Dental Abscess: Signs and When to Seek Care

A dental abscess is a pocket of pus from a bacterial tooth infection, and it needs a dentist promptly, usually the same day, because it will not heal on its own. Common signs are throbbing pain, swelling, a gum bump and a bad taste. If swelling spreads or makes breathing or swallowing hard, call 911 instead.

Key Takeaways

• A dental abscess is a bacterial infection that collects pus at the tip of a tooth root or in the gum beside a tooth.
• Pain, swelling, gum redness, a bad taste, a pimple-like bump on the gum and fever are common signs of a tooth infection.
• An abscess does not go away on its own; pain can fade if it drains while the infection continues.
• Treatment removes the source of infection, often by drainage, root canal treatment, gum cleaning or extraction; antibiotics alone rarely solve the problem.
• Difficulty breathing or swallowing, swelling spreading into the neck or around an eye, or high fever with feeling very unwell means 911 or the emergency department.

What is a dental abscess?

A dental abscess is a collection of pus caused by a bacterial infection in or around a tooth. According to the American Dental Association's MouthHealthy site, it can start from tooth decay, gum disease or a cracked tooth that lets bacteria reach the pulp, the soft tissue inside the tooth. When pus builds up at the root tip in the jaw bone, it forms an abscess.

Dentists describe two main types:

• A periapical abscess forms at the tip of the root. It usually follows deep decay, an old injury or a crack that let bacteria into the pulp.
• A periodontal (gum) abscess forms in the gum and bone beside the root. It is often linked to gum disease and deep gum pockets.

"Dental abscess" and "tooth infection" are often used interchangeably, but an abscess is a specific stage of infection, where pus has collected. A tooth can be infected or inflamed before an abscess forms. Either way, the problem needs a dentist.

A dental abscess is not the same as a canker sore, a cold sore or a pimple on the face. If you are not sure what a bump is, a dentist can tell you at an exam.

Signs and symptoms of a tooth infection

MedlinePlus, from the U.S. National Library of Medicine, describes the main symptom of a tooth abscess as severe, continuous pain that may feel gnawing, sharp, shooting or throbbing. Other common signs include:

• pain when biting or chewing, or a tooth that feels "high" or loose;
• sensitivity to hot or cold that lingers;
• swelling of the gum, cheek, jaw or face;
• a red, tender gum near one tooth;
• a small pimple-like bump on the gum that may leak fluid;
• a bad or salty taste, or bad breath that does not go away;
• fever or feeling generally unwell;
• tender, swollen glands under the jaw or in the neck.

Not everyone has every sign. Some abscesses cause intense pain, while others cause little pain at all, especially if they drain through a gum bump. A tooth that had a root canal or a deep filling years ago can still develop an abscess.

Similar symptoms can come from other problems, such as a cracked tooth, sinus pressure, an impacted wisdom tooth or gum irritation. Online checklists cannot confirm a dental abscess. An examination can.

Symptoms and what they usually mean

What you notice	What it may suggest	How soon to act
Throbbing pain that keeps you awake	Infection or inflammation inside the tooth	Call the dental office today
Pimple-like bump on the gum, bad taste	An abscess draining through the gum	Call the dental office today, even if pain is mild
Gum or cheek swelling near one tooth	Infection spreading into nearby tissue	Call the dental office today
Fever with tooth pain or swelling	The body responding to infection	Call the dental office today; seek medical care if you feel very unwell
Swelling under the tongue, down the neck or closing an eye	Infection spreading into deeper spaces	Call 911 or go to the emergency department
Trouble breathing, swallowing or opening the mouth	Possible airway threat	Call 911

Can a tooth infection spread?

Yes. An untreated tooth infection can spread beyond the tooth. MouthHealthy notes that without treatment, infection can involve the jaw bone, nearby teeth and surrounding tissues. MedlinePlus adds that, rarely, infection can reach the bloodstream, bones or brain and become life-threatening.

Serious spread is uncommon, especially when a dental abscess is treated early. But it can happen faster than people expect, and some people are at higher risk. This is why "wait and see" is a poor plan for a swollen or feverish tooth infection.

