Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Tooth Abscess

(Dental Abscess; Abscessed Tooth)
by Rick Alan
Definition

A tooth abscess is a sac of pus (infected material) in a tooth or the gums. There are two types of tooth abscesses:

  • Abscess between the tooth and gum
  • Abscess of the pulp (blood and nerve supply inside the tooth)

Causes

A tooth abscess is caused by bacteria. It begins when bacteria invade and infect 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:

  • Severe tooth decay
  • Break or crack in a tooth that lets bacteria invade the pulp

Food or other foreign matter that becomes trapped between the tooth and gum may lead to a bacterial infection in the area around the tooth.

Risk Factors

These factors increase your chance of developing a tooth abscess. Tell your dentist if you have any of these risk factors:

  • Build up of tartar or calculus beneath the gum line
  • Malnutrition, including severe vitamin and mineral deficiencies
  • Poor dental hygiene (leading to cavities and periodontal diseases)
  • Poor fluoride application to teeth via fluoridated water, toothpaste, or mouthwash
Symptoms

If you have any of these symptoms do not assume it is due to a tooth abscess. These symptoms may be caused by other conditions. Tell your dentist if you have any of these:

  • Bad breath or foul taste in mouth
  • Fever
  • Open, draining sore on the gums
  • Pain when biting on a tooth
  • Redness, tenderness, or swelling of the gums
  • Spontaneous tooth pain
  • Swollen neck glands
  • Throbbing/lingering pain in a tooth or gum area
  • Tooth discoloration

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 and perform a detailed exam of your teeth and gums.

Your dentist will test the tooth for pain and sensitivity by:

  • Lightly tapping on the tooth
  • Sliding a probe between the tooth and gum to measure gaps or tissue loss
  • Stimulating the tooth nerve with a low electrical current
  • Stimulating the tooth nerve with heat or cold

Your dentist will also take an x-ray of the tooth and surrounding bone.

Treatment
Removal of Abscess Via Root Canal
  • If an abscess results from infection between the tooth and gum:
    • In some cases, surgery to reshape the gum is done to prevent recurrence of infection.
    • The abscess is drained and thoroughly cleaned.
    • The root surface of tooth is cleaned and smoothed.
  • If an abscess results from tooth decay or a break or crack in the tooth:
    • A crown is placed on the tooth to protect it.
    • Pus and dead tissue are removed from the center of the tooth.
    • The interior of the tooth and the root (nerve) canals are cleaned and filled with a permanent filling.
    • The tooth and surrounding tissue is numbed and a hole is drilled through top of the tooth.
Tooth Extraction (Removal)
  • If the tooth is extracted, it will be replaced with a:
    • Denture
    • Partial bridge
    • Tooth implant
  • Removal of the tooth may be required if:
    • 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.
    • Tooth decay and/or tooth infection is too extensive for filling or root canal treatment.
Medication
  • Nonprescription pain relief drugs ( ibuprofen or acetaminophen ) and warm salt water rinses
  • Antibiotics to fight residual infection of the tooth or gums
Prevention

To help reduce your chance of getting a tooth abscess, take the following steps:

  • Proper dental hygiene, including:
    • Daily flossing between teeth and gums
    • Brushing teeth with fluoride toothpaste after meals or at least twice per day
    • Regular dental check-ups (every six months)
    • Regular professional teeth and gum cleaning (every six months)

Last reviewed: September 2011 by Laura Morris-Olson, DMD.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Beers MH, Fletcher AJ. The Merck Manual of Medical Information—Home Edition . New York, NY: Simon and Schuster, Inc.; 2000.
  • Root canal (endodontic) treatment. American Dental Association website. Available at: http://www.ada.org/2890.aspx . Accessed July 27, 2011.
  • Tooth abscess. Mayo Clinic.com website. Available at: http://www.mayoclinic.com/health/tooth-abscess/DS01189 . Updated August 2010. Accessed July 27, 2011.