Tooth Abscess: Causes, Symptoms and Treatment

If you have ever suffered an abscess — an infection of the mouth, face, jaw or throat — you can attest to the fact that it’s one of the most painful dental experiences. Even worse, abscesses actually can be life-threatening if left untreated.

Tooth abscesses always require professional dental care. They occur when bacteria invade the dental pulp, the soft inner part of the tooth that contains blood vessels, nerves and tissue. Bacteria enter through a dental cavity, chip or crack in the tooth and spread to the root. The bacterial infection causes swelling and the formation of pus (bacteria, dead tissue and white blood cells). If unchecked, the bacterial infection spreads from the tooth root to different parts of the body.

Common Causes

Common causes of tooth abscesses are severe, untreated tooth decay, tooth injury, such as broken or chipped teeth, and gum diseases like gingivitis or periodontitis. Two other causes are persistent disease and infection following root canal therapy, and infected tooth fillings.

Who is at Risk?

Anyone who does not receive treatment for a cracked tooth, exposed root or a deep cavity runs the risk of developing a tooth abscess. People who have not gone to the dentist for a long time are especially vulnerable because they likely have not received treatment for severe cavities caused by factors such as prolonged poor oral hygiene, a high-sugar diet or financial restrictions. People with diabetes, an autoimmune disease or those who are receiving chemotherapy/radiation cancer care treatment (or have another medical condition that weakens their immune system) also are at higher risk of abscesses.

Symptoms

A tooth abscess usually affects only one tooth, but if the infection remains untreated, other teeth also may become infected. To prevent serious complications that can develop from non-treatment, it is important to see a dentist if you experience any of the following symptoms:

Toothache (continuous and characterized by gnawing, sharp, shooting or throbbing sensations)
Bitter taste in the mouth
Foul breath
Discomfort/ill feeling
Pain when chewing, especially when biting or closing the mouth tightly
Tooth sensitivity to hot and cold temperatures
Red, swollen gums that drain pus
Swollen lymph nodes in the neck and jaw areas
Headaches

If the infection kills the tooth nerve, the toothache may stop. However, this doesn’t mean the infection has healed; the infection continues to spread and destroy tissue. With advanced infection, you may experience nausea, vomiting and chills. Fever and facial swelling may indicate that the infection has spread deeper into your jaw and surrounding tissue, or even to other areas of your body. If you can’t reach your dentist, go to an emergency room.

Possible Complications of Tooth Abscesses

An abscess may create an eruption or fistulae through the skin that leaks and drains pus into the mouth or through the cheek. More serious and dangerous, the abscess may erupt into the bone area and spread throughout the body, infecting surrounding tissue and possibly damaging nerves as it travels. A severe case that has perforated bone and extended into the soft tissue can eventually progress into osteomyelitis (bone infection) and cellulitis (skin infection).

When left untreated, an advanced infection can eat away the jaw, leading to tooth loss and possible facial disfigurement as a result of compromised, soft facial bones. It can put you at greater risk of systemic (whole body) problems such as diabetic flare-ups, blood infection (septicaemia), breathing problems, heart disease and vascular infection.

An example of a severe abscess complication requiring immediate hospitalization is Ludwig’s angina, a serious form of cellulitis that inflames the tissues of the floor of the mouth. In extreme cases, this condition can close the air pathway and cause suffocation.

Infection also can spread to the mid-chest area, which has serious consequences on vital organs such as the heart. If the abscess doesn’t drain, it may lead to sepsis, a whole-body infection that can cause limb loss, organ dysfunction and death.

In rare cases, the spread of infection to soft tissue, the jawbone and other areas of the body may result in meningitis, brain abscess and pneumonia.

Treatment Options

A tooth abscess won’t resolve without treatment. Even if the abscess disperses, bursts or drains and the pain stops, you still need professional dental treatment. Common treatments consist of the following:

Prompt treatment of cavities and traumatized teeth: Treatment goals include draining the abscess, eradicating and stopping the spread of infection, preserving the tooth (whenever possible) and preventing complications.

