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A dental abscess is a collection of pus that forms in your teeth and spreads to the surrounding tissue. It forms as a result of a bacterial infection.
The main symptom of a dental abscess is a severe, throbbing pain. The pain usually comes on suddenly and then gets gradually worse over a few hours or a few days, and causes teeth to be tender and sensitive.
Read more about the symptoms of a dental abscess.
Types and causes of dental abscesses
There are two types of dental abscess:
- periapical abscess – where the abscess forms under the tooth (this is the most common type of dental abscess)
- periodontal abscess – where the abscess forms in the supporting gum and bone
Both types of dental abscess are caused when bacteria builds up inside your mouth. This usually occurs due to a combination of:
- poor dental hygiene – not cleaning your teeth and gums properly and regularly
- consuming lots of sugary or starchy food and drink – the carbohydrates in these types of food and drink encourage bacteria to grow, causing tooth decay
Read more about the causes of a dental abscess.
Treating dental abscesses
You should make an appointment with a dentist as soon as possible if you think you may have a dental abscess.
There is little your GP can do, other than recommend painkillers, such as ibuprofen or paracetamol, to help relieve the pain. You can get these over the counter from your local pharmacist.
Treatment varies, depending on what caused the abscess. Generally, treatment involves draining the pus, either with root canal treatment, removing the affected tooth or gum treatment.
This type of treatment should not be too painful because local anaesthetic will be used to numb the affected area of your mouth.
Unlike some other types of infection, a dental abscess will not get better on its own and must be treated by a dentist. With appropriate treatment, the bacterial infection that causes a dental abscess can usually be successfully cured. Antibiotics are not used to treat a dental abscess, but may occasionally be used to reduce the symptoms.
Read more about how a dental abscess is treated.
Complications of dental abscesses
It is rare for complications to develop as a result of a dental abscess, but they can be serious if they do occur. For example, the infection may spread to nearby bone (osteomyelitis).
Read more about the complications of a dental abscess.
Finding an NHS dentist
If you are not registered with an NHS dentist, there are a number of options available to you. You can:
If you have severe pain, you may need emergency out-of-hours dental treatment.
Find out how you can access an NHS dentist in an emergency or out-of-hours.
Depending on your individual circumstances, you may have to pay a fee for your treatment.
Who gets dental abscesses?
Anyone with teeth can develop a dental abscess – children and adults are equally affected.
A study carried out in America found that on average one in eight people seek treatment for a dental abscess in any given two-year period.
In the UK, the figure is probably higher because levels of dental hygiene tend to be poorer in this country.
The main symptom of a dental abscess is an intense, throbbing pain in your affected tooth or area of gum.
The pain usually comes on quite suddenly and may gradually worsen over a few hours to a few days.
Sometimes, the pain may spread to your ear, lower jaw and neck on the same side as your affected tooth. There can also be severe swelling in the face, which can spread if the abscess is not treated.
Other symptoms of a dental abscess can include:
- tenderness of your tooth and surrounding area
- sensitivity to very hot or cold food and drink
- an unpleasant taste in your mouth
- bad breath (halitosis)
- a general feeling of being unwell
- difficulty opening your mouth
- dysphagia (difficulty swallowing)
- disturbed sleep
- a high temperature (fever)
You may also find the NHS Direct Wales Dental Symptom Checker useful.
When to seek immediate medical help
The following symptoms can be a sign of the infection spreading to other parts of your body:
- swelling in your face
- a high temperature (fever) of 38°C (100.4°F) or above
- severe pain that does not respond to treatment with painkillers
- breathing difficulties
If you develop any of these symptoms and you are not due to see a dentist straight away, you will need to access NHS emergency dental services. In this situation, you can call:
Alternatively, you could visit the accident and emergency (A&E) department of your local hospital.
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A dental abscess occurs when bacteria infect and spread inside a tooth, your gums or the surrounding tissue.
Your mouth is full of bacteria, which combine with small particles of food and saliva to form a sticky film called plaque, which builds up on your teeth. Brushing your teeth helps to stop plaque from building up.
