Abscessed Teeth and Gums

Abscessed Teeth Gums

Also called: Endodontic Abscess, Gum Abscess, Abscessed Teeth, Periodontal Abscess, Mouth Abscess, Tooth Abscess, Abscessed Gums, Dental Abscess

Summary

A pocket of infected liquid (pus) that collects in a small area within the body is known as an abscess. In the mouth, abscesses can occur at the end of a tooth’s root or in the space between the teeth and gums. Infection may spread into the tissue and bones surrounding the tooth. If left untreated, it may also spread throughout the body, affecting the heart or lungs.

Dental abscesses occur when bacteria enter certain areas (e.g., pulp of the tooth, deep gum pockets) of the mouth. Typically, decay or cracks in a tooth’s enamel allow bacteria access to the inner tooth (pulp). Gum disease can create deep spaces between the teeth where bacteria may thrive and develop into an abscess.

Dental abscesses usually cause significant pain. This pain may be sharp or throbbing and is usually persistent. Additional symptoms of a dental abscess can include fever, sensitivity to hot and cold, a visible boil in the gums near a tooth (which may rupture and leak fluid), or red, swollen gums.

Patients who experience dental pain, or who have visible signs of an abscess, should consult their dentist immediately. Even if the pain goes away, any infected tissue needs to be removed and the cause of the abscess treated.

A dentist can usually diagnose an abscess based on examination of the patient’s mouth, which may include gently tapping a patient’s teeth (to identify the extent of damage to the pulp) and x-rays (to determine if bone loss has occurred). In addition, patients are usually asked to provide details about their symptoms. 

Treating an abscess includes draining the abscess and treating the cause of the infection. These are often done at the same time, such as in the case of a root canal procedure. This allows the pus to drain from the tooth root while removing diseased tissue that led to the abscess. When the tooth damage is severe, tooth extraction may be required. Follow-up care may include antibiotics to eliminate the spread of infection, saltwater rinse to soothe inflamed tissue and follow-up x-rays to ensure proper bone and tissue regrowth in the area.

A dental abscess can be prevented by preventing its causes – primarily tooth decay. Thus, practicing daily brushing and flossing and committing to regular dental visits can help prevent dental problems that may lead to infection and abscess.

About abscessed teeth & gums

An abscess is pus that collects in a small, contained space within the body. It occurs as a result of a bacterial infection, when inflamed tissues secrete fluid (pus) that consists of bacteria, white blood cells and cellular debris. If this pus is unable to drain from the area, it pools and forms an abscess.

Abscesses can occur anywhere in the body, including the mouth. Dental abscesses may occur at the tip of a tooth’s root or in the area between the teeth and gums. An abscess may develop at any age after the teeth have erupted.

A tooth abscess may develop after bacteria gains access to the pulp (the innermost, living core of the tooth), causing an infection inside the tooth. Bacteria can reach the pulp through a crack or decay in tooth enamel. If this infection goes untreated (the diseased tissue in the pulp is not removed) pus can begin to build up in the root of the tooth, near the jawbone, forming an abscess.

The infection can spread into the ligaments that secure the tooth to the jawbone and to the jawbone itself. When infection occurs in the bone surrounding teeth, bone loss may occur. This causes teeth to become loose and may lead to tooth loss.   

An abscess can form in the gums when food and bacteria gather in deep pockets of space between the teeth and gums. These pockets usually appear in people with periodontal disease (when the gums pull away from the teeth). When food or other debris remain embedded deep in the gums, bacteria can grow, and an abscess may form. In addition, an untreated abscess may cause scar tissue to develop, which can result in a fistula (tunnel in tissue) for drainage.

Most dental abscesses cause considerable pain. It is important to consult a dentist immediately if a dental abscess is suspected. The abscess will not heal itself – it requires treatment.

Dental abscesses that are left untreated may lead to a number of serious health complications. This includes bacterial infection that may spread to the jawbone, soft tissue of the face or other areas of the body (e.g., brain, heart, lungs). Tooth loss may occur as a result of bone infection, or from necessary treatment (e.g., tooth extraction).

