Tooth, mouth & gum abscess treatment: a detailed guide

Introduction

An abscess in the mouth is not the most pleasant thing to experience.

It can be painful and uncomfortable.  

The good news is that they can be treated, but you will need to see a dentist.

If you are concerned you may have an abscess, this article is for you.

Read on to understand what an abscess is, what to do to treat it and how to prevent them and much more.

What is a dental abscess?

A dental abscess is a pus filled pocket that can form in or on the teeth or gums.

Quite often painful, they are caused by a bacterial infection.

An abscess is a natural defence barrier that the body creates.

It tries to block the infection spreading to other parts of the mouth or body.

Unlike some conditions that get better in time or with simple at-home treatment, a dental abscess needs to be looked at by a dentist.

Types of dental abscess

An abscess is a more generalised term to describe the swelling experienced within the mouth.

There are in fact different types of abscess.

The differentiating factor between each of these are the position of the abscess within the mouth.

These effect either the gum or the tooth.  Therefore you will have either a gum or tooth abscess.

Gum and tooth abscess is simpler explanation of the types of abscess that might be found in the mouth, but to dentists and dental professional who actually treat the abscess for you, they are classified further.

The 3 main types of abscess are:

• Gingival
• Periodontal
• Periapical

Less common are:

• Pericoronal abscess
• Combined periodontial-endodontic abscess

They share similar symptoms, but as they originate from different parts of the mouth, the treatment required can differ.

Gingival (gin-giv-al) abscess

This is an abscess within the soft gum tissue.

Gingival abscesses on the surface along the gumline of the teeth – where the soft pin gum meets the tooth.

It has no impact on the tooth or the ligaments that help hold the tooth in place within the bone.

An abscess here is often caused by food or some form of foreign object impact into the gum around this tooth.

Periodontal (per-e-o-don-tul) abscess

This is an abscess within the soft gum tissue, between the tooth and the gum.

It gets deeper within the gum, heading more towards the root of the tooth.

It is usually caused by an infection (bacteria build up) in the space between the tooth and gum.

The gums become inflamed, which can make the tissue surrounding the root of the tooth separate from the base of the tooth.

What is known as a periodontal pocket (a tiny gap) is formed when the periodontal ligament separates from the root.

The pocket gets dirty easily and is very hard to keep clean. As bacteria builds up in the periodontal pocket, a periodontal abscess is formed.

Unlike a gingival abscess, a periodontal abscess affects more of the gum tissue as there is nowhere for the pus to drain.

Periapical  (per-e-ap-ih-kul) abscess

This is an abscess at the very end of the root of the tooth.

This is the most common form of dental abscess.

If the exterior layers of the tooth, the enamel and dentine, become damaged, it exposes the soft inner core.

Decay (caries) is a common reason for the damage of the enamel and dentin, but trauma to the tooth can also cause this to happen.

Once the pulp is exposed the bacteria can build up in the pulp of the tooth.

When the tooth’s nerve is dead or dying, the tooth has essentially lost its ability to fight off infection.

This means that bacteria can more easily form and spread through the ‘pulp chamber’ and exits the bottom of the tooth, through the root and into the bone. The body doesn’t want this bacteria to spread so it traps the bacteria and their waste products in an abscess.

The pus within the abscess contains dead white blood cells, tissue debris and bacteria and causes the surrounding bone and tissue which becomes inflamed.

Causes of dental abscesses

Bacteria is the common cause of an abscess.

Everyone has bacteria in their mouth.

The bacteria feeds on the food and drink we consume and create a substance called plaque.

We brush our teeth to remove this plaque and reduce sugars that feed the bacteria.

However, failing to clean away the plaque properly, will cause the bacteria to spread and cause areas of infection in the tooth and gums.

Bacteria spreading to the pulp causes infection inside the tooth. This infection spreads causing periapical abscesses.

Bacteria spreading underneath the gum can cause gingival and periodontal abscesses.

An injury or surgery on the teeth and gums can increase the chances of infection.

Food stuck between the teeth and gums, as well as trauma and rough brushing can also be associated with increased risk of gingival and periodonal abscesses.

A weakened immune system, as a result of conditions such as diabetes can put you more at risk of each type of abscess.

