Tooth Abscess: Symptoms, Causes & Treatment

A tooth abscess is a pocket of pus caused by a bacterial infection in or around a tooth, and it usually requires prompt dental treatment rather than home care alone.

The presence of an abscessed tooth indicates an infection. It’s a sign that should not be ignored, as this condition can be life-threatening. Common dental problems like tooth decay, gum disease, and fractured teeth can lead to a tooth abscess.

There are several signs and symptoms of tooth abscesses to watch out for, especially swollen, abscessed teeth. Infection can spread to other parts of the body, such as your throat and lungs, causing swelling and making it hard for you to breathe. This article provides comprehensive information on the symptoms, causes, treatments, and prevention tips for a Tooth Abscess.

According to the National Hospital Ambulatory Medical Care Survey, there were about 2.2 million emergency department visits for dental conditions in the United States in 2018.

The American Dental Association warns that swelling, fever, or trouble breathing can signal a serious spreading infection that needs urgent care.

• Hospital emergency room visits related to a dental abscess and other dental issues are very common.
• A study reported that approximately 1 in 2,600 of the population in the United States is admitted to the hospital emergency room for dental infection.

What is a Tooth Abscess?

What is an abscessed tooth? What does an abscessed tooth look like? If you are wondering the answer to these questions, look no further. Below, we will explain what to watch out for with a tooth abscess.

An abscessed tooth is a bacterial infection that can cause many serious health problems if left untreated. It commonly appears as a raised pimple on the gum tissue around a potentially damaged or infected tooth. Inside the ‘pimple’ is a collection of pus containing bacteria, which can be painful until the infection is drained. The formation of pus, consisting of dead cells, bacteria, and tissue debris, is a sign of this immune response. Recognizing it early can prevent the spread of infection to other parts of the body.

Dental abscesses are commonly associated with severe pain, swelling, and signs of infection that prompt urgent care; in a large U.S. claims analysis, dental-related emergency department visits numbered more than 2.1 million in 2019, according to the Agency for Healthcare Research and Quality.

As the American Dental Association notes, untreated tooth infections can spread and become serious, which is why timely dental evaluation is important.

Types of Abscessed Teeth

There are several different types of tooth abscesses depending on their location in the mouth. In this paragraph, we will discuss the various types, including periodontal, gingival, pericoronal, periapical, and combined periodontic-endodontic abscesses. Periapical abscesses are the most common type and usually start with infection inside the tooth, while periodontal and gingival abscesses begin in the supporting gum tissues.

Type	Typical location	Common cause	Usual clinical pattern
Periodontal abscess	Along the gumline beside a tooth root	Gum disease	Swollen, tender gum pocket
Gingival abscess	Gum tissue only	Localized irritation or trapped debris	Localized gum swelling
Pericoronal abscess	Tissue around a partially erupted tooth	Food/bacteria trapped around a wisdom tooth	Pain and inflammation near the crown
Periapical abscess	Root tip	Untreated decay or pulp infection	Deep tooth pain, swelling, and pus formation

Periodontal Abscess: Periodontal abscesses are often located on the gums near a tooth’s root. This type of abscess often significantly impacts the tooth’s surrounding tissue and bone. One of the main causes of a periodontal abscess is gum disease. As the American Dental Association notes, untreated periodontitis can create deep pockets that trap bacteria and increase the risk of abscess formation.

Gingival Abscess: A gingival abscess can be found on the gum tissues. This infection typically does not affect the tooth or its supporting structures.

Pericoronal Abscess: A pericoronal abscess is usually found on the gum tissue surrounding the dental crown portion of a partially or fully erupted tooth. This type of abscess is sometimes referred to as a wisdom tooth abscess due to its common association with impacted wisdom teeth. It can become painful quickly because the gum flap over a partially erupted tooth can trap food and bacteria, creating a pocket that is hard to clean effectively.

Periapical Abscess: A periapical abscess can be found at the tip of a tooth’s root. Bacteria that have spread and infected the inside layer of a tooth, the dental pulp, will often invade the tooth’s root. This can cause infection and swelling around the root, which can eventually destroy the surrounding bone too. Dental pulp infection often follows untreated decay or a crack in the tooth, and that progression can end in pulp necrosis if the inflamed pulp loses its blood supply.

Combined Periodontic-Endodontic Abscess: Combined periodontic-endodontic abscesses typically impact a specific tooth or multiple teeth in one area. The bacterial infection may come from the dental pulp, the surrounding periodontal tissues, or both. These cases can be harder to diagnose because symptoms overlap, so clinicians often use a dental exam and radiographs to identify whether the infection is primarily root-based, gum-based, or both, according to the Cleveland Clinic.

