Abscessed Tooth

Topic Overview

What is an abscessed tooth?

When you have tooth decay or gum disease, you can get infection deep within the tooth or gum. This infection is an abscessed tooth and can be very painful. If it is not treated, the infection can spread and you can lose your tooth or have other health problems.

What causes an abscessed tooth?

Damage to the tooth, an untreated cavity, or gum disease can cause an abscessed tooth.

If a cavity is not treated, the inside of the tooth (called the pulp ) can become infected. Bacteria can spread from the tooth to the tissue around it, creating an abscess.

Gum disease causes the gums to pull away from the teeth, leaving pockets. If food builds up in one of these pockets, bacteria can grow, and an abscess can form. Over time an abscess can cause the bone around the tooth to dissolve.

What are the symptoms?

You may have:

• Throbbing pain, especially when you chew.
• Red, swollen gums.
• A bad, salty taste in your mouth.
• Swelling in your jaw or face.
• A fever.
• A bump (gumboil) that looks like a pimple on the cheek side or tongue side of the gum near the tooth.

Over time as the infection spreads, the bone in your jaw may begin to dissolve. When this happens, you may feel less pain, but the infection will remain. If you lose too much bone, your tooth will become loose and may have to be removed.

If you have a severe toothache or notice drainage of pus, call your dentist right away. You may have an abscessed tooth. If it is not treated, the infection could spread and become dangerous.

How is it treated?

If you have an abscessed tooth, your dentist will give you antibiotics to kill the bacteria causing the infection. Antibiotics may help for a while. But to get rid of the abscess, your dentist will need to get rid off the source of infection. This is done by making hole in the tooth or gum to drain the infection. Usually this will relieve your pain.

If the inside of your tooth is infected, you will need a root canal or to have the tooth removed. A root canal tries to save your tooth by taking out the infected pulp. If you don't want a root canal or if you have one and it doesn't work, the dentist may have to remove your tooth. You and your doctor can decide the best step to take.

You may be able to reduce pain and swelling from an abscessed tooth by putting an ice pack wrapped in a towel against your cheek. You can also try over-the-counter pain medicine, including aspirin, acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin). But you still need to see your dentist for treatment.

How can you prevent an abscessed tooth?

You can prevent an abscessed tooth by preventing bacterial infections in your mouth. The best way to do that is to take good care of your teeth and gums:

• Brush your teeth 2 times a day, in the morning and at night, with fluoride toothpaste approved by the American Dental Association.
• Use dental floss to clean between your teeth every day.
• See your dentist for regular dental cleanings and checkups.
• Eat a healthy diet, and limit between-meal snacks.

Some people have a very dry mouth. This can cause deep dental cavities to form quickly, which can infect the pulp of a tooth and lead to an abscess. You may be able to prevent these problems by taking frequent sips of water, chewing gum, or sucking on sugarless candy. If you have severe dry mouth symptoms, you may need to take medicine to treat the problem.

Many medicines can cause a dry mouth, including some medicines used to treat depression and high blood pressure.

Frequently Asked Questions

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Symptoms

Symptoms of an abscessed tooth include:

• Throbbing pain, especially when you chew or you touch your tooth.
• Red, swollen gums .
• A bad, salty taste in your mouth.
• Fever.
• Swelling in any area of the mouth, face, upper or lower jaw, or neck.
• Creamy or yellow pus or blood oozing from a red, swollen, pimplelike area in your mouth.
• Your tooth turning pink or gray.
• A feeling that the tooth is being raised out of its socket, and you cannot close your teeth together properly.

As the infection spreads, you may feel less pain. This is because the bone in your jaw has begun to dissolve and the nerve to the tooth may be dying. If too much bone dissolves, your tooth will become loose and may have to be removed.

Call your dentist immediately if you have a severe toothache that has not improved after an hour or two of home treatment. You may have an abscessed tooth, and the infection may be spreading.

Call your dentist to make an appointment as soon as possible if you have:

• A mild to moderate toothache.
• A toothache with a fever of 100 °F (38 °C) or higher.
• Swelling in the mouth, jaw, or face that is new or getting bigger.
• A tooth that is very sensitive or painful when pressure is applied to it (such as when you chew).