If you are undergoing treatments such as chemotherapy or are receiving steroid based medication you are also more susceptible.

Symptoms of tooth infection/dental abscess

Not all abscesses will be painful, but often this is an indicator of something not being quite right.

Eating and drinking can be more difficult or sensitive than it was previous to an abscess being present.

Other typical symptoms of a dental abscess include:

• Tenderness to the tooth and gum
• Sudden or gradual pain in the possibly affected tooth and gum, with intense or throbbing feeling
• More intense pain when laid down
• Putting pressure or warmth on the tooth increased the pain
• Swelling in and around the gum
• Swelling and redness in your face
• Sensitivity to hot or cold food
• A loose tooth
• A tender tooth
• Discoloration to a tooth
• A bad taste in the mouth

More serious symptoms include:

• Fever
• Headache
• Swollen lymph gland
• Pain that appears to spread to the ear, jaw and neck on the same side as the affected tooth or gum.
• A high temperature and general unwell feeling.
• Difficulty opening the mouth and swallowing.
• Diarrhea
• Nausea

If you believe you are suffering with an abscess you may show one or more of these symptoms.

These symptoms are typical of what might be called an ‘acute abscess’.

Infections within the tooth can progress quite rapidly and you may go from mild discomfort to quite severe pain in a relatively short space of time.

Whether the discomfort continues or subsides, it is worthwhile getting it checked out by a dentist at the earliest opportunity to be sure.

There are also ‘chronic abscesses’ that can be virtually painless and take much more time to develop.  You may not even know that it is present.  In these cases the pressure built up by the infection is relieved by the pus being able to drain. An example of this is a periapical abscess (at the end of the root of the tooth) that bursts, and may come and go.

Dentists are trained to look for signs of such and regular dental checkups will assist in diagnosing any potential for a chronic abscesses to form.

What to do if I suspect I have a dental abscess?

Book to visit your dentist as soon as is possible.

Explain when you ring or contact them that you feel it might well be an abscess and describe some symptoms.  They should be able to book you in and see you fairly quickly.

Avoid making an appointment with or seeking assistance from a doctor, as there is little they can do.

If you do not have a dentist, find one quickly.

Upon seeing a dentist they can undertake relevant treatment during normal office hours.

Should you be suffering when your dental office is closed, it is possible to seek out of hours treatment or an emergency appointment for the most severe cases.

Most dental practices will have an answerphone message that gives details of how to access this out of hours dental treatment, if required.

If you are struggling to breathe, contact or visit the ER.

Diagnosis

Symptoms for a dental abscess are not necessarily unique.

Pain, discomfort and trouble eating might be a sign for another dental issue. 

In fact, an abscess is commonly a side effect of an underlying problem, such as tooth decay.

Upon visiting your dentist, they will carry out an assessment of the tooth, gum and surrounding area.

This assessment will be the start of them diagnosing whether or not you have an abscess.

The dentist may tap on the tooth.  Those with an abscess at its root are normally more sensitive to touch and pressure.

You will usually have an x-ray.

In cases where you have or do feel pain in the neck, a CT scan may well be required.

X-ray or CT scans, are used to determine the extent and spread of the infection and guide the dentist in the necessary treatment.

Tooth abscess treatment

Removing the source of the infection is key in treating a dental abscess.

As outlined earlier in this article, the different location/type of the abscess impacts the treatment a dental professional will give.

Most common treatments are:

• Draining the abscess
• Root canal treatment
• Removal of the affected tooth (extraction)

Priority is given to draining the abscess.

Draining the abscess

It might sound a little unpleasant, but this can be a fast and effective way to relieve the pain.

Just a small amount of pressure on the abscess can be enough to free the pus with the likes of a gingival abscess.  

Periodontal abscesses are generally treated with a local anesthetic.

A small cut into the abscess or gum may well be required. The dentist can then drain the pus from the affected area.

As part of this process the dentist will ensure all remaining infected material such as plaque and calculus  is removed. A small probe is used to scrape out this material.

It is possible an ultrasonic scaler will be used to help clear out any remaining bateria.  The use of a mouthwash containing chlorhexidine or saline may be used to flush out the area too.

Bleeding is to be expected as the area is normally inflamed

Relief of the pain is likely as a result of this action.