Understanding these types helps tailor treatment to each unique case, making dental consultations crucial for proper diagnosis and intervention. A quick rule of thumb is that pain centered deep in a tooth often points to a periapical source, while swelling along the gumline more often suggests a periodontal or gingival source, according to the NHS.

Stages of Tooth Abscesses

There are several stages of tooth abscesses that continue to progress if left untreated. A tooth abscess usually develops after bacteria reach the dental pulp, causing inflammation, pulp death, and then a localized pocket of pus around the root or in the surrounding gums. It is important to familiarize yourself with pictures of the stages of a tooth abscess so you know what to look for in your mouth. 

According to the Centers for Disease Control and Prevention, 13.2% of children ages 5–19 and 25.9% of adults ages 20–44 had untreated dental caries in 2015–2018, a major pathway to pulp infection and abscess formation. The earlier you treat a dental abscess, the more likely you are to stop the infection from spreading. 

As Dr.Maria L. Geisinger, DDS, MS, Professor at the University of Alabama at Birmingham School of Dentistry, has explained, dental infections can progress quickly, so early diagnosis and treatment are critical to prevent spread beyond the tooth.

If the infection spreads beyond the tooth into the face, jaw, or neck, it can cause facial swelling, fever, swollen lymph nodes, and trouble opening the mouth — this stage needs emergency care.

Enamel Decay: Tooth enamel is the outermost layer of teeth. If bacteria accumulate in the mouth, they form a sticky film known as dental plaque, which can break down tooth enamel and cause tooth decay. Over time, this can lead to the development of pus and the formation of a dental abscess. 

Without proper oral hygiene to thoroughly eliminate plaque from your teeth and gums, you will be at a high risk of developing dental disease. A white spot on the enamel can be an early sign of demineralization, before a cavity forms, which is one reason routine exams matter, according to the NHS.

Dentin Decay: The dentin is the second layer of teeth positioned right underneath the dental enamel. Dentin is much softer and more susceptible to decay than dental enamel. Once the dentin is penetrated, bacteria can spread fast, and you will likely develop tooth sensitivity and other uncomfortable symptoms.

Dentin decay signifies a significant progression of the bacterial invasion, as bacteria can move more rapidly and deeper once the enamel barrier is breached. At this stage, hot, cold, and sweet foods may trigger a sharper, longer-lasting ache because dentin tubules can transmit irritation toward the pulp.

Tooth Pulp Infection: The innermost layer of teeth is the dental pulp. The pulp contains blood vessels and nerve endings, which can trigger pain if penetrated by bacteria. Bacteria can destroy the nerves within the tooth, causing them to die and leading to a dental abscess. This inflammatory phase is often described as pulpitis: reversible pulpitis may settle if the decay is treated early, while irreversible pulpitis usually progresses unless the tooth is treated promptly.

Abscess Formation: As tooth decay progresses and bacteria spread throughout the tooth, an abscess may form. Dental abscesses can extend deep into the gums and jawbone. The formation of an abscess is typically accompanied by gum redness, swelling, and pain. In a periapical abscess, the infection commonly forms at the root tip after the pulp dies, and the pocket of pus can increase pressure inside the tooth and surrounding bone.

Abscess formation marks a critical point. Intervention at this juncture can prevent the need for more invasive measures, such as tooth extraction. Early stages might be reversible with prompt dental care, highlighting the importance of regular checkups.

Tooth Loss: In extreme cases, an untreated abscess will ultimately result in tooth loss. You will likely experience throbbing pain and notice tooth mobility. A dental abscess erodes the jawbone that supports the teeth, and when it progresses, it can lead to tooth loss. If the swelling spreads to the face or neck, or if fever, difficulty swallowing, or trouble breathing develops, the infection requires emergency evaluation, as it may be spreading beyond the tooth, according to the NHS.

What Does a Tooth Abscess Feel Like?

A tooth abscess often feels like a persistent, throbbing toothache that may worsen when chewing, with swelling, bad taste, fever, or tenderness in the gums and jaw. If symptoms include facial swelling, trouble swallowing, or breathing difficulty, seek urgent care immediately.