Types and differences

Abscesses are pockets of infected material (pus) contained within a limited area in the body. They may occur in three different areas of the mouth. These types of dental abscesses are identified as follows:

  • Tooth abscess. This type of abscess occurs in the bottom-most portion of a tooth – the tip of the tooth root (closest to the jawbone). This is also known as a periapical abscess.
  • Periodontal abscess. This occurs when infection travels from the tooth root into the ligaments (connective tissue) that secure the tooth to the jawbone, and the jawbone socket (alveolar socket) itself. In some cases, a gum abscess develops when food particles become lodged deep in the space between the teeth and gums.
  • Pericoronal abscess. Abscess that occurs when the flap of tissue covering a partially erupted tooth becomes inflamed and infected. It occurs most commonly in the third molars (wisdom teeth).

Potential causes of abscessed teeth & gums

Dental abscesses occur when bacteria is able to reach the pulp of a tooth, or grows deep in the space between the teeth and gums. Infection develops, which can cause an abscess. Bacteria may gain access to these areas for several reasons, including:

  • Untreated decay. Deep cavities that lead to the inner tooth and affect the pulp are among the most common causes of a tooth abscess.

  • Cracked tooth. Fractures or cracks in the enamel and dentin can allow bacteria into the pulp, which may lead to infection and abscess. This is a common cause of tooth abscesses.

  • Periodontal disease. Gum disease causes the gums to pull away from the teeth, creating deep pockets of space between the teeth and gums. If food particles become stuck in these pockets, bacteria may grow and an abscess can develop in the gums.

  • Unrepaired restorations. Weakened dental restorations (e.g., fillings) may break down over time and allow bacteria access to the pulp, potentially causing an infection and abscess.

Signs and symptoms of abscessed teeth & gums

The most obvious sign of a dental abscess is pain. It is usually severe and persistent, and may feel like a throbbing, gnawing, sharp or shooting pain. The pain of an abscess may be especially bothersome when biting, chewing or tightly closing the mouth. It may also include sensitivity to heat and cold. 

Additional signs of an abscess in the mouth include:

  • Red, swollen gums
  • Fever
  • Swelling of the jaw or face
  • Swollen lymph nodes in the neck
  • Sinus pressure
  • Visible boil in the gums near a tooth – which may rupture and leak fluid
  • Dysgeusia (bad taste in the mouth)
  • Halitosis (bad breath)

Patients with any type of dental pain, or visible sign of an abscess, should consult their dentist immediately – even if the pain decreases or appears to go away. Severe pain that suddenly disappears may indicate that an abscess has ruptured, or that a nerve within the tooth pulp has died. Either way, the patient’s condition will continue to worsen without treatment, despite the pain relief. Diseased tissue remains in the tooth, and if the cause of the abscess (e.g., tooth decay) is not repaired, infection may recur.

Diagnosis methods for abscessed teeth & gums

A dentist can usually diagnose an abscess by examining the patient’s mouth. This includes looking for visible signs of an abscess, such as a boil in the gums near a tooth, or redness and swelling of gum tissue. The dentist may also ask questions concerning a patient’s symptoms, such as when the pain started, where it is located, and if pain is felt when biting or closing the mouth.

The examination may also include:

  • Pulp test. This may confirm the extent of damage to the pulp of the tooth. A dentist may gently tap a tooth, apply cold or heat, or use electrical stimulation. If pain is not felt during these tests, the nerves in the pulp may no longer be alive.
  • Pushing on the swollen area of the gum. This may provide tactile evidence of an abscess beneath gum tissue.
  • Dental x-rays. These may be used to identify any erosion of bone that may occur in the bone surrounding an abscessed tooth.

Treatment options for abscessed teeth & gums

Treating a dental abscess is a multistep process. It involves treating the abscess itself, and then treating the cause and preventing any further damage or injury (including tooth loss) if possible. A dentist or endodontist will usually perform this work. More than one office visit may be necessary in treating an abscess.

