Tooth abscess: symptoms, when it's an emergency, and treatment

What’s probably going on

An abscess is a pocket of pus from a bacterial infection in or around a tooth. It usually starts when bacteria get in through a deep cavity, a chip or a crack. They infect the pulp, the soft tissue in the middle of the tooth, then spread out through the tip of the root.

It can also start in the gum and bone around the tooth, often along with gum disease.

Signs that often mean an abscess:

• Severe, constant, throbbing pain that can spread to your jaw, neck or ear. It may hurt all the time or only when you chew.
• Pain with hot or cold, or with the pressure of biting.
• A pimple-like bump on the gum near the tooth, sometimes draining pus.
• A bad taste or bad breath. If the abscess bursts, you may get a sudden rush of salty, foul-tasting fluid and some pain relief.
• Swelling of the gum or jaw, a loose tooth, or swollen glands in your neck.
• A fever.

An abscess doesn’t heal on its own. If it bursts or the nerve inside dies, the pain can ease or stop, but the infection is still there and can keep spreading. Get it treated even if it stops hurting.

Cracks are one way bacteria get in; see cracked tooth.

Is a tooth abscess an emergency?

An abscess always needs a dentist soon, ideally today. It becomes an emergency when the infection spreads beyond the tooth into your jaw, throat or neck.

The red box at the top of this page lists the signs that mean the ER. If you have a fever and facial swelling and can’t reach a dentist, go to the ER. Cleveland Clinic adds three more reasons to go with a tooth abscess: a fever of 100.4°F (38°C) or higher, confusion, or a racing heart.

Left untreated, the infection can spread to your jaw, sinuses or bloodstream, and rarely to the heart or brain. Sepsis, an infection that spreads through the body, can be life-threatening. The risk is higher if your immune system is weakened.

What to do tonight

The main job tonight is getting on a dentist’s schedule. Call your dentist first thing in the morning, or tonight if they have an after-hours line. Until then:

1. Rinse with warm salt water. Swish gently and spit. It can ease the pain for a while.
2. Take an over-the-counter pain reliever as the label directs. An anti-inflammatory such as ibuprofen or naproxen, alone or with acetaminophen, can ease the pain. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.
3. Watch for changes overnight. Take your temperature if you feel hot. If swelling spreads, you run a fever, or swallowing or breathing gets harder, go to the ER rather than waiting for morning.

Pain relief is not a sign the infection is gone. The tooth still needs treatment.

What not to do

• Don’t put aspirin on the tooth or gum. It can burn the gum tissue.
• Don’t use heat on a swollen face.
• Don’t take leftover antibiotics or someone else’s. They may be the wrong drug for your infection, they can cause side effects, and they won’t fix the tooth.
• Don’t take more pain reliever than the label allows, even if the pain is bad. Call a dentist instead.
• Don’t cancel the appointment because the pain eased.

How a dentist fixes it, and what it costs

A dentist will look at the tooth, tap on it, and take X-rays to find the source and see whether the infection has spread. If it has reached your neck, you may need a CT scan.

Treatment aims to clear the infection and, when possible, save the tooth. That means one or more of:

• Drainage. The dentist makes a small cut to let the pus out, and may leave a small rubber drain in for a while.
• Root canal. The infected pulp is removed, and the inside of the tooth is filled and sealed. This helps clear the infection and can save the tooth, though you may need a crown afterward.
• Extraction. If the tooth is too damaged to save, it’s taken out.

Why antibiotics alone don’t fix it

Antibiotics may help fight bacteria that have spread, for example if you have a fever. But they don’t remove the cause, which is the infected tooth. An infection that hasn’t spread usually doesn’t need them at all; it needs treatment at the tooth, such as a root canal.

Only a dentist or doctor can prescribe antibiotics. If they do, the tooth still needs drainage, a root canal or extraction.

What it costs

The price depends mostly on which treatment you need. A root canal on a front tooth usually costs less than on a molar, which has more canals. Complex anatomy, a severe infection and where you live all push the price up.

Pulling the tooth can look cheaper at first. But replacing it with an implant or bridge tends to cost more, and take more visits, than a root canal.

Ask for a written estimate before any work starts. If you don’t have dental insurance, a dental savings plan (a discount membership, not insurance) can lower the price at participating dentists.

How to keep it from coming back

An abscess starts as something smaller: a cavity, a crack, or gum disease.

• Brush twice a day with a fluoride toothpaste, and floss once a day.
• Replace your toothbrush every three to four months.
• Cut back on sugary foods and drinks.
• Get regular checkups and cleanings, and have cavities treated while they’re small.
• Have a chipped, cracked or loose tooth checked right away.
• If you often have a dry mouth, mention it at your checkup. Bacteria thrive when there’s less saliva.
• If you smoke, know that it raises your risk: people who smoke are about twice as likely to get a tooth abscess.

For help choosing a brush, see the best electric toothbrush.