Individuals may present with various symptoms of a tooth abscess. It is important to pay attention to these signs and symptoms and seek immediate medical attention if you are experiencing any of the following:

• Throbbing, Constant Tooth Pain - It is common to feel a throbbing pain that lingers in the area of the affected tooth. The pain can gradually worsen and spread to other areas of your head and neck.
• Discomfort when Chewing - An abscessed tooth can be painful and make it hard for you to chew. You may notice loss of appetite due to oral pain.
• Fever - As the infection spreads, you may develop a fever. You may experience other flu-like symptoms and generally feel unwell.
• Face, Cheek & Neck Swelling - The appearance of face, cheek, and neck swelling can be a concerning symptom and should be addressed immediately. Swelling in these areas can make it hard for you to breathe and can become life-threatening.
• Jaw Lymph Nodes Swollen - A tooth abscess can trigger an inflammatory response that leads to jaw lymph node swelling. You may notice small lumps near your jawline and neck.
• Bad Breath - Persistent bad breath is commonly caused by a bacterial infection. Pus within the abscess contains odor-producing bacteria that cause bad breath.
• Bitter Mouth Taste - An abscess is filled with pus that contains lots of bacteria. As the pus drains, it can leave a bitter taste in your mouth.
• Loose Tooth - A dental abscess can destroy the jawbone and cause tooth mobility. If left untreated, the abscess can result in tooth loss.
• Breathing /Swallowing Issues - The bacterial infection from the tooth can spread to your throat and neck region. Swollen tissues can block your airway, which is a life-threatening emergency.
• Puffy Gums - A tooth abscess creates an inflammatory response within the body that leads to oral swelling. This can make your gums appear puffy, red, and cause them to pull away from the teeth.
• General Discomfort in Mouth - A dental abscess can cause general discomfort in the mouth. It may be hard to speak, eat, and perform normal daily functions due to the pain.
• Tooth, Gum Sensitivity - An abscess can cause tooth and gum sensitivity. It will often hurt to chew, and you may be sensitive to hot, cold, or sweet foods and beverages.
• Gum Bump like a Pimple - A gum bump that resembles a pimple is a tell-tale sign of an abscessed tooth. The bump is filled with purulent material and causes swelling of the gum tissue.

According to the American Dental Association, swelling, fever, and trouble breathing are red-flag symptoms that require prompt evaluation, because a dental infection can spread into deeper facial spaces. The NHS notes that a dental abscess can cause pain, swelling, and a bad taste in the mouth, and may need urgent treatment to stop the infection from spreading.

Noticing these symptoms early can significantly help prevent severe complications. Promptly addressing these signs with a dental professional can mitigate the spread of infection and provide relief from discomfort.

What Causes Tooth Abscess?

Wondering what causes an abscessed tooth? There are several causes worth noting, all of which can be prevented with good oral and lifestyle habits. The most common cause is bacteria reaching the inner tooth or surrounding gum tissue after decay, a crack, trauma, or gum disease creates an opening for infection.

• Tooth Decay - Tooth decay, also known as cavities, is primarily caused by oral bacteria that destroy your teeth and gums. The bacteria produce harmful acids that can lead to infections, including a tooth abscess.
• Poor Oral Hygiene - Poor oral hygiene is a common cause of many oral issues, including dental abscesses. It is necessary to regularly brush, floss, and visit your dentist to maintain oral health.
• Damaged Teeth - Teeth that are broken, fractured, or injured can allow bacteria to invade the tooth. If not treated, the bacteria can spread into the layers of the tooth and cause a dental abscess.
• Gum Disease - Gum disease is an oral infection and inflammatory disease caused by bacteria. As gum disease progresses, the bacteria continue to accumulate and can create an abscess.
• Eating Sugary Foods - Sugary foods promote bacterial growth in the oral cavity. Frequent consumption of sugary foods can increase your risk of developing tooth decay, dental abscesses, gum disease, and many other oral issues.
• Smoking - Smoking is a negative habit that significantly impacts overall health. Individuals who smoke are found to be approximately twice as likely to get tooth abscesses as non-smokers. In a 2019 systematic review and meta-analysis, current smokers had higher odds of periodontitis than never-smokers.
• Dry mouth - Without adequate saliva, bacteria tend to thrive and wreak havoc. Dry mouth is associated with many oral diseases, including tooth decay and tooth abscesses.

It is worth noting that systemic health issues, such as diabetes and immunocompromised conditions, also predispose individuals to infections. Keeping these conditions under control is crucial for oral health as well. The Centers for Disease Control and Prevention reports that 38.4 million people in the United States had diabetes in 2021, a condition that can increase the risk of oral infections when blood sugar is poorly controlled.

How Is a Tooth Abscess Diagnosed?

A dentist usually diagnoses a tooth abscess by combining your symptoms with a clinical exam and dental imaging. They may look for tenderness, swelling, drainage, and signs that the infection has reached the tooth root or surrounding bone.