A reduction in pain is not proof that the infection is gone. When an abscess breaks open and drains, the pressure falls and the pain may ease. The source of infection, whether inside the tooth or in a gum pocket, is still there and usually flares again.

Delay also tends to make treatment more involved. A tooth that could have been saved with a root canal may become harder to save once more bone is affected.

Dental office or hospital? Red flags for a dental abscess

Most dental abscesses are best treated in a dental office. The dentist can find the source, take X-rays, drain the infection and treat the tooth.

Call the dental office today for:

• a toothache with swelling of the gum or cheek;
• a gum bump that drains or tastes bad;
• pain when biting, with or without a mild fever;
• swelling that is stable and not affecting breathing, swallowing or vision.

Call 911 or go to the Emergency Department at the Colchester East Hants Health Centre for:

• difficulty breathing or noisy breathing;
• difficulty swallowing, drooling or being unable to manage saliva;
• swelling under the tongue or in the floor of the mouth;
• swelling that spreads down the neck or up toward or around an eye;
• being unable to open your mouth more than a little;
• high fever with confusion, chills, a racing heart or feeling severely unwell.

These red flags matter because infection in the head and neck can, in rare cases, press on the airway or spread quickly through tissue spaces. Hospital teams can protect the airway, give intravenous antibiotics and arrange surgical drainage if needed. After a hospital visit, you will still need a dentist to treat the tooth that started the infection.

If you are unsure which level you fit, call 811 and describe your symptoms to a registered nurse. If breathing or swallowing is affected, do not wait for advice. Call 911.

How a dentist treats a dental abscess

Treatment has two goals: remove the infection and, when possible, keep the tooth.

The exam

The dentist will ask when the pain began, whether you have had fever or swelling, and about recent dental work, injuries and your medical history. They will look at the teeth and gums, feel for swelling, and may tap or test teeth to find the source. Digital X-rays can show changes around the root tip or bone loss that cannot be seen by looking in the mouth.

Treatment options

Depending on what the exam shows, a dentist may discuss:

• Drainage. A small opening lets the pus drain and relieves pressure.
• Root canal treatment. If the infection started inside the tooth, the infected pulp is removed, the inside is cleaned and sealed, and the tooth is usually protected with a crown afterward.
• Gum treatment. For a periodontal abscess, the dentist may clean out the infected pocket and treat the underlying gum disease.
• Extraction. If the tooth cannot be predictably saved, removing it removes the source of infection. Replacement options can be discussed once the area heals.
• Antibiotics, when indicated. Antibiotics may be prescribed when there is fever, spreading swelling or other signs that the infection is affecting more than the tooth.

What antibiotics can and cannot do

Antibiotics do not remove pus or clean out an infected tooth. The American Dental Association's evidence-based guidance on antibiotics for dental pain and swelling emphasizes treating the source, such as drainage, root canal treatment or extraction, for most localized tooth infections. Antibiotics are reserved for cases where a clinician finds they will help, such as systemic signs. Taking leftover antibiotics at home can hide symptoms while the infection continues and adds to antibiotic resistance.

No article can say which option fits your tooth. Before you leave, ask what was found, what was done today, which warning signs mean you should seek care urgently, and when to come back.

What not to do at home, and what can help

Do not:

• pop, cut or squeeze a gum bump or swelling with a pin, needle or blade;
• place aspirin or other tablets against the gum, which can burn the tissue;
• put a heating pad or hot pack on a swollen face;
• take leftover or borrowed antibiotics;
• rely on essential oils, alcohol swishes or home remedies to "kill" the infection;
• ignore a swelling because the pain has eased.

Until you are seen, you may:

• rinse gently with warm salt water, which can soothe the area but does not cure the infection;
• use over-the-counter pain relief such as ibuprofen or acetaminophen only as the label directs and only if it is safe for you (ask a pharmacist if you are unsure);
• hold a cold pack wrapped in a cloth on the outside of the cheek for short periods;
• chew on the other side and choose soft, lukewarm foods;
• brush gently around the sore area to keep it clean;
• note when symptoms started and whether swelling or fever is changing.

If swelling grows, fever rises or swallowing becomes difficult while you wait, treat it as a red flag and follow the hospital guidance above.