Eating and drinking food and drink high in carbohydrates (sugary or starchy) causes the bacteria in plaque to turn the carbohydrates into the energy they need to reproduce. Acids are then produced, which leads to tooth decay.
Tooth decay can lead to the formation of a dental abscess. This can either occur when bacteria spread into:
- the centre of a tooth (the pulp) through tiny holes in the tooth (dental caries) that are caused by the excess amount of acid –when this spreads under the teeth this is known as a periapical abscess
- your gums and surrounding tissues – this is known as a periodontal abscess
When a periapical abscess occurs, plaque bacteria infect your tooth as a result of dental caries that form in the hard outer layer of your tooth (the enamel).
Dental caries break down the enamel and the softer layer of tissue underneath (dentine), eventually reaching the centre of the pulp. This is known as pulpitis. The dental pulp in the middle of the tooth dies and the pulp chamber becomes infected.
The bacteria continue to infect the pulp until it reaches the bone that surrounds and supports your tooth (alveolar bone), where the periapical abscess forms.
A periodontal abscess is caused by gum disease (known as gingivitis or periodontitis.
A periodontal abscess may also occur as a result of:
- gum damage, even if you do not have periodontitis
- smoking and using smokeless tobacco – read more information about quitting smoking
Risk factors for a dental abscess include:
- poor oral hygiene – if you do not brush your teeth and floss between them regularly, your risk of developing a dental abscess is increased
- having a diet high in sweet and sticky food and drink – such as chocolate, sweets, sugar and fizzy drinks and/or starchy foods, such as crisps, white bread, pretzels and biscuits
- having a weakened immune system – this may be due to having an underlying health condition, such as diabetes, or the side effects of treatments such as steroid medication (corticosteroids) or chemotherapy
Read more about the risks of gum disease.
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If you think you may have a dental abscess, you must see a dentist as soon as possible.
Find a dentist in your local area.
Your dentist will carry out some tests to determine whether your symptoms are being caused by a dental abscess. For example, they may:
- tap on the affected tooth or area of gum – if infection is present, your tooth or gum will be sensitive to any pressure
- examine your gums – an infection will usually cause an area of your gums to become red and swollen
- take an X-ray of the affected area to help assess the spread of infection
In some cases, your dentist may be able to confirm a diagnosis by simply asking you about your symptoms.
Your dentist will then discuss the most appropriate treatment.
Your dentist may refer you for treatment in hospital if you have a dental abscess and:
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- you are feeling unwell with a high temperature, a rapid pulse rate or low blood pressure (hypotension) and rapid breathing
- you are in severe pain despite using painkillers
- you have a spreading facial infection
- you have a weakened immune system (for example, because you are having having treatment such as chemotherapy)
The only way to cure a dental abscess is with dental treatment.
Your GP will be able to advise you, but they cannot provide the treatment needed to cure an abscess.
Your dentist will treat your abscess using dental procedures, and, in some cases, surgery (see below).
A dental abscess can be very painful, but you can use over-the-counter painkillers from your local pharmacy to control the pain while you are waiting to receive dental treatment.
Ibuprofen is the preferred painkiller for dental abscesses, but if you are unable to take ibuprofen for medical reasons, you can take paracetamol instead.
If one painkiller fails to relieve the pain, taking both paracetamol and ibuprofen at the same time can often be effective (this is safe for adults, but not for children under 16 years of age).
Always read and follow the information on the packet about how much to take and how often, and do not to exceed the maximum stated dose.
Accidental overdoses have been reported in people who take too many painkillers when trying to relieve the pain of a dental abscess.
Painkillers cannot treat or cure a dental abscess, so they should not be used to delay dental treatment.
Follow the advice below to take painkillers safely:
- Do not take ibuprofen if you are asthmatic or if you have (or ever have had) stomach ulcers.
- Do not take more than one painkiller at the same time without first checking with your GP or Pharmacist. This can be dangerous because many over-the-counter products contain similar painkillers and it is possible to overdose when combining products.
- Ibuprofen and paracetamol are both available as liquid preparations for children.