Common steps include a visual exam, percussion testing, palpation of the gums and face, pulp vitality testing, and x-rays. In some cases, imaging helps show whether the infection is a periapical abscess, whether bone is involved, or whether the infection has started to spread beyond the tooth.

What is the Treatment for an Abscessed Tooth?

An abscessed tooth is usually treated by removing the source of infection and draining the pus; antibiotics may be used as a supplement, but they do not replace dental treatment. The right option depends on whether the tooth can be saved, whether the infection has spread, and how much structural damage is present.

Tooth abscess treatment requires the help of dental professionals. In most cases, the abscess must be drained. In addition, your dentist may recommend other treatments to eliminate the tooth abscess.

Root Canal Treatment

Root canal treatment removes bacteria from within the tooth's pulp, eliminating the infection. This is a great option to help save your tooth. Once the infection is removed, the tooth’s root is filled with a protective material that helps prevent reinfection. A dental crown is also typically placed over the tooth after a root canal to help protect the tooth from bacteria.

Abscess Drainage

Abscesses contain a pocket of pus filled with bacteria. Your dentist will make a small cut in the abscess to drain the pus and resolve the infection. Drainage of the abscess often helps relieve oral pain caused by the infection.

Tooth Extraction

In some cases, a tooth extraction procedure may be necessary to eliminate the infection. This may be recommended for teeth that are damaged beyond repair. Your dentist will inform you of the best options to help replace your tooth to restore the appearance and function of your smile.

Antibiotics

Your dentist may prescribe antibiotics for a tooth abscess to help fight off the harmful bacteria, along with other dental procedures such as those mentioned above. Antibiotics alone, however, will not cure the dental abscess.

According to the American Dental Association, antibiotics are not recommended as the sole treatment for most dental abscesses because definitive dental care is needed to remove the source of infection. As dentists commonly explain to patients, dental infections generally require treatment of the source; antibiotics by themselves do not fix the problem.

The decision between a root canal and extraction depends on several factors, such as the extent of the decay, the patient's health, and the tooth's position. Your dentist will formulate a plan best suited to ensure long-term oral health and functionality.

When a tooth abscess is accompanied by facial swelling, fever, trouble swallowing, or difficulty breathing, urgent same-day care is needed because the infection may be spreading beyond the tooth, according to the Cleveland Clinic and NHS.

The Risks Associated with Extracting an Abscessed Tooth

Extracting an abscessed tooth can carry some risks. It is important to consider options to replace an extracted tooth to help minimize the risks mentioned below.

The main risks of extracting an abscessed tooth are bone loss at the extraction site, shifting teeth, and bite changes if the space is left unreplaced for too long.

Your dental professional may determine that your tooth needs to be extracted to resolve the abscess. There are risks to pulling an abscessed tooth, particularly if you do not replace the missing tooth as soon as possible after the extraction. A common risk is jawbone loss around the site of the extracted tooth. In addition, the neighboring teeth can drift into the space left by the missing tooth, causing the bite to become misaligned.

As Dr.Michael Glick, DMD, who led the Journal of the American Dental Association as Editor-in-Chief for 15 years before joining Penn Dental Medicine's Center for Integrative Global Oral Health in 2021, has explained, when a tooth is removed, the surrounding bone begins to remodel; preserving the space with a timely replacement can help maintain function and alignment.

To prevent such complications, dental implants or bridges are often recommended as replacements to support oral structure and function post-extraction.

A review published by the American Academy of Implant Dentistry reported that implant-supported restorations can help preserve jawbone by transferring chewing forces into the bone, unlike an unreplaced gap that may continue to shrink over time.

Complications of Untreated Abscessed Tooth

If a tooth abscess is left untreated, the infection can spread beyond the tooth and become a medical emergency. The most serious complications involve nearby tissues, the jaw, the bloodstream, and, in rare cases, the brain or chest. Early dental treatment lowers the risk of these outcomes, according to the NHS.

As with most untreated diseases, numerous health complications can arise if treatment is not initiated. In the case of an abscessed tooth, failing to treat it can be life-threatening. Listed below are several possible complications of an untreated abscessed tooth.

