Tooth abscess

Alternative Names

Periapical abscess; Dental abscess; Tooth infection; Abscess - tooth

Definition

A tooth abscess is a collection of infected material (pus) in the center of a tooth. It is due to bacterial infection.

Causes

A tooth abscess is a complication of tooth decay. It may also occur when a tooth is broken or chipped. Openings in the tooth enamel allow bacteria to infect the center of the tooth (the pulp). Infection may spread from the root of the tooth to the bones supporting the tooth.

Infection results in a collection of pus and tissue swelling within the tooth. This causes a painful toothache. The toothache may stop if the pulp of the tooth dies unless an abscess develops. The infection can remain active and continue to spread causing more pain and destroying tissue.

Symptoms

The main symptom is a severe toothache. The pain is continuous. It can be described as gnawing, sharp, shooting, or throbbing.

Other symptoms may include:

Bitter taste in the mouth
Breath odor
General discomfort, uneasiness, or ill feeling
Fever
Pain when chewing
Sensitivity of the teeth to hot or cold
Swelling of the gum over the infected tooth, that may look like a pimple
Swollen glands of the neck
Swollen area of the upper or lower jaw -- a very serious symptom

Exams and Tests

The dentist will closely look at your teeth, mouth, and gums. You may have pain when the dentist taps the tooth. Biting or closing the mouth tightly also increases the pain. The gums may be swollen and red and may drain thick material.

Dental x-rays and other tests can help your dentist determine which tooth or teeth are causing the problem.

Treatment

The goals of treatment are to cure the infection, save the tooth, and prevent complications.

Antibiotics may be given to fight the infection. Warm salt-water rinses may help ease the pain. Over-the-counter pain relievers may relieve the toothache and fever.

Do NOT place aspirin directly over the tooth or gums. This increases irritation of the tissues and can result in mouth ulcers.

A root canal may be recommended in an attempt to save the tooth.

If there is a severe infection, the tooth may be removed, or surgery may be needed to drain the abscess. Some people may need to be admitted to the hospital.

Outlook (Prognosis)

Untreated abscesses may get worse and can lead to life-threatening complications.

Prompt treatment cures the infection in most cases. The tooth can often be saved.

Possible Complications

Loss of the tooth
Blood infection (sepsis)
Spread of infection to soft tissue (facial cellulitis, Ludwig's angina)
Spread of infection to the jaw bone (osteomyelitis of the jaw)
Spread of infection to other areas of the body resulting in brain abscess, endocarditis, pneumonia, or other complications

When to Contact a Medical Professional

Call your dentist if you have a throbbing toothache that does not go away.

Prevention

Prompt treatment of dental caries reduces the risk of tooth abscess. Broken or chipped teeth should be examined right away by the dentist.

References

Amsterdam JT. Oral Medicine. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 70.