Dental abscess: symptoms, what to do at home and how it is treated

How does an abscess form?

When decay reaches the nerve of a tooth or the tooth fractures, bacteria enter the root canal, the nerve dies and infection spreads into the bone at the root tip (periapical abscess). In gum disease, bacteria collecting in deep pockets cause an abscess in the gum (periodontal abscess). In both cases the body tries to contain the infection; as pressure builds, pain intensifies.

Symptoms

• Constant, throbbing toothache that worsens at night; may be aggravated by heat
• Sharp pain on biting or touching the tooth; the tooth feels "raised"
• Swelling and redness of the gum; sometimes a pimple-like bump (a fistula) and a bad taste — this means the pus has found a way out; pain eases temporarily but the problem continues
• Swelling of the cheek, jaw or under the eye
• Fever, malaise, tender lymph nodes under the jaw

Emergency signs

If any of the following is present, see a dentist the same day without waiting — or go to an emergency department if none is available:

• Swelling spreading to the face, around the eye or into the neck
• Difficulty swallowing or breathing, inability to open the mouth
• Fever above 38 °C, chills

Until you see the dentist

1. Take an over-the-counter painkiller at the dose on the leaflet; never place aspirin on the tooth or gum (it burns).
2. Rinse gently with warm salt water; don't squeeze or pierce the abscess.
3. Don't apply heat; an external cold compress can reduce swelling.
4. Don't chew on that side; avoid very hot and very cold.
5. Don't start leftover antibiotics on your own; antibiotics taken without a dental assessment mask the picture and breed resistance.

Treatment

The source is identified by examination and X-ray. The aim is to remove the source of infection:

• Root canal treatment: If the tooth can be saved, the canal is opened, the pus drains, the canals are cleaned and filled; a crown is then needed. See Root canal treatment.
• Drainage: If swelling is marked, the pus is drained through the gum or the canal; relief is quick.
• Gum treatment: In a periodontal abscess the pocket is cleaned and root planing done.
• Extraction: If the tooth cannot be saved. See Extractions and oral surgery.
• Antibiotics: Prescribed by the dentist for spreading infection, fever, swelling or immunocompromised patients; they do not replace treating the source.

What if an abscess is left untreated?

Pain may ease temporarily through a fistula, but the infection keeps destroying bone; it can affect neighbouring teeth and the sinus; rarely it leads to serious infections spreading to the neck and chest. Pain going away does not mean healing.

Prevention

Early treatment of deep decay, not leaving fractured teeth, taking bleeding gums seriously and 6-monthly check-ups prevent the great majority of abscesses.