• Soft Tissue Infection - An untreated tooth abscess can lead to the spread of infection from your oral cavity to other areas of the body, such as the soft tissue. This can lead to swelling of the soft tissues of your face and neck.
• Jaw Bone Infection - An untreated abscessed tooth can also impact your jaw bones. The infection can lead to bone and tooth loss.
• Brain Abscess - In extreme cases, infection caused by an untreated tooth abscess can spread to the brain, and you could develop bacterial meningitis. This is a life-threatening condition that requires immediate medical attention.
• Blood Infection - If a dental abscess is not treated, the bacteria can enter the bloodstream. This can cause sepsis, which is a life-threatening response to infection.
• Loss of the Tooth - Normally, the jawbone helps house teeth and keep them stable within the mouth. The jawbone may deteriorate due to an untreated tooth abscess, which can lead to tooth loss.
• Pneumonia - An abscessed tooth can lead to an infection within the lungs. As a result, the displaced oral bacteria may cause pneumonia.

Further complications such as Ludwig’s Angina and cavernous sinus thrombosis, though rare, underscore the severity of untreated abscesses. Such conditions can progress rapidly and necessitate emergency medical intervention.

As the American Dental Association notes, a dental infection should not be ignored because a dental abscess is a pocket of pus that can form in different parts of the tooth, and it may require urgent treatment to prevent spread.

Seek emergency care right away if you have facial swelling, fever, trouble swallowing, trouble breathing, or swelling that is spreading quickly. These are red-flag symptoms of a potentially serious infection, according to the NHS.

How to Lower Tooth Abscess Risk?

The best way to lower the risk is to prevent decay and gum disease before bacteria can reach the tooth pulp. Daily fluoride use, regular cleanings, and timely repair of cavities or cracked teeth are the most effective practical steps.

One of the best ways to avoid a tooth abscess is to practice preventive measures to lower your risk of developing one. There are many simple tasks you can perform to keep your mouth healthy.

• Brush with Fluoride Toothpaste Twice Daily - Brushing your teeth twice daily is essential to remove dental bacterial plaque from your teeth and gums. Without proper toothbrushing habits, bacteria can accumulate, contributing to tooth decay, gum disease, tooth abscesses, and other health problems. It is recommended to use a toothpaste that contains fluoride, which offers cavity-fighting and tooth remineralization benefits.
• Change Toothbrush Every 3-4 Months -The American Dental Association (ADA) recommends switching out your toothbrush every 3-4 months. You may need to change your toothbrush earlier, particularly if you are sick or the bristles appear frayed. Replacing your toothbrush is essential, as bacteria can build up and harm your teeth if it's not replaced in a timely manner.
• Cut down on sugary and starchy foods - Do your best to limit your consumption of sugary and starchy foods. These ingredients are loved by bacteria, allowing them to thrive in your oral cavity. The bacteria can use sugars and starches to produce acids that make your mouth more susceptible to infection.
• Rinse with Fluoride or Antiseptic Mouthwash - A fluoride or antiseptic mouthwash can help rinse away harmful bacteria that cause dental infections like a tooth abscess. Fluoride fights off bad bacteria and makes you less susceptible to tooth decay. Look for a mouthwash with these qualities and the ADA Seal of Acceptance.
• Get Regular Dental Checkups and Teeth Cleanings - Regular dental checkups and teeth cleanings are a form of preventive dentistry that helps keep your smile healthy. Our team at Gentle Dental looks forward to seeing you and treating all your dental needs. Be sure to visit your dentist at least every 6 months for a teeth cleaning, or more frequently if your dentist recommends.

According to the Centers for Disease Control and Prevention, about 42% of U.S. adults aged 30 and older have periodontitis. The American Dental Association also advises replacing a toothbrush every 3 to 4 months for effective cleaning.

As Dr.Brett Kessler, DDS, President of the American Dental Association, has emphasized, the mouth is a window to your overall health, and regular dental care is essential to keeping problems from becoming serious.

In addition to these measures, maintaining good hydration can help combat dry mouth and promote saliva production, a natural defense mechanism against bacterial overgrowth. Additionally, addressing any systemic issues, such as controlling blood glucose levels, especially in diabetics, can significantly reduce the occurrence of dental abscesses.

Conclusion

An abscessed tooth can cause more health issues than just throbbing pain. Leaving a dental abscess untreated can lead to life-threatening complications, as oral bacteria can spread to other parts of the body. With immediate treatment by a medical or dental professional, an abscessed tooth can go away relatively quickly before progressing through the harmful stages of a tooth abscess. If you’re experiencing signs or symptoms of a dental abscess, like a gum pimple, persistent tooth pain, fever, oral or facial swelling, loose teeth, bad breath, bad taste in the mouth, puffy gums, or tooth sensitivity, seek medical assistance immediately for treatment.

Prompt action can not only relieve pain but also prevent serious systemic issues. Make dental health a priority in your everyday wellness routine.