The following video gives you a real life example of an abscess being drained.

WARNING. For those who find this sort of things a bit graphic, avoid watching.

dental abscess drainage...Abscess tooth removal

Often though, this treatment is temporary, the cause of the abscess potentially still remains.

Further treatment will be required to address the real cause behind the abscess, such as untreated periodontal disease.

Root canal treatment for abscessed teeth

Advances in dental care means it is possible for a periapical abscess (tooth abscess) to be treated with a process called a root canal treatment/therapy.

This applies to teeth that are dead or dying with damage to the internal pulp and blood vessels.

This avoids having to remove the tooth and having to consider dentures.

Local anesthetic is applied to the tooth. The tooth is then drilled through to get access to the centre of the tooth – the pulp chamber

Pus is drained through this hold,and the cavity is cleaned and disinfected. In an emergency this stage can be completed quickly and a temporary dressing and filling will be placed over the top.

For a permanent root filling, files are used to carefully widen the canal to make it easier to fill.

Chemicals also help flush out the bacteria.  A permanent root filling is placed, usually a type of rubber called gutta-percha.

The process can take several visits to the dentist and often a crown will have to be placed on the tooth.

The following video gives you a brief overview of the process.

Root Canal Treatment Step by Step

Cleaning a periodontal abscess

With a periodontal abscess a deep clean of the gum pocket will be performed to allow for a thorough assessment to be made.

Removal of teeth

Whilst root canal treatment is an option for periapical abscesses, and cleaning is an options for periodontal abscesses, a combined periodontal-endodontic abscess is very difficult to treat.

Always the last resort is tooth removal, but it may well be necessary in the case of a periapical, periodontal, or perio-endo abscess.

It will also be an option where previous root canal treatment has failed.

Tooth extraction is a relatively common procedure for dentists. But you might be left wanting a denture to replace that missing too.

Read our tooth extraction article to learn more.

Medication for dental abscess treatment

Whilst it is natural to think that some medication may be given to help with the pain or ensure the infection is cleared up, medication is not normally provided.

The best way to get rid of an abscess is to physically remove the bacteria by cleaning them out; this may mean scaling a gingival or periodontal abscess, or it may mean root canal treatment or extraction for periapical abscesses.

Aside from the recommendation of typical painkillers like Ibuprofen to ease pain prior or after treatment, antibiotics are not normally prescribed.

Only in severe cases might this be necessary.  Your dentist will make an informed decision based on the circumstances of your abscess.

How much does it cost to treat an abscess in the mouth?

The cost to deal with an abscess on the gum or tooth will depend to some extent on the treatment required and whether you are getting treatment on the privately or as part of a dental insurance plan.

A gingival abscess might well be covered under a routine treatment that comes in at a lower cost. 

A periodontal of periapical abscesses will require additional treatment and likely cost a fair bit more.

Expect costs to increase if you require a root canal or extraction.

For a simple extraction you can expect to part with $100-250.

A root canal may cost up to $900.

These costs do not include other necessary associated treatment like x-rays or the fitting of a denture or crown, if required.

Consult any medical or dental insurance you may have to see what fees, if any are covered.

Any dentist should be able to provide a rough idea of the costs prior to treatment.

Pregnancy and dental abscesses

With proper consultation there is no reason an abscess cannot be treat whilst pregnant.

However, the possibility of delaying extraction will be looked at.

X-rays and any anesthetic, be that local or general, can theoretically have a negative effect during pregnancy. Generally dental professionals wish to avoid unnecessary stress or harm to the mother or baby.

Guidance given to dentists about x-rays,  explains that the radiation dose to the pelvic area is so small that potential risk to a developing baby is almost zero. For this reason x-rays during pregnancy are, for the most part, safe. However if a pregnant woman decides she does not want an x-ray, this will always be respected.

In reality, dental professionals prefer to wait as long as is feasibly possible before undertaking treatment on pregnant women. Ideally permanent treatment would be undertaken once the pregnancy has ended.

An abscess is unlikely to fall into this category.  No professional will allow for a patient to endure pain and discomfort or the potential of the problem worsening.

The abscess may be drained and cleaned, but if extraction is required they may well be delayed.

Judgements will be made on case by case basis.

