Tooth Abscess: How to Tell, and When It Can't Wait
Most of the toothaches I see on short notice have been building for a while. The pain came and went for a few weeks, then one morning there is a tender bump on the gum, or the side of the face looks different in the mirror. That is usually the point where someone calls. An abscess is one of the few dental problems where waiting a few days genuinely changes how it goes, so I want to lay out what it is, how to recognize it, and which signs mean you should be seen the same day.
What an abscess actually is
An abscess is a pocket of pus, which is your body walling off a bacterial infection. Around a tooth it starts one of two ways. Either decay or a crack has reached the pulp, the nerve and blood supply inside the tooth, the pulp dies, and the infection works its way out the tip of the root into the bone. Or it starts in a deep gum pocket alongside the root. Either way the pus has nowhere easy to go, and bone does not give way readily, so pressure is most of what you feel.
The signs
A deep, constant ache or throb, rather than the quick jolt you get from sensitivity
Pain on biting down on one particular tooth, or when it gets tapped
A tender bump on the gum, sometimes with a bad taste or a salty discharge if it has started to drain
Swelling in the gum, cheek, or along the jaw
A tooth that feels slightly high, as though it hits first when you close
Tender glands under the jaw
Two things fool people here. The first is that the pain can stop on its own. When the nerve inside the tooth finally dies, the ache often fades, and that reads like the problem resolving. It has not. The infection carries on quietly, usually without much to feel. The second is a bump that drains. The pressure drops and it feels better, but a draining abscess is a chronic infection that has found an exit, not a healed one.
When it cannot wait
Most abscesses are urgent rather than dangerous, and a dental office is the right place for them. A few are different, because infection in the face and neck can spread into spaces that affect breathing and swallowing. Go to an emergency room rather than waiting for a dental appointment if you have:
Swelling that is closing an eye, or spreading down the neck or under both sides of the jaw
Any trouble swallowing or breathing, or drooling because swallowing hurts
Trouble opening your mouth
Fever alongside facial swelling, or feeling genuinely unwell rather than just sore
If you are diabetic, pregnant, or taking medication that suppresses your immune system, call sooner than you otherwise would. Infections tend to move faster and matter more in those situations.
What treatment involves
An abscess settles when the source is dealt with and the pus has a way out. In practice that means one of three things:
A root canal, which cleans the infected tissue out of the inside of the tooth and removes the source while keeping the tooth
An incision and drainage, where the swelling is opened so the pus can escape, often done alongside one of the other two
An extraction, which takes out the tooth and the source together
Antibiotics deserve their own paragraph, because this is where I get the most pushback. They help the body get on top of an infection that is actively spreading, and we do prescribe them for that. What they cannot do is cure an abscess on their own, because there is no longer a blood supply inside a dead tooth to carry a drug to where the bacteria are living. Current guidance for otherwise healthy adults points toward treating the tooth rather than prescribing an antibiotic and leaving it there. A course with no dental treatment after it usually buys a few comfortable weeks and then the same tooth, the same swelling.
Until you are seen
None of this treats the infection, but it helps:
Over-the-counter pain relief, taken as the label directs
Warm salt water rinses a few times a day
Sleeping with your head propped up, since lying flat tends to make the throb worse
Soft food, and keeping very hot and very cold off that side
Please do not squeeze or try to open a swelling yourself, and skip the heating pad on your cheek, which can encourage an infection to spread outward. Do not take leftover antibiotics from an old prescription either. The wrong drug at a partial dose makes the next infection harder to treat.
Mostly, call instead of waiting it out. An abscess that gets drained this week is a much smaller event than the same abscess next month.
This is general information rather than a diagnosis. A swelling or a toothache needs an exam, and usually an X-ray, before anyone can tell you what is causing it or what it needs. If something in your mouth is painful or swollen, call us and we will find you a time.
Hashimi Dental, 3701 Market St. Suite E, Riverside, CA 92501
Comments