Tooth Abscess: What It Is, Stages, Symptoms & Treatments

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Medically Reviewed By:
Mark Arredondo, M.D.

MONDAY, April 24, 2023 (HealthDay News) -- If you’ve ever experienced a toothache, you know how distracting the pain can be. Focusing at work or school, and getting a good night’s sleep, can become next to impossible.

But if the toothache is caused by a tooth abscess, the pain can be that much more severe.

What is a tooth abscess?

What does a tooth abscess look like? The Mayo Clinic defines a tooth abscess as a pocket of pus caused by a bacterial infection. The abscess can occur in different areas near the tooth for different reasons. For example, a periapical abscess occurs at the tip of the root. A periodontal abscess, on the other hand, occurs in the gums at the side of a tooth root. Unfortunately, both conditions are relatively common, but periapical abscesses occur more frequently.

According to Dr. Shawn de Vyver, a dentist in Michigan, “the most common cause of tooth abscesses is tooth decay. When dental cavities are left untreated, the bacteria that cause decay can penetrate the tooth's pulp and generate an abscess. Gum disease, trauma to the tooth and previous dental procedures can also cause abscesses.”

Tooth abscess stages

Tooth abscesses go through several stages before they become fully developed:

  • Tooth decay: Tooth decay and cavities are the first stages of a tooth abscess. Bacteria accumulates on your teeth throughout the day and sometimes, despite the best brushing and flossing attempts, you can’t remove it all. That bacteria build up on the surface of the teeth and harden into dental plaque. This plaque then eats away at the healthy tooth enamel, resulting in a cavity. Over time, that same bacteria eats through the tooth until it reaches the dentin layer. Once the bacteria gets through the dentin and attacks the pulp within, a tooth abscess forms.

  • Infected pulp: The next stage of a tooth abscess is the infection itself. When the bacteria is in the pulp, nerves begin to die. As a result, your immune system tries to fight the infection, leading to further inflammation. Pus forms around the dying tooth root.

  • Infection spread: Once the abscess enters this stage, the infection has spread to other areas within your mouth. That infection can chip away at your bone tissue along the jawline. If patients with tooth abscesses don’t seek timely treatment, it can lead to serious medical complications, including death.

Tooth abscess causes and risk factors

According to New York dentist Dr. Daniel Weinstein, “Our mouths are full of bacteria, which can form a sticky film on the teeth called plaque. If you don’t keep your teeth clean, acids produced by the bacteria in plaque can damage your teeth and gums, leading to tooth decay and gum disease. Many things can increase your chances of developing a dental abscess, including poor oral hygiene, consuming lots of sugary or starchy food and drink, an injury or previous surgery to your teeth or gums, or having a weakened immune system.”

And patients are more at risk of developing a tooth abscess if they engage in the following behaviors:

  • Poor oral hygiene practices

  • Consuming sugary or starchy foods and drinks

  • Smoking or using tobacco products

  • Weakened immune system due to medical conditions or medications

  • Age (tooth decay and gum disease become more common as people age)

  • Genetics (some people may be more prone to dental problems due to their genes)

  • Poor nutrition or a diet lacking in essential vitamins and minerals.

Tooth abscess symptoms

The American Dental Association cites the following symptoms for a tooth abscess.

  • Pain in the affected tooth, which may be sharp or throbbing and may worsen with pressure or temperature changes

  • Swelling and tenderness in the gums around the affected tooth

  • Redness or inflammation in the gums

  • A bad taste in the mouth, which may be caused by pus draining from the abscess

  • Fever, which may be a sign of a more severe infection and requires prompt medical attention.

Tooth abscess treatments

If you have a tooth abscess, you must immediately seek treatment from a licensed dentist or physician. Per the U.S. National Library of Medicine, if the abscess doesn't drain, the infection may spread to the jaw and other head and neck areas.

The primary goals of treating tooth abscesses are to eliminate the infection and prevent further complications. Various treatments include:

  • Incision and drainage: A small incision is made in the abscess to allow the pus to drain out.

  • Root canal: A root canal is designed to eliminate bacteria from the infected root canal, prevent reinfection of the tooth and save the natural tooth.

  • Tooth extraction: In cases where the tooth is too damaged to be saved, extraction may be necessary. Your dentist may recommend this option if the tooth cannot be saved.

  • Antibiotics: Your dentist may prescribe antibiotics for tooth abscesses to help fight off any remaining bacteria. According to California dentist Dr. Rana Baroudi, “commonly prescribed antibiotics include penicillin, amoxicillin and clindamycin. It is essential to take the antibiotics as prescribed and to finish the entire course, even if the symptoms improve. Failure to do so can lead to antibiotic resistance and future complications."

SOURCES: Shawn Van de Vyver, DDS, Great Lakes Dentistry, Royal Oak and Shelby Township, Mich.; Daniel Weinstein, DDS, ProHealth Dental, Corona, N.Y.; Rana Baroudi, DMD, periodontics and dental implants, San Jose, Calif.

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