A dental abscess is an infection of the mouth, face, jaw, or throat that begins as a gum infection, tooth infection, or cavity. These infections are common in people with poor dental health and result from a lack of proper and timely dental care.
Bacteria from a cavity can extend into the gums, the cheek, the throat, beneath the tongue, or even into the jaw or facial bones. A dental abscess can become very painful when tissues become inflamed. Pus collects at the site of the infection and will become progressively more painful until it either ruptures and drains on its own or is drained surgically.
Sometimes the infection can progress to the point where swelling threatens to block the airway, causing difficulty breathing. Dental abscesses can also make you generally ill, with nausea, vomiting, fevers, chills, and sweats.
The term dentoalveolar abscess comprises 3 distinct processes, as follows:
- A periapical abscess that originates in the dental pulp and is usually secondary to dental caries is the most common dental abscess in children. Dental caries erodes the protective layers of the tooth (ie, enamel, dentin) and allows bacteria to invade the pulp, producing a pulpitis. Pulpitis can progress to necrosis, with bacterial invasion of the alveolar bone, causing an abscess.
- A periodontal abscess involves the supporting structures of the teeth (periodontal ligaments, alveolar bone). This is the most common dental abscess in adult but may occur in children with impaction of a foreign body in the gingiva.
- Pericoronitis describes the infection of the gum flap (operculum) that overlies a partially erupted tooth.
Generally, a non-pathologic resident bacterium gains entry when the host’s defenses are breached, rather than when a non-typical microorganism is introduced. The predominant species associated with a dental abscess include Bacteroides, Fusobacterium, Actinomyces, Peptococcus, Peptostreptococcus, and Porphyromonas as well as Prevotella oralis, Prevotella melaninogenica, and Streptococcus viridans.
A dental abscess occurs when bacteria infect and spread inside a tooth or your gums. The bacteria responsible for this are found in plaque, which also contains food particles left over from eating combined with saliva. Periapical abscesses are much more common than periodontal abscesses.
Causes of a periapical abscess
When a periapical abscess occurs, plaque bacteria infect your tooth as a result of dental caries (tiny holes caused by tooth decay) that form in the hard outer layer of your tooth (the enamel).
Dental caries breaks down the enamel and the softer layer of tissue underneath (dentine) and eventually reach the center of your tooth (pulp). This is known as pulpitis. The dental pulp in the middle of the tooth dies and the pulp chamber becomes infected.
The bacteria continue to infect the pulp until it reaches the bone that surrounds and supports your tooth (alveolar bone), where the periapical abscess forms.
Causes of a periodontal abscess
A periodontal abscess occurs when plaque bacteria affect your gums, causing gum disease (known as periodontitis). Periodontitis causes inflammation (redness and swelling) in your gums, which can make the tissue that surrounds the root of your tooth separate from the base of your tooth. This separation creates a tiny gap known as a periodontal pocket, which can be very difficult to keep clean and allows bacteria to enter and spread. The periodontal abscess is formed by the build-up of bacteria in the periodontal pocket.
A periodontal abscess may also occur as a result of:
- Dental procedures that create accidental periodontal pockets
- Antibiotic use in untreated periodontitis, which can mask the beginnings of an abscess
- Damage to your gums, even if you do not have periodontitis
- Poor dental hygiene. Not taking proper care of your teeth and gums – such as not brushing your teeth twice a day and not flossing – can increase your risk of tooth decay, gum disease, tooth abscess, and other dental and mouth complications.
- A diet high in sugar. Frequently eating and drinking foods rich in sugar, such as sweets and sodas, can contribute to dental cavities and turn into a tooth abscess.
The most common symptom of an abscess is an ache in the bone around the tooth, but you may also experience pain when chewing, swelling of the gums, or other symptoms.
More symptoms include:
- You may have a throbbing toothache that can radiate to your jaw, neck, or ear.
- Your teeth may be sensitive to hot, cold, and the pressure of chewing.
- You may develop a fever.
- You might have swelling in your face, cheek, and the lymph nodes of your jaw or neck.
- Your gums may be red and swollen.
- If the abscess ruptures, you might get a rush of bad-tasting and smelling discharge in your mouth and have an open, draining sore.
- If left untreated, the pain can become severe, often excruciating.
Symptoms of advanced infection may include:
Don’t ignore a gum abscess. If left untreated, the infection can spread deeper into the gum tissue and affect surrounding teeth and bones. This can cause increased pain and swelling, and the infection could travel to other parts of your face and body. The following are the complications arise if the abscess is untreated.
- Dental cysts
- Cavernous sinus thrombosis
- Ludwig’s angina
- Maxillary sinusitis
In rare cases, a gum infection can travel to the bloodstream and cause a life-threatening complication known as sepsis. Sepsis symptoms include:
- A temperature above 101˚F (38˚C)
- Difficulty breathing
- Abdominal pain
- High heart rate
Diagnosis and Test
In addition to examining your tooth and the surrounding area, your dentist may:
- Tap on your teeth. A tooth that has an abscess at its root is generally sensitive to touch or pressure.
- Recommend an X-ray. An X-ray of the aching tooth can help identify an abscess. Your dentist may also use X-rays to determine whether the infection has spread, causing abscesses in other areas.
- Recommend a CT scan. If the abscess has spread to other areas within the neck, a CT scan may be used to assess the extent of the infection.
Treatment and Medications
Dental abscesses are treated by removing the source of the infection and draining away the pus.
Depending on the location of the abscess and how severe the infection is, possible treatments include:
- Removing the affected tooth (extraction) – this may be necessary if root canal treatment isn’t possible
- Root canal treatment – a procedure to remove the abscess from the root of an affected tooth before filling and sealing it
- Incision and drainage – where a small cut (incision) is made in the gum to drain the abscess (this is usually only a temporary solution and further treatment may be needed)
A local anesthetic will usually be used to numb your mouth for these procedures. More extensive operations may be carried out under general anesthetic (where you’re asleep).
Antibiotics aren’t routinely prescribed for dental abscesses but may be used if the infection spreads or is particularly severe.
- There are actions you can take at home to relieve the pain.
- Avoid food and drink that is either too hot or too cold.
- Chewing on the side of your mouth without an abscess will probably be less painful
- Do not floss around the affected area.
- Use a very soft toothbrush.
While home remedies can help make a person more comfortable while they wait for treatment, it is important to visit a healthcare professional for treatment to avoid any of the complications of a dental abscess.
Avoiding tooth decay is essential to preventing a tooth abscess. Take good care of your teeth to avoid tooth decay:
- Use fluoridated drinking water.
- Brush your teeth at least twice a day with a fluoride toothpaste.
- Use dental floss or an interdental cleaner to clean between your teeth on a daily basis.
- Replace your toothbrush every three or four months, or whenever the bristles are frayed.
- Eat healthy food, limiting sugary items and between-meal snacks.
- Visit your dentist for regular checkups and professional cleanings.
- Consider using an antiseptic or a fluoride mouth rinse to add an extra layer of protection against tooth decay.