Tooth Abscess: Symptoms, Treatment and Red Flags

This page is general information and does not replace an examination.

What is a tooth abscess?

A dental abscess is a build-up of pus in the teeth or gums caused by an infection^[1]. Pus is the body’s reaction to bacteria: white blood cells, dead tissue and bacteria collect in a pocket that cannot drain, and the pressure causes pain.

Infections of dental origin start in the tooth or its supporting structures and can spread into the surrounding tissues. When they reach the face, the infection usually comes from a dead (necrotic) pulp, a gum pocket, or inflamed gum around a partly erupted tooth (pericoronitis)^[3]. Dental abscesses account for the majority of dental-related visits to medical settings^[3].

Tooth abscess vs gum abscess

Patients often use “tooth abscess” and “gum abscess” for the same swelling. Dentists distinguish them by where the infection started, because that decides the treatment.

Sources: NHS [1][7], StatPearls [3]. Only an examination with X-rays shows which type it is.

Symptoms of a tooth abscess

The NHS lists these symptoms^[1]:

• intense toothache or pain in the gums;
• redness inside the mouth, or outside on the face or jaw;
• sensitivity to hot or cold food and drink in the affected area;
• a bad taste in the mouth;
• difficulty opening the mouth and chewing food;
• a swollen face or jaw;
• swollen glands on each side of the neck;
• a high temperature.

Pain can ease for a while if the pus finds a way out through the gum (a draining ‘gum boil’); this is pressure relief, not healing. The NHS is clear that a dental abscess will not go away on its own, so the tooth still needs to be examined^[1].

Red flags: when swelling is an emergency

The reason is the rare but serious spread of infection into the deep spaces of the face and neck. Ludwig angina, for example, is a rare, life-threatening spreading infection of the floor of the mouth and neck; true Ludwig angina starts from an infected lower molar, and the main danger is a blocked airway. Early recognition and treatment are critical^[4]. Growing swelling under the jaw or tongue belongs in the emergency department, not the dental chair.

Causes and risk factors

A dental abscess usually forms when pus builds up beneath the teeth or gums because of an infection in the mouth. According to the NHS, you may get one if^[1]:

• you have a tooth that has not grown out of the gum properly (an impacted tooth);
• you have tooth decay or gum disease;
• you have injured your teeth, gums or mouth;
• you are having radiotherapy or chemotherapy.

A tooth with a large old filling or a crack can also let bacteria reach the pulp without much warning. That is one reason regular check-ups with X-rays matter even when nothing hurts.

How a tooth abscess is treated

The aim is to remove the source of the infection. Dental abscesses are usually treated by a dentist who drains the pus; if a problem with the tooth caused the abscess, the tooth may need root canal treatment or removal, under local anaesthetic^[1]. Painkillers may be given for a few days afterwards, and sometimes antibiotics^[1].

• Root canal treatment cleans and seals the infected canals so the tooth can be kept. See root canal treatment.
• Extraction is the choice when the tooth cannot be restored. The gap can later be replaced, for example with an implant or a bridge.
• Gum treatment for a gum abscess: cleaning the pocket, then treatment of the gum disease behind it.

The exact order depends on the case. When swelling is spreading or the mouth hardly opens, treatment may be staged; see how we do it at our clinic below.

Antibiotics: when they help and when they do not

Many people expect antibiotics to cure an abscess. An expert panel of the American Dental Association reviewed the evidence for toothache and swelling coming from the pulp or root tip in healthy adults^[2]:

• With likely negligible benefits and potentially large harms, the panel recommended against antibiotics in most situations, whether or not dental treatment was immediately available^[2].
• It recommended antibiotics for patients with systemic involvement, for example malaise or fever, or a high risk of progressing to it^[2].
• In all cases, definitive dental treatment should be prioritised^[2].

In other words, antibiotics support treatment of a spreading infection; they do not replace removing its source. Only take antibiotics prescribed for you after an examination, and complete them as your prescriber tells you. Never use leftover tablets or someone else’s.

What you can do while you wait

These steps ease pain until you are seen; they do not treat the infection^[1].

• Over-the-counter pain relief, such as ibuprofen or paracetamol, as directed on the package, if your physician or pharmacist has not told you otherwise. Children under 16 should not take aspirin^[1].
• Soft food such as soup, scrambled eggs, mashed potatoes and yoghurt^[1].
• A soft toothbrush, and avoiding very hot or cold food and drink^[1].

Prevention

The NHS recommends^[1]:

• brushing with fluoride toothpaste at least twice a day, spitting after brushing without rinsing;
• cleaning between the teeth every day with floss or interdental brushes;
• replacing your toothbrush every 2 to 3 months;
• regular dental check-ups so problems are found early;
• not using mouthwash straight after brushing, and not smoking.

Toothache that lasts more than 2 days should be seen by a dentist^[5]: treating decay or a cracked tooth early often prevents an abscess from forming.

How we treat abscesses at our clinic

Both of our dentists, Dr. Ali Cem Ulubey and Dr. Surur Ulubey, see and treat patients themselves; there are no rotating dentists.

• Diagnosis: examination, a panoramic X-ray for every patient and periapical X-rays in the clinic, to find which tooth or gum pocket is the source.
• Drainage and swelling: drainage is a standard option: where a localised abscess can be opened and drained through the tooth or the gum at the first visit, the dentist may choose to do that straight away^[1][2]. When the face is already swollen, the mouth opens poorly and the patient feels unwell, our usual approach is different: we do not drain on the same day, because the procedure is then very painful and hard to perform. We prescribe antibiotics chosen for the case (written by the dentist after the examination, filled at a pharmacy, including for visiting patients) and start the definitive treatment once the swelling has settled, typically within a few days. The source of the infection is always treated; antibiotics only bridge the time^[2].
• Definitive treatment: root canal treatment when the tooth can be kept, extraction when it cannot, or gum treatment for a gum abscess.
• Pain relief: when we prescribe it, usually an anti-inflammatory (NSAID) such as diclofenac, naproxen or dexketoprofen, chosen for the individual patient. Follow the prescription and package leaflet.
• Hospital first: any sign on the red-flag list above goes to the emergency department (112 in Türkiye), not to a dental clinic.

Prices for root canal treatment and extractions are on our dental treatment prices page. Toothache without swelling is covered in our toothache guide.

Frequently asked questions