Steps taken to treat an abscess may include:

  • Draining the abscess. Any material (pus) trapped inside the tooth or under the skin must be released. Once an abscess is drained, signs of pain should immediately disappear. Abscesses can be drained in a number of ways. If the abscess is in the gums, it usually involves incision and drainage through gum tissue. If the abscess is in the tooth root, it can be drained by an opening made through the tooth. This may be done as part of a root canal procedure or tooth extraction.

  • Treating the source of the infection. This may include:

    • Root canal. This involves removing diseased tissue from the pulp of the tooth and allows the patient to save the original tooth. The area is filled in with a material similar to rubber (gutta percha) and topped with a filling or crown. If infected pulp is not removed, pain and swelling may continue and the infection may spread.

    • Tooth extraction. If an abscess is severe, a tooth or the jaw is badly damaged and a root canal procedure will not likely save the tooth, a tooth extraction may be necessary. Before the development of many modern dental procedures, extraction was the only way to treat an abscessed tooth.

  • Preventing complications. This includes preventing infection that may spread to other areas of the body, as well as reducing pain and swelling.

    • Medication. This may include antibiotics to ensure the infection has been eliminated and to prevent its spread. Prescription or over-the-counter pain relievers may be recommended to relieve pain and swelling related to the abscess or its treatment. Patients should never place aspirin directly on the gums because it may burn skin tissue, causing mouth sores.

    • Saltwater rinse. Patients may be advised to rinse their mouths with a saltwater solution (1/8 teaspoon salt and 8 ounces of warm water). This can help cleanse the mouth, encourage drainage and may temporarily lessen pain and pressure in the area. This may be done several times a day for a few days after treatment of a dental abscess.

    • Ice pack outside the cheek. This may help reduce facial inflammation.

    • Follow-up x-rays. These may be taken six months after treatment of an abscess. They are used to confirm that bone and tissue have appropriately regenerated in the treated area. If not, a patient may be referred to a periodontist (to surgically reshape gums for easier cleaning) or endodontist (to surgically remove a persistent abscess) for additional treatment.

Prevention of abscessed teeth & gums

The primary method of abscess prevention is engaging in dental hygiene practices that can prevent tooth decay (a common cause of dental abscesses). These practices include:

  • Brushing teeth. Removes plaque that can cause tooth decay. Teeth should be brushed upon awakening, before sleep and after every meal.

  • Daily flossing. Removes plaque and food particles that become lodged between teeth. Teeth should be flossed every day.

  • Regular dental examinations and cleanings. This removes the buildup of tartar on the teeth and helps to identify problems early, while they are easy to treat and before they can become abscesses.

  • Sugarless gum. Chewing sugarless gum may help rid the mouth of food particles and bacteria when people are unable to brush their teeth (e.g., after meals when away from home).

  • Healthy diet. A well-balanced diet can help people maintain their immune systems and avoid infections. Patients should specifically avoid sugary foods and beverages that can lead to tooth decay.

  • Treat dry mouth. A lack of saliva in the mouth (which helps to keep the area clear of food particles and bacteria) can increase the risk of tooth decay. Drinking plenty of water, chewing sugarless gum or sucking on sugarless candy can help promote saliva production. Medication may be needed to treat severe cases of dry mouth.

  • Avoid tobacco. Smoking or chewing tobacco can increase the risk of gum disease and potentially lead to infections and dental abscesses.

Some patients may receive antibiotics prior to any dental treatment to prevent the risk of infection. This includes patients with immune system deficiencies, other medical conditions (e.g., heart valve problems) or on certain medications.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their dentists regarding their conditions. Patients may wish to ask their doctor the following questions related to abscessed teeth and gums:

  1. Is an abscess causing my dental pain?
  2. What will x-rays show you?
  3. How severe is my abscess?
  4. What do you suspect caused my abscess?
  5. How will you treat my abscess?
  6. Will I need antibiotics?
  7. What type of at-home care should I receive while I am recovering?
  8. Are there specific over-the-counter medications you can recommend for me? Are there any that I should avoid?
  9. Will I need a root canal? Will I lose my tooth?
  10. How can I prevent this from occurring in the future?
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