- Aspirin is not suitable for children under the age of 16.
- If you are pregnant or breastfeeding, you should take paracetamol.
Other self care techniques that can help include:
- avoid anything that makes the pain worse, such as hot or cold foods or cold air
- holding cooled water or crushed ice around the tooth can sometimes ease the pain
- the pain can often feel worse when you are lying flat, so lying propped up may help ease pain
Your dentist will first discuss with you which treatment is appropriate. This could be:
Antibiotics are not routinely prescribed to treat dental abscess because:
- draining the abscess is a more effective treatment
- using antibiotics to treat non-serious infections makes them less effective at treating more serious infections (this is known as antibiotic resistance).
Antibiotics are usually only required if:
- there are signs of severe infection
- there are signs that the infection is spreading, such as swelling of your face or neck
- you have a high risk of complications – for example, people with a weakened immune system or diabetes
If antibiotics are required, an antibiotic called amoxicillin or phenoxymethylpenicillin is usually recommended. If you are allergic to amoxicillin, which is a type of penicillin, clarithromycin may be prescribed instead.
In cases where the infection is severe or spreading, metronidazole may be prescribed. If you are allergic to metronidazole, clindamycin may be prescribed.
If you have a periapical abscess and your infection recurs, you may need to be referred to a specialist for further treatment.
In some cases, a dental abscess infection can reoccur even after dental and surgical procedures. If this happens, or if your tooth is severely broken down, it may need to be removed altogether (extracted).
Caring for your tooth
To limit pain and pressure on your dental abscess you should:
- avoid very hot or cold food and drink
- eat cool, soft foods using the opposite side of your mouth from the abscess
- use a soft toothbrush and avoid flossing around the affected tooth.
Fear of the dentist
Dental abscesses often occur in people who have not seen a dentist for many years because they are afraid to go.
Being afraid of the dentist can have a number of possible causes, such as the thought that treatment will hurt, or the sounds and smells bringing back memories of bad experiences during childhood.
The good news is that most dentists understand their patients’ fears, and they are able to make dental treatment as painless and as stress free as possible.
Over the years, advances in technology have also improved dentistry significantly. Nowadays, treatment is often completely painless.
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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
With appropriate dental treatment, a dental abscess can be treated quite easily. However, in rare cases, complications can occur.
Most complications arise as a result of spreading bacterial infection when the abscess is left untreated.
Some of these complications are detailed below.
Loss of the tooth
The affected tooth may need to be removed (extracted). This is more likely if a dental abscess returns, or if your tooth is severely broken down.
Sinusitis is an infection of the small air-filled cavities inside your skull.
It is usually the cavities behind your cheekbones that can become infected as a complication of a dental abscess. These are known as the maxillary sinuses.
Symptoms of sinusitis include:
- a blocked or runny nose
- facial pain and tenderness
- a high temperature (fever) of 38°C (100.4°F) or above
Sinusitis often clears up without treatment but, if necessary, antibiotics can be prescribed.
Read more about sinusitis.
Osteomyelitis is an infection of the bone. It is caused by the bacteria in a dental abscess spreading and causing inflammation.
This condition can cause symptoms such as fever, nausea (feeling sick) and severe pain in the affected bone, which can often be in the area surrounding a dental abscess.
However, as the infection is spread through your blood, it is possible for it to affect any bone in your body. Osteomyelitis can be treated by taking antibiotics orally or injecting them into a vein.
For more information, see osteomyelitis.
Cavernous sinus thrombosis
Cavernous sinus thrombosis is a rare, but serious, condition where a blood vessel in the brain becomes infected and a clot develops.
Read more information about cavernous sinus thrombosis.
Ludwig's angina is a potentially life-threatening infection of the tissues of the floor of the mouth, under the tongue.
Symptoms can include:
- pain when moving the tongue
- neck swelling
- difficulty swallowing (dysphagia)
- difficulty breathing
In severe cases, you may have trouble breathing or experience an abnormal breathing sound, caused by a blocked airway.
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Last Updated: 23/06/2014 10:38:48