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Tooth Abscess: Things To Know

Table of contents:


Overview

A tooth abscess is a type of dental abscess with endodontic origins, meaning the infection originates from within the tooth and thus requires endodontic treatment.


It is a full blown infection in which you can expect pain, swelling, and pus to be present. It should not be taken lightly because it requires prompt treatment. Delaying it will only lead to more complications and more complex treatment that will be even more expensive.


tooth abscess diagram
Tooth abscess

Types of abscesses

We wish to be crystal clear about the semantics in regards to a tooth abscess so you know what we're talking about. There appears to be a lot of confusion about the types of abscesses in your mouth.

  • Tooth abscess - the infection originates from the tooth.

  • Gum abscess - the infection originates from the gums that surround the tooth.

  • Dental abscess - an umbrella term which may indicate a tooth OR gum abscess.


Tooth abscess stages


tooth abscess stages

For a tooth abscess, it will progress through each stage sequentially with the symptoms becoming more severe.

  1. Tooth decay

  2. Pulp infection

  3. Periapical abscess

  4. Facial swelling

  5. Throat swelling


 

Symptoms

An abscessed tooth often presents with very vivid signs and symptoms that can't be ignored. If you have one, it will occupy all of your mental and emotional bandwidth.

  • Toothache. Tooth pain that may be be constant or it comes and goes. The pain can feel sharp, shooting or dull. It can also throb and radiate across your entire face.

  • Swelling. Most commonly the area around the tooth will swell up. However it can also spread to your face, cheeks, neck, glands and lymph nodes.

  • Purulence. A tell-tale sign of an abscess is if you see pus, which is a white fluid that is filled with dead bacteria and white blood cells.

  • Sensitivity. May feel extremely sensitive to hot and cold foods/drinks. The discomfort will often linger for up to a few minutes.

  • Gum boil. A pimple on the gums that is filled with pus.

  • Chewing pain. It hurts to chew or bite down.

  • Fever. You may get a fever or the infected area can simply feel warm to the touch.

  • Foul odor. Bad taste or bad smell in your mouth.

  • Loose tooth. Abscessed teeth will often be mobile. If you touch the tooth it can move.


When to see a dentist

If you are experiencing any of these symptoms, you should contact your dentist promptly. Treating it as soon as possible will lead to less complications. A wait and see approach will only make the treatment more complex and more expensive.


This is especially true if you have any type of swelling. It can spread and even affect your airway and how you breathe which may be life-threatening. The risk of death may be imminent at that point.


Causes

The most common cause for a tooth abscess would be untreated tooth decay but it may be caused by other conditions as well.

  • Severe tooth decay. When cavities are left unattended they will progress through the stages of tooth decay and eventually turn into an abscess.

  • Bacterial infection. Bacteria can sneak in and infect the tooth.

  • Trauma. Receiving a forceful impact to your tooth can kill it and cause an infection. This is common for sports injuries or accidents.

  • Fractured tooth. A cracked tooth usually leads to a tooth abscess sooner or later.


Diagnosis

An abscessed tooth may be difficult to diagnose because it can be difficult pinpointing the exact tooth that is causing the infection. Usually patients will present with pain and swelling but literally all of the teeth in the area will feel like they hurt.


It is unlikely for all of the teeth to have developed an abscess because usually it is just one. For that reason it is important for your dentist to be able to figure out which tooth it is. You don't want to be prescribed treatment for the wrong tooth!


Diagnostic tools:

  • Take an x-ray. Taking a PA x-ray may show the location of the abscess. It will present itself as a radiolucent halo around the tooth root.

  • Percussion test. Tapping on the tooth with the back end of a dental mirror will tell your dentist about the health of the tooth. The abscess will form at the root tip so by tapping the tooth, it will feel painful if it is present.

  • Vitality test. Endo ice is a cold test that can be used to detect whether the tooth is dead. Abscessed teeth as you may have guessed are often no longer vital.

  • Gutta percha tracing. If a gum boil is present your dentist can stick gutta percha (root canal filling) in an attempt to identify the source of the infection.

