A dental abscess is a collection of pus that forms around the tissues of the tooth and can spread into the surrounding tissues.
It is most often caused by a bacterial infection of the pulp of the tooth secondary to decay or trauma to the tooth.
They are not always immediately painful or symptomatic, such that you may not be aware of it’s presence for some time until it’s too late.
There are two main types of dental abscess, a periapical abscess (related to the main body of the tooth) and a periodontal abscess (related to the gum tissue of the tooth).
What are the signs and symptoms of a dental abscess?
- Severe, persistent, throbbing toothache that can radiate to the jawbone, neck or ear
- Sensitivity to hot and cold temperatures from the tooth
- Sensitivity/pain on chewing or biting
- Fever/raised temperature
- Swelling in your face or cheek or lips/chin, or the area under the eye. You may also develop a swelling in the gum besides the tooth, and this may develop a pimple like opening.
- Tender, painful and swollen lymph nodes under your jaw or in your neck
- Sudden rush of foul-smelling and foul-tasting, salty fluid in your mouth and pain relief if the abscess ruptures
- The offending tooth may feel loose and raised, such that you touch that tooth prior to any others when closing your mouth.
A dental abscess is something that you cannot ignore. Although symptoms may reduce, especially if any swelling bursts, they will not go away, may become more aggressive and may leave you open to dangerous complications.
You need to see a 24 hour dentist immediately. Left untreated the fluid may spread to other structures and cause difficulties breathing. There is also a risk of septicemia.
Signs of complications
- Difficulty in opening the mouth
- Very high fever
- Severe difficulty in breathing and or swallowing
- A raised tongue, such that your mouth feels smaller than usual
- In rare circumstances dental abscesses can spread to other organs including the brain
The main principle is to manage the source of the abscess
- Opening the tooth to allow a portal for pus to drain (initiating root canal treatment)
- Removal of the offending to tooth
- Incisional drainage of any well-formed swelling. This is normally done inside the mouth, but in extreme cases may be required from the skin side.
- Prescription of antibiotics
Normally, a combination of some of these treatments is performed, the aim is to allow the abscess to resolve prior to definitive treatment.
- Do not ignore
- Do not hope that it will go away. You need to see an emergency dentist.
- Do not attempt to lance or drain the swelling yourself
- Do not attempt to remove the tooth yourself (yes, we’ve seen people try)
- Using your partner’s antibiotics that your girlfriend’s GP gave to her 2 years ago for a UTI will not help. You are just delaying appropriate treatment.
- If you are feeling very unwell, experiencing difficulties in breathing and running a very high temperature, then a trip to A/E may be in your best interest.