Exams and Tests

Your dentist will examine your mouth to look for swelling and other signs of infection that suggest an abscessed tooth. He or she may tap on the tooth, apply heat or cold to the tooth, or probe the gums around the tooth. He or she may also ask questions about your pain, how long you have had it, and where it is located.

Your dentist may also take dental X-rays.

Treatment Overview

An abscessed tooth will be treated by your dentist or by an endodontist, a dentist who specializes in diseases of tooth pulp. The dentist may:

• Give you antibiotics to destroy the bacteria causing the infection.
• Make a hole in the top or back of the tooth so the infection can drain. Usually this will relieve your pain.
• If needed, lance the swollen area near the tooth to allow it to drain.

If the inside (pulp ) of your tooth is infected, the dentist will have to do root canal treatment (also called a root canal). A root canal tries to save your tooth by taking out the infected pulp.

You will need to be treated with antibiotics before having a root canal if you:

• Have damaged or artificial heart valves.
• Were born with heart defects.
• Have had bacterial endocarditis, an infection of the lining of the heart.
• Have diabetes or another disease that causes an impaired immune system.
• Have liver disease (cirrhosis).
• Have artificial joints, such as a hip replacement.
• Take steroids for other conditions, such as Crohn's disease or asthma.

If a root canal cannot be done or is unsuccessful, removal of the tooth (extraction) may be necessary.

What to think about

You should begin treatment for an abscessed tooth as soon as possible to avoid a more serious infection, such as cellulitis.¹ Bacteria from an untreated abscess can spread to the blood, infect other parts of the body, and become life-threatening. This risk increases if you have diabetes, heart valve disease or an artificial valve, or if you take steroids for other conditions, such as asthma or Crohn's disease.

Home Treatment

You may be able to reduce pain and swelling in your face and jaw from an abscessed tooth by using an ice pack on the outside of your cheek. (Do not use heat.) You can also try a nonprescription medicine to help relieve your face or jaw pain, such as:

• Acetaminophen, such as Tylenol or Panadol. Acetaminophen can lower fever and relieve pain but does not reduce swelling.
• Medicines that reduce swelling. Examples include ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
• Aspirin, which can also reduce swelling. Some people should not take aspirin; these include pregnant women, people with a history of bleeding problems, and anyone younger than 20.

Be sure to read the label carefully and follow all nonprescription medicine precautions.

Call your dentist immediately if you have a severe toothache that has not improved after an hour or two of home treatment. If you have an abscessed tooth, the infection may be spreading.

Prevention

You can prevent an abscessed tooth by preventing bacterial infections in your mouth. The best way to prevent bacterial infections is to take good care of your teeth and gums:

• Brush your teeth 2 times a day, in the morning and at night, with fluoride toothpaste approved by the American Dental Association.
• Use dental floss to clean between your teeth every day.
• See your dentist for regular dental cleanings and checkups.
• Eat a healthy diet, and limit between-meal snacks.

Once your abscessed tooth has been treated, you can help prevent further tooth problems:

• Brush and floss every day, and have regular dental checkups.
• Eat healthy foods, and avoid sugary foods and drinks.
• Don't smoke or use other types of tobacco. Tobacco use slows your ability to heal. It also increases your risk for gum disease and cancer of the mouth and throat.

For more information on how to brush and floss properly, see:

Dental care: Brushing and flossing your teeth.

For more information on general care of your teeth, see the topic Basic Dental Care.

Other Places To Get Help

Organizations

Related Information

• Basic Dental Care
• Gum Disease
• Tooth Decay

References

Citations

1. Wayne DB, et al. (2001). Tooth and periodontal disease: A review for the primary-care physician. Southern Medical Journal, 94(9): 925-932.

Other Works Consulted

• Douglass AB, Douglass JM (2003). Common dental emergencies. American Family Physician, 65(3): 511-516.

• MacLeod DK, Kern DE (2007). Common problems of the teeth and oral cavity. In NH Fiebach et al., eds., Principles of Ambulatory Medicine. 7th ed., pp. 1864-1878. Philadelphia: Lippincott Williams and Wilkins.

• Peterson LJ, et al., eds. (1998). Contemporary Oral and Maxillofacial Surgery, 3rd ed. St. Louis: Mosby.

• Roberts G, et al. (2000). ABC of oral health: Dental emergencies. BMJ, 321(7260): 559-562.

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