  • CBCT scan. A cone beam is not often used for detecting infections but it can be. It's more helpful in determining root fractures and extra tooth nerves.


tooth abscess on x-ray
tooth abscess on x-ray

Treatment

Tooth abscesses can be treated palliatively with an incision and drainage as an emergency procedure. However you will need to return for definitive treatment, which will be a root canal or extraction.

  • Incision and drainage. If there is a lot of facial swelling present you may need to have it drained prior to receiving definitive treatment. Your dentist will make an incision into the swollen abscess and then drain it.

  • Root canal. The vast majority of the time, the source of the infection is coming from an infected tooth nerve. A root canal procedure will remove the infected nerve.

  • Extraction. If the infection is too severe, the only option left may be to have the entire tooth removed. If that is the case you would need an implant afterwards to replace it.

  • Antibiotics. There is a good chance your dentist may prescribe you antibiotics such as amoxicillin if the facial swelling is severe enough. This is adjunctive therapy aimed at assisting the efforts in clearing out the bacteria.


Which treatment will I need?

The treatment that you will need will depend on the severity of the abscess swelling.


abscessed tooth decision tree
abscessed tooth decision tree

Minimal swelling

If there is mild to minimal swelling present, you can move straight to definitive treatment with a root canal or extraction.

  • Good prognosis (tooth is not badly damaged) ~> Root canal

  • Poor prognosis (tooth is severely damaged) ~> Extraction


Moderate to severe swelling

If there is moderate to severe swelling present, your dentist may not be able to do the root canal or extraction immediately. They may need to drain the abscess first and put you on antibiotics for about 2-3 days.


That will get the swelling and inflammation down so your dentist can accurately diagnosis the abscessed tooth. Once the swelling/inflammation has resided, you can finally get the root canal or tooth extraction.


 

Complications


Complications if left untreated

Teeth with abscesses must be treated promptly because the condition will worsen when left untreated. The inflammation but particularly the swelling may spread to other parts of your body. The swelling will spread from your mouth to your face and can even go to your neck.


If it manages to involve your neck and airway space, it can become life threatening. Neck swelling may interfere with your breathing and that is NOT good. If that happens to you, don't walk but run to the nearest emergency department.


Complications after treatment

Despite the treatment and antibiotics, sometimes the infection can be so bad that it doesn't go away. Normally after a day or two you should notice the inflammation and swelling decrease. If it does not improve you will need to return to your dentist.


Some of the abscess may have escaped detection or you could potentially have an antibiotic resistant strain of bacteria. There is a good chance your doctor may need to switch you to a different but stronger antibiotic.


Prevention

There are times where it may be inevitable but good lifestyle habits and oral hygiene can go a long way in decreasing the chances that it happens.


Oral hygiene tips for prevention:

  • Brushing after every meal. Brushing with a fluoridated toothpaste or one with hydroxyapatite can help fight tooth decay.

  • Mouth rinsing. Using a mouth rinse can help reduce bacterial load in your mouth and keep it clean from plaque.

  • Regular dental check ups. A check up and cleaning every 6 months can help keep your teeth and gums healthy.

  • Fluoride treatments. Those who are at high risk for cavities may benefit from professional fluoride treatment. These products are highly concentrated in fluoride.


Nutritional tips for prevention:

  • Drink water. About 73% of the public water system in the US is fluoridated. Simply drinking water throughout the day can wash away plaque and help remineralize teeth.

  • Minimize snacking. Whenever you eat or drink, the pH in the mouth drops and the bacteria become active. It only gets exacerbated if you're having sweets.

  • Healthy diet. A healthier diet with whole foods and less processed foods.


 

FAQs


Can it go away on its own?

Unfortunately if you have an abscessed tooth, it will not heal all on its own. There is in fact no home remedy which can cure it either. Your only option would be to see a dentist since definitive treatment involves a root canal or extraction. Neither of them you can do at home.


Our dentists in Long Island City recommends that you see a dentist as soon as possible.

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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!

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