Antibiotics: Antibiotics kill the germs responsible for tooth abscesses, helping the body to repair the tooth and bone. Your dentist usually prescribes antibiotics — most commonly penicillin — after X-rays have been reviewed to confirm that you have an infection. Antibiotics normally are effective in controlling the abscess; most of the symptoms will be alleviated within two days, and the abscess typically will heal after five days of antibiotic treatment.

If the infection is limited to the abscessed area, antibiotics may not be necessary. However, if the infection has spread to nearby teeth, your jaw or other areas, your dentist likely will prescribe antibiotics to stop the spread of infection. Antibiotics also may be prescribed if you have a weakened immune system.

Warm salt-water rinses: If an abscess erupts by itself, warm salt-water rinses will soothe, help clean the mouth and encourage drainage until you are able to see your dentist. Your dentist also may recommend them during the treatment recovery time to alleviate discomfort and promote healing.

Over-the-counter (OTC) pain medication: Painkillers such as ibuprofen help alleviate discomfort while the area is healing. However, while these medications will diminish pain, they won’t treat the abscess. You still need to see your dentist for proper follow-up care.

Root canal treatment: This procedure can help eliminate the infection and save your tooth. This involves removal of the diseased pulp and draining of the abscess. The tooth’s pulp chamber and root canals are filled and sealed, then capped. Root canal surgery also may be recommended to remove any diseased root tissue after the infection has cleared. This option is only recommended when enough tooth structure is left on which to place a permanent restoration.

Extraction of infected tooth: If the tooth can’t be restored through root canal treatment, it must be extracted. Your dentist will remove the tooth and drain the abscess to eliminate the infection. Your dentist then will follow up by performing curettage (removing by scraping or scooping) of all infected soft tissue at the tip of the tooth. Tooth extraction and cleaning the affected area will allow the wound to heal.

Surgery: An abscess that has spread to the floor of the mouth or to the neck may need to be drained in the operating room under anesthesia. Additionally, if an abscess still doesn’t heal, or it enlarges after undergoing conventional root canal treatment, you most likely will need surgery and filling of the root tips, as well as a diagnostic biopsy.

Hospitalization: Serious infections of the tooth and jaw, secondary infections of the body and their complications may be life-threatening and require emergency room and/or longer-term hospital care.

Who Treats Tooth Abscesses

If you have an abscess, your general dentist may decide to cut it open and drain the pus, or treat it with antibiotics. Unless the abscess ruptures on its own, this generally is the only way to cure the infection. As needed, your dentist typically will prescribe pain relievers, rinses and antibiotics; follow-up care will be scheduled for reassessment.

If you require root canal treatment, your general dentist likely will refer you to an endodontist, a specialist in root canals. An oral surgeon is recommended in cases involving removal of non-salvageable, diseased teeth, especially when general anesthesia is required and/or the evaluation and treatment of pathologic conditions, such as severe infections of the oral cavity, jaws and neck; and reconstructive/cosmetic surgery for facial disfigurement and the eating away of jaw areas and facial tissue.

Emergency room physicians also may be required in extreme cases. If hospital admittance becomes necessary, a general medical practitioner can treat secondary infections that result from abscesses that have been left untreated too long or from fast-spreading infections.

Cost of Treatment

Because there are so many possible treatment options and factors involved, the cost of treatment is difficult to determine. Variables in the cost equation include procedure(s) required, the type and severity of the tooth abscess, possible complications and secondary conditions resulting from the spread of the abscess or tooth infection, patient’s age and health condition, the type, length and complexity of treatment, the type of dentist(s) needed, location of where treatment is given (such as a dental office, emergency room or hospital operating room) and dental insurance coverage.

Antibiotics to clear a tooth abscess infection may cost a patient with insurance under $20. A simple extraction of an abscessed tooth on a child performed by a general dentist may cost around $300; root canal treatment — including additional related procedures and expenses — performed by an endodontist may cost between $800 and $1,500 for a tooth with between one and four canals, while emergency room and/or hospital care can run into several thousands of dollars.