Who needs faster care for a tooth infection

Some people should call as soon as they notice any sign of a dental abscess, and mention their situation when they do.

• People with diabetes, especially when blood sugar is hard to control, may fight infection less well.
• People with weakened immune systems, such as those having chemotherapy, taking long-term steroids or other immune-suppressing drugs, or living with some chronic illnesses.
• People with certain heart conditions or joint replacements, who may have specific instructions from their doctor about dental infections.
• Pregnant people. Dental infection should not wait until after the baby is born. Tell the dental team how far along you are, and check with your pharmacist, doctor or midwife about pain relief.
• Children. Facial swelling in a child can progress quickly. Call the dental office the same day, and use 911 for any trouble breathing or swallowing.
• Older adults, who may have fewer obvious symptoms and more medical conditions and medications.

Preventing the next abscess

Most dental abscesses begin with untreated decay, a crack or gum disease. Regular checkups, cleanings and X-rays when indicated can catch these early, often before any pain. Brushing twice a day with fluoride toothpaste, cleaning between the teeth daily and getting a chipped or cracked tooth checked all lower the risk. Our guides to gum disease signs and dental checkups cover these habits in more detail.

Getting help for a tooth infection in Truro

For a suspected dental abscess without red flags, call Landmark Dental Care at 902-893-2919. The office is at 125 Queen St in downtown Truro and is open Monday to Friday, 8:30am to 5:00pm, and sees patients from Truro, Bible Hill and across Colchester County. Calling, rather than sending a message, lets the team ask about swelling and fever and advise how soon to come in. Learn more on the emergency dentistry page.

If swelling starts spreading on an evening or weekend, or you have any trouble breathing or swallowing, call 911 or go to the Emergency Department at the Colchester East Hants Health Centre, 600 Abenaki Road, Truro, which is open 24 hours.

If you are unsure whether your symptoms need the hospital tonight or the dentist tomorrow, call 811 for advice from a registered nurse at any hour.

For questions about paying for treatment, including the Canadian Dental Care Plan, call the office to confirm current participation and billing, and read our CDCP page. Children aged 14 and younger with a valid Nova Scotia health card may have some treatment, such as fillings and necessary extractions, covered by the provincial Children's Oral Health Program.

FAQ

Can a dental abscess go away on its own?

No. A dental abscess may drain and hurt less for a while, but the source of the infection usually stays and flares again. A dentist needs to treat the tooth or gum to clear it.

Should I go to the ER for a tooth infection?

Go to the emergency department or call 911 if you have trouble breathing or swallowing, swelling spreading into the neck or around an eye, or high fever with feeling very unwell. For pain and swelling without those signs, call a dentist the same day.

Are antibiotics enough to cure a tooth infection?

Usually not. Antibiotics can help when an infection is spreading, but they do not remove the pus or the infected tissue inside the tooth. Treatment such as drainage, a root canal or an extraction is typically needed.

How long can a tooth abscess go untreated?

There is no safe waiting period. Some abscesses stay quiet for weeks while others spread within days, so the safest plan is to see a dentist promptly and to treat spreading swelling as an emergency.

What does a gum abscess look like?

A gum abscess often looks like a red, swollen bump or a small pimple on the gum beside a tooth, sometimes with pus. It can be tender or painless, and it still needs a dental exam.

Next step

If you notice signs of a possible dental abscess, call Landmark Dental Care for urgent dental concerns at 902-893-2919, or visit the practice at 125 Queen St, Truro. You can also use our contact page for non-urgent questions. If you have trouble breathing or swallowing, swelling spreading into your neck or around your eye, or you feel severely unwell, call 911 or go to the Colchester East Hants Health Centre emergency department.

References

• ADA MouthHealthy: Abscess
• American Dental Association: Antibiotics for Dental Pain and Swelling
• American Dental Association: Antibiotic Stewardship
• MedlinePlus: Tooth Abscess
• Government of Nova Scotia: 811 Health Advice
• Nova Scotia Health: Colchester East Hants Health Centre

This article provides general educational information and is not a diagnosis or a substitute for care from a dentist or other qualified health professional.