Dental abscess: signs, symptoms and treatment

Go to a hospital emergency department now if you have

• Swelling of the face, jaw, or under the eye, or swelling that is spreading
• Difficulty breathing, swallowing, or opening your mouth
• Fever alongside dental pain or swelling
• Swelling closing the eye, or spreading down the neck
• Feeling generally very unwell, confused or drowsy

Call 000 if breathing or swallowing is affected.

A dental infection that spreads into the tissues of the face and neck can compromise the airway. This is uncommon but it is a genuine medical emergency, and it can progress over hours. It is a hospital presentation, not a dental appointment, and it should never wait until morning.

What a dental abscess is

A collection of pus caused by bacterial infection — in the tooth, the gum, or the surrounding bone. Bacteria reach the inner tissues, the body walls the infection off, and pressure builds.

Common causes: untreated decay reaching the nerve inside the tooth; advanced gum disease creating deep pockets; a cracked or broken tooth giving bacteria a route in; and occasionally a failed root canal or an impacted wisdom tooth.

The three types, and why the distinction matters

They look similar from the outside and need different treatment, which is one of the reasons an examination and a radiograph come before anything else.

How it develops

1. Bacteria breach the enamel through decay, a crack, or a deep gum pocket
2. The pulp — the living tissue inside the tooth — becomes inflamed. This is the stage that usually hurts most
3. The pulp dies. The pain often eases, sometimes completely, and people assume it has resolved
4. Infection travels down the root canal and out of the root tip into the surrounding bone
5. The body walls it off. Pressure builds; the tooth becomes sore to bite on and feels taller than its neighbours
6. It finds a route out — through the gum as a boil, or into the soft tissues of the face

Step 6 is where it stops being a tooth problem and starts being a medical one.

Signs and symptoms

• Severe, persistent throbbing pain, which may radiate to the jaw, ear or neck
• Pain worse on biting or chewing, or when lying down
• Swelling, redness and tenderness of the gum or face
• Sensitivity to hot and cold
• A gum boil — a pimple-like lump on the gum, which may discharge
• A foul taste or smell, particularly if it discharges
• The tooth feeling raised, loose, or sore to tap
• Swollen glands under the jaw, fever, feeling unwell

An abscess does not resolve on its own

This is the point that most needs making.

If the pain suddenly stops, that is not recovery. It usually means the pressure has found a way to drain, or the nerve has fully died. The infection remains and will flare again — often worse, and often at the least convenient moment.

An abscess left alone can spread into the bone, into the tissues of the face and neck, and rarely into the bloodstream. Prompt treatment is not optional.

A gum boil that discharges and disappears is the same situation. It has found a drainage route, which relieves the pressure and removes the pain. The infection at the root tip is unchanged.

Antibiotics alone will not fix it

Antibiotics can control an infection that is spreading, and are sometimes needed before or alongside treatment. They do not cure a dental abscess, because they cannot reach the dead tissue inside a tooth where the bacteria live.

The source has to be dealt with — by draining the abscess, root canal treatment, treating the gum condition, or removing the tooth. A course of antibiotics that settles things without treating the cause simply postpones the problem, and repeated courses contribute to antibiotic resistance.

If you have been given antibiotics elsewhere and feel better, you still need the tooth treated.

Before your appointment

• Rinse with warm salty water several times a day
• Cold compress on the outside of the cheek
• Paracetamol or ibuprofen as directed on the packet; check with your pharmacist if you take other medication
• Sleep with your head elevated — lying flat often makes the throbbing worse
• Soft food; avoid very hot or cold things and chewing on that side

Do not try to squeeze, lance or drain it yourself, apply heat to the outside of the face, or hold aspirin against the gum.

Higher risk

Untreated decay or gum disease; dry mouth, including from medication; a high-sugar diet; smoking; and conditions or medications that suppress the immune system — including poorly controlled diabetes.

If you are immunosuppressed or have poorly controlled diabetes, treat any dental swelling as more urgent, and say so when you call.

Two other groups worth naming:

• Children. Facial swelling in a child can progress considerably faster than in an adult, and a child with facial swelling and fever should be seen the same day, or presented to a hospital emergency department after hours.
• Pregnancy. An untreated dental infection carries risks of its own, and treatment is generally appropriate rather than deferred. Tell us you are pregnant when you ring so treatment and any medication are planned accordingly.

Treatment

We examine the area and take radiographs where clinically indicated to find the source and see how far it extends. We have an on-site OPG.

Depending on what is found:

• Drainage to relieve pressure, which usually brings rapid relief
• Root canal treatment to remove the infected pulp and save the tooth
• Periodontal treatment where the abscess arises from the gum
• Extraction where the tooth cannot be saved
• Antibiotics alongside the above where infection is spreading or you are systemically unwell

Complex cases are referred to a registered endodontist or oral and maxillofacial surgeon. We are a general dental practice and hold no specialist registration.

What drainage is like

The area is numbed first. Drainage is achieved either through the tooth — opening into the pulp chamber so the pressure escapes — or through a small incision in the swollen gum. It takes minutes, and the relief when the pressure releases is usually immediate and dramatic.

Achieving good numbness can be harder in the presence of an active infection, because inflamed tissue responds less predictably to local anaesthetic. Your practitioner may use a different technique or more anaesthetic than usual. Tell us if you are feeling anything sharp rather than pushing through it.

Afterwards

Come back sooner if the swelling increases rather than decreases after day two, a fever develops, the pain returns sharply, or you have difficulty opening your mouth or swallowing.

Finish any prescribed antibiotic course even once you feel well, unless you are told otherwise.

Preventing the next one

An abscess is almost always the end point of something that was treatable earlier and cheaper.

• Routine examinations catch decay while it is still a filling rather than a root canal
• Radiographs at appropriate intervals find decay between teeth, which is invisible to the eye
• Treat gum disease rather than living with bleeding gums
• Do not ignore a cracked or chipped tooth because it does not hurt — a crack is an open route for bacteria
• Deal with a lost or broken filling promptly
• If you have had one abscess, take the recall interval your practitioner recommends seriously

Outside our hours

We are open Monday to Friday, 8:00am to 5:00pm and do not run an after-hours service.

• Facial swelling, fever, difficulty breathing or swallowing — 000 or the nearest emergency department. Do not wait
• Urgent but not life-threatening — Nurse-on-Call, 1300 60 60 24, 24 hours
• Public emergency dental care — Royal Dental Hospital of Melbourne, 720 Swanston Street, Carlton, for eligible patients
• Otherwise call (03) 9088 5808 when we open; online booking is available at any hour

Cost

Fees depend on what treatment is needed, which is not known until you have been examined — draining an abscess, root canal treatment and extraction differ substantially in cost. You are given the figure before treatment starts. HICAPS on-the-spot claiming; Afterpay and Zip accepted.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · book online

Read more about dental emergencies, toothache, facial and cheek swelling or root canal treatment.

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances, and it is not a substitute for being examined. If in doubt, seek care rather than waiting. Please see our Disclaimer.