Dental abscess

A dental abscess is a collection of pus that can form inside a tooth, in the gums, or in the bone that holds the teeth in place. A bacterial infection causes it.

An abscess at the end of a tooth is called a periapical abscess. One in the gum is called a periodontal abscess.

A dental abscess is often painful, but not always. Either way, a dentist should look at it.

You should get help as soon as possible, because abscesses don't go away on their own. They can sometimes spread to other parts of the face and neck and make you ill.

A dental abscess can show up in a few different ways. The signs of an abscess in your tooth or gum may include:

• an intense, throbbing pain in the affected tooth or gum that may come on suddenly and gets gradually worse
• pain that spreads to your ear, jaw and neck on the same side as the affected tooth or gum
• pain that's worse when lying down, which may disturb your sleep
• redness and swelling in your face
• a tender, discoloured and/or loose tooth
• shiny, red and swollen gums
• sensitivity to hot or cold food and drink
• bad breath and/or an unpleasant taste in your mouth

If the infection spreads, you may also develop a high temperature (fever) and feel generally unwell. In severe cases, you may find it hard to fully open your mouth, and you may have difficulty swallowing or breathing.

• you have difficulty breathing or swallowing

• you have any symptoms of a dental abscess

While you're waiting to see a dentist, painkillers can help control the pain of a dental abscess.

Ibuprofen is the preferred painkiller for a dental abscess. If you can't take it for medical reasons, you can take paracetamol instead.

Aspirin shouldn't be given to children under 16.

If one painkiller doesn't relieve the pain, taking both paracetamol and ibuprofen at the doses shown in the medicine leaflet may help. This is safe for adults, but not for children under 16.

It may also help to:

• avoid hot or cold food and drink if it makes the pain worse
• try eating cool, soft foods if possible, using the opposite side of your mouth
• use a soft toothbrush

These measures can help relieve your symptoms temporarily, but you shouldn't use them to delay getting help from a dentist.

A dental abscess is treated by removing the source of the infection and draining away the pus. Which treatment you need depends on where the abscess is and how severe the infection is. The options are:

• removing the affected tooth (extraction), which may be necessary if root canal treatment isn't possible
• root canal treatment, a procedure to remove the abscess from the root of the affected tooth before filling and sealing it
• incision and drainage, where a small cut (incision) is made in the gum to drain the abscess (this is usually only a temporary solution)

Local anaesthetic will usually be used to numb your mouth for these procedures. More extensive operations may be carried out under general anaesthetic (where you're asleep).

Antibiotics aren't routinely prescribed for a dental abscess, but they may be used if the infection spreads or is particularly severe.

Your mouth is full of bacteria, and these form a sticky film on your teeth called plaque. If you don't keep your teeth clean, the bacteria in plaque produce acids that can damage your teeth and gums. This leads to tooth decay or gum disease, and either one can lead to a dental abscess.

Some things make a dental abscess more likely:

• poor oral hygiene: plaque can build up on your teeth if you don't brush and clean in between your teeth regularly
• too much sugary food and drink: these help the bacteria in plaque grow and may lead to decay that can result in an abscess
• an injury or previous surgery to your teeth or gums: bacteria can get into any damaged parts of the teeth or gums
• having a weakened immune system: this includes people with certain underlying health conditions, such as diabetes, and those having treatment, including steroid medicine or chemotherapy

You can lower your risk of getting a dental abscess by keeping your teeth and gums as healthy as you can.

• use an interdental brush or floss at least once a day to clean between your teeth and under the gum line
• brush your teeth with a fluoride toothpaste twice a day, spending at least 2 minutes each time
• don't rinse your mouth with water or mouthwash after brushing, because this washes the protective toothpaste away
• cut down on sugary food and drinks, particularly between meals or shortly before going to bed
• visit your dentist regularly, as your dentist can suggest how often you should have a check-up based on your oral health