Definition

A tooth abscess is a sac of infected material called pus in a tooth or the gums.

Abscess Between Tooth and Gum
Abscess tooth

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Causes

A tooth abscess is caused by bacteria. It begins when bacteria invade and infect the tissue around a tooth. This results in pus build-up. When the pus is unable to drain, an abscess results.

Conditions that allow bacteria to invade a tooth include:

  • Severe tooth decay
  • Break or crack in a tooth that lets bacteria invade the pulp
  • Failed root canal treatment
  • Advanced periodontitis
  • Dental trauma

Risk Factors

Factors that may increase your chance of a tooth abscess include:

  • Build up of tartar or calculus beneath the gum line
  • Poor dental hygiene leading to cavities and periodontal diseases

Symptoms

A tooth abscess may cause:

  • Throbbing/lingering pain in a tooth or gum area
  • Pain when biting
  • Pain from hot or cold
  • Sudden tooth pain
  • Redness, tenderness, or swelling of the gums
  • Fever
  • Bad breath or foul taste in mouth
  • Open, draining sore on the gums
  • Loose tooth

If left untreated, complications of tooth abscess include:

  • Loss of tooth and surrounding tissues or bone
  • Spread of infection to surrounding tissue or bone

Diagnosis

Your dentist will ask about your symptoms and medical history. A detailed exam of your teeth and gums will be done.

Images may need to be taken of the tooth and surrounding bone. This can be done with x-rays.

A sample of the abscess fluid may be taken and tested.

Treatment

Drainage of Abscess

  • If an abscess results from infection between the tooth and gum:
    • The abscess is drained and thoroughly cleaned.
    • The root surface of tooth is cleaned and smoothed.
    • In some cases, surgery to reshape the gum is done to prevent a repeat infection.

Removal of Abscess Via Root Canal

  • If an abscess results from tooth decay or a break or crack in the tooth:
    • The tooth and surrounding tissue is numbed and a hole is drilled through the top of the tooth.
    • Pus and dead tissue are removed from the center of the tooth.
    • The interior of the tooth and the root canals are cleaned and filled with a permanent filling.
    • A crown is placed on the tooth to protect it.

Tooth Extraction (Removal)

  • Tooth extraction may be required if:
    • Tooth decay and/or tooth infection is too extensive for filling or root canal treatment.
    • The break or crack in the tooth is too severe to be repaired.
    • The infection or loss of tissue/bone between the tooth and gum is severe.
  • If the tooth is extracted, it will be replaced with a:

Medication

  • Antibiotics to fight residual infection of the tooth or gums
  • Over-the-counter pain relief drugs, such as ibuprofen or acetaminophen

Prevention

To help reduce your chance a tooth abscess:

  • Brush your teeth with fluoride toothpaste after meals or at least twice per day.
  • Using a soft-bristled toothbrush or a powered toothbrush.
  • Floss between your teeth and gums every day.
  • Get regular dental check-ups and teeth and gum cleanings every 6 months.
RESOURCES:

Academy of General Dentistry
http://www.agd.org

Mouth Healthy—American Dental Association
http://www.mouthhealthy.org

CANADIAN RESOURCES:

Canadian Dental Association
http://www.cda-adc.ca

The Canadian Dental Hygienists Association
http://www.cdha.ca

REFERENCES:

Abscess (toothache). Mouth Healthy—American Dental Association website. Available at: http://www.mouthhealthy.org/en/az-topics/a/abscess. Accessed August 22, 2017.

Acute apical dental abscess. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T435303/Acute-apical-dental-abscess. Updated June 15, 20175. Accessed August 22, 2017.

Dental abscess. NHSinform website. Available at: https://www.nhsinform.scot/illnesses-and-conditions/mouth/dental-abscess. Updated April 13, 2017. Accessed August 22, 2017.

Toothache and Infection. The Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/dental-disorders/symptoms-of-dental-and-oral-disorders/toothache-and-infection. Updated September 2016. Accessed August 22, 2017.

Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP  Last Updated: 9/30/2013