the very first thing you should feel is the tooth pain going away. It may take anywhere from 1-4 hours before you start noticing the pain from the toothache start decreasing. That is approximately how long it takes for the amoxicillin or other antibiotic to work its way through the digestive track and get absorbed.


Some people may feel it quicker than others but it all depends on the individual. Another factor will also be whether you ate it on an empty stomach or a full stomach.

  • Taking it on an empty stomach. It may work faster if you take the antibiotic without eating because there won't be food getting processed ahead of it. This means that your body can process it right away. The downside is that when taken on an empty stomach, you may have stomach pains.

  • Taking it on a full stomach. You may delay the pain relief a little bit longer but at least you won't get any stomach pains from taking it. Our doctors and all the other doctors in the world will tell you to take it with a meal because the pain from having it on an empty stomach is pretty miserable!



How long does it take for antibiotics to reduce swelling from a tooth infection?

The first noticeable effect from the antibiotics may be pain relief but the second effect of reducing swelling may take a longer time for it to happen. It may take 24-48 hours after taking the antibiotic before you'll notice a decrease in swelling from a tooth abscess. The reason is because the swelling is filled with infected bacteria so it takes a much longer time for the medicine to start getting rid of it.


The amount of time it takes for the swelling to come down will also depend on how big the swelling is. If it is small and just mildly swollen, you may see the effects within 24 hours. Although if the swelling is about the size of a golf ball, it could take up to 48 hours before the size of your face returns back to normal. Therefore, it all depends on how much swelling you start with.



Tooth abscess still swollen after 3 days of antibiotics

Most tooth infections should subside after taking antibiotics but if it is still swollen after 3 days then it means you have a complication. You should not wait to finish taking the entire course of the antibiotic (usually 7-10 days) before going back to see your dentist. Call your dentist immediately and get an appointment as soon as possible because the antibiotic is not working as intended.


Here are a couple of reasons as to WHY it may not be working:


Started the antibiotics TOO LATE

Antibiotics will reduce swelling from a tooth abscess only if it is taken within the first 48 hours of when it began to swell. If you start the antibiotics after the 48 hours have passed, it may be too late. The infection may have progressed too far for the antibiotic to fight it.


Usually at around the 72 hour mark, which is 3 days, the swelling on your face will start to turn hard. Once this happens, taking just antibiotics is insufficient to treat it. Hard swellings from a dental abscess will need more than antibiotics because it will also need to be drained.


Incision and drainage

The treatment for swelling that does not go away after 3 days is called an incision and drainage. This involves cutting into the abscess and squeezing out all of the infection. Here are the steps for how it is done.

  1. Administer local anesthesia (lidocaine) to numb the area.

  2. Make an incision into the abscess with a scapel.

  3. Drain the abscess with finger pressure and also a hemostat.

  4. Irrigate out the inside of the abscess with saline.

  5. You may need a physical drain sutured into the abscess so that you can keep it open and let it drain for the next 2-3 days.

  6. If a drain is placed, it will need to be removed at the end of the time period.

After the tooth abscess is drained, you should continue and finish the entire course of the antibiotics. This time around, the medication will completely bring down the swelling.



Wrong type of antibiotic

The most common type of antibiotic for a dental infection is amoxicillin but sometimes it may not be the right one for your infection. If the swelling is not going down, you may need to switch to a different type to see if it works.


Here are the other types of antibiotics your dentist may prescribe you:

If the swelling goes away after switching to a new antibiotic, then it means that the bacteria simply didn't react as well to the first one. The second or newer antibiotic is more effective for this particular strain of bacteria.



Antibiotic resistant bacteria

There are rare cases where you could have an antibiotic resistant strain of bacteria. This is a very dangerous situation because you may need to be treated at a hospital. Some dentists may be comfortable with trying to treat this condition but overall, we do recommend that you go to a hospital for this because they'll be more equipped to manage it.


The reason as to why you may have antibiotic resistant bacteria could be due to the fact that you've taken too many antibiotics recently. If you take a lot of it, the bacteria will start to develop immunity towards the drug.


This is why, most dentist shy away from prescribing antibiotics loosely. You may have also noticed that you typically don't get any from even removing a wisdom tooth unless it was impacted. Fully erupted wisdom teeth and regular teeth alike do not require antibiotics after they are extracted!




Takeaway

If you have swelling from a tooth abscess, taking antibiotics should reduce it within 48 hours but if it does not go away then you may have a complication. You should seek out medical help immediately and not wait to finish the course of antibiotics. It could be something very serious and that needs to be addressed sooner rather than later.


Hopefully that answers all of your questions regarding dental abscesses and swellings. If you have any further questions regarding your oral health such as brushing or flossing, feel free to leave us a message!



Author: This article was written by Dr David Chen, an emergency dentist in long island city.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!