Children and abscesses

When it comes to children’s teeth and abscesses, the potential treatment options are in part the same as for an adult.

However, treatments such as a root canal therapy, whilst perfectly possible will not be carried out that frequently in a child’s tooth.

A child’s tooth will come out at some point naturally anyhow, as part of the process to getting adult teeth and as such the process of retaining the tooth is somewhat redundant.

That said, there arguments for the process and retaining that tooth.

Consideration should be made by the dentist and the parent/guardian as to the best course of action.

Failing to treat the abscess

The consequences of failing to deal with an abscess depend on you, the abscess type and the circumstances.

Ultimately pain and discomfort will become so great that eating and drinking and just living daily life will become difficult.

Failing to take swift corrective action may result in more of the teeth and gums being infected and your overall bodily health being impacted too.

The abscess if left untreated will eventually find a way of emptying or discharging.

This is often through a hollow tunnel, known as a fistula. This tunnel will pass through bone and skin to allow the pus to drain.

Discharge will cause a bad taste and feeling in the mouth.

Ultimately the resulting damage caused by failing to treat an abscess is not something you want to consider and it is much better to get it treated sooner.

Questions to ask your dentist

If you go to a dentist with a suspected abscess or suffering and dental pain, your dentist will likely ask you a few questions to help diagnose the issue.

However you should ensure that you are comfortable with what is going on and any treatment you may receive.

If you are not clear on what is wrong with you, what the prescribed course of treatment is and the implications, be sure you ask.

Questions you may like to consider asking your dentist are:

• What type of abscess do I have?
• What was the likely cause?
• What is the suggested treatment?
• Are there any other options?
• How long will the treatment take?
• What is involved with the treatment?
• How long will recovery be?
• What steps can I take to prevent such issues in the future?

Depending on the answers given you may wish to enquire further about particular topics.

Tooth extraction is a possible outcome, so might you need to consider what is involved here and whether you will require a denture.

How to treat a tooth abscess or relieve symptoms at home

Let’s be clear.  Seeing a dentist is the only option when it comes to treating a dental abscess, be that on or under the gum or in the tooth.

However, there are options you have to help with pain and discomfort you may have until you can get to see a dentist.

Subject to the pain you are experiencing with the dental abscess will influence what action you take.

Simple steps to try are:

• Avoid hot or cold foods if this makes the pain worse.
• Eat cool, soft foods if possible, using the opposite side of the mouth.
• Use a soft toothbrush to clean the teeth and mouth, but avoid flossing the affected area.

If simple measures like this do not help, ibuprofen is a recommended painkiller for dental abscess.

Should medical reasons prevent you from using ibuprofen, then paracetamol is the next best option.

If pain relief is not achieved by taking one painkiller, taking both paracetamol and ibuprofen at the doses shown in the documentation, may help.

Children under 16 should not take medication like this at the same time.  

If the pain or symptoms do subside, you should still seek a professional assessment as you may have a condition that needs treatment.

How to prevent tooth and gum abscesses

There is no guaranteed way to prevent a dental abscess, but preventative steps can be taken.

Most effective is generally good oral hygiene and maintenance, which includes:

• Brushing your teeth twice a day with a soft bristled toothbrush.
• Flossing once a day.
• Use a fluoride based toothpaste.
• Avoid rinsing after brushing the teeth.
• Having regular dental checkups.
• Reducing the consumption of sugary or starchy foods, particularly between meals or before going to bed.

Cavities in teeth which can lead to periapical abscess, the most common dental abscess can still form, even if you adhere to all the suggestions above.

But, if you are taking preventative steps and getting regular checkups, a dentist will spot and can deal with decay to reduce chances of infection.

Preventative steps before the abscess has a chance to form are much preferred by all.  It can be cheaper, less painful and cause less worry.

Any queries or concerns you have now or in the future about your dental health, make sure you speak to a dentist.  Getting professional advice and assistance no matter how big, small or insignificant you might think your concern is, the better it is for you.

References

• NHS
• Wikipedia
• Webmd
• Colgate
• Colgate
• Medical News Today
• Mayo Clinic
  
• Medicine Net
• Nidirect
• Dental Care
• Dr Anderson Premier Dental
• Levinsons Textbook for Dental Nurses