A tooth abscess, also called a dental abscess, is a painful condition. It not only causes toothache but also radiating pain in the face, ear, jaw, and neck, along with other symptoms. The sooner you see a dentist about a tooth abscess, the greater the chances of saving your tooth and restoring your mouth to good health. In this article, we tell you everything there is to know about tooth abscesses – what causes them, how to recognize them, what the treatment entails, and how much it costs to get treatment.
What is a tooth abscess? What are the different types?
A tooth abscess is a bacterial infection of the pulp inside a tooth. The pulp is the soft, innermost part of the tooth that houses the nerves, blood vessels, and connective tissue. A tooth abscess consists of a pocket of pus that collects at the base of the root.
The tooth is a closed structure with a limited blood supply. The rigid walls of the tooth and the tiny opening at the tip of the root restrict the amount of blood that can flow into the infected site. As a result, the swelling caused by the infection puts pressure on the surrounding gum areas, intensifying the pain, which can be felt in the neck, jaw, or ear. Without treatment, the infection can spread and become serious, even life-threatening.
The pocket of pus in a tooth abscess can collect in different parts of the tooth. The types of tooth abscess are classified according to the location: 1
- A periapical abscess forms at the tip of the root.
- A periodontal abscess forms in the gums next to the root.
- A gingival abscess forms in the gums.
What causes a tooth abscess?
Dental caries (tooth decay due to poor dental hygiene) are very common in the United States – it is estimated that more than 90% of adults have them.  A common cause of a periapical tooth abscess is an untreated dental cavity. Bacteria enter the pulp of the tooth through the cavity, causing an infection of the tooth root. Tooth abscesses can also be caused by injury or having dental work done. A crack or chip in the tooth can extend to the tooth root.
Causes of periodontal and gingival abscesses include gum disease. Sometimes, a foreign body like a small piece of popcorn or toothbrush bristle gets embedded in the gums, giving bacteria access to the gum tissue. Another cause of tooth abscess is a partially erupted tooth, frequently a wisdom tooth, whereby bacteria get trapped between the tooth and the gums and cause infection and inflammation. 2 Essentially, anything that provides bacteria a passage into the inside of the tooth can cause a tooth abscess.
There are some less common causes of tooth abscess as well. Some genetic diseases predispose a person to weak enamel, making the teeth more susceptible to wear and tear. Certain medical conditions and medications cause dry mouth, which accelerates the growth of bacteria in the mouth. Also, irritants like cigarette smoke, medical conditions like HIV/AIDS, and immunosuppression from chemotherapy can predispose a person to dental caries, and therefore, to a tooth abscess.
What are the symptoms of a tooth abscess?
Tooth abscess symptoms include:
- Severe, persistent toothache. The pain can radiate to the ear, jaw, or neck.
- Pain that is worse with biting or chewing or when lying down.
- Hot and cold sensitivity.
- Bad taste in the mouth.
- Foul-smelling breath.
- Red, swollen gums.
- Redness and swelling of the face.
- Swollen, tender lymph nodes in the neck or jaw.
- The sudden presence of foul-smelling, salty, foul-tasting liquid in the mouth (this occurs if the abscess ruptures).
Risk factors for tooth abscess
Poor dental hygiene is a leading risk factor for tooth abscess. Not brushing your teeth twice a day and flossing once a day can lead to tooth decay and tooth abscess as well as other dental complications. People who consume high-sugar foods, snacks, and drinks like sodas are also at high risk of dental cavities, which can turn into a tooth abscess. Having a dry mouth is a risk factor for tooth decay and tooth abscess. Dry mouth can be the side effect of certain medications or the result of aging.
How do dentists diagnose a tooth abscess?
Your dentist will examine the painful tooth and surrounding area. They may tap on the tooth to see if it is sensitive to touch or pressure (this is a sign of tooth abscess). An X-ray can help identify an abscess and also show whether the infection has spread. Your dentist may order a CT scan if they suspect the infection has spread to other parts of the head and neck.
How do you treat an abscessed tooth?
The goal of tooth abscess treatment is to eliminate the infection. Dentists accomplish this by various means. 3
Incision and drainage are recommended if the abscess is minor and is located near the gum surface. It involves making a small cut in the gums to allow the pus to drain out. This is done under local anesthesia. The area is then rinsed with saline (saltwater). A small drain may be left in place to drain out excess fluid while the area heals. While incision and drainage relieve the pressure in the gums, and can, therefore, ease your tooth pain, this procedure does not address the infected pulp in the tooth.
Root canal is a procedure that removes the infected tissue in the abscessed tooth. It can help save your tooth. In this procedure, the dentist numbs the tooth and gums and then removes the crown of the tooth to reveal the infected pulp. They then drill into the center of the tooth and remove the infected pulp with a suction device or laser. The pulp chamber is then filled and sealed with a synthetic material. The tooth is then capped with a crown to prevent further damage. A crown is especially recommended if it is a back tooth. A root canal procedure is performed over two appointments. At the first appointment, a temporary crown is placed on the tooth, and at the second, a permanent crown is cemented into place.
Tooth extraction involves pulling the affected tooth and draining the abscess to eliminate the infection. This treatment is recommended if the tooth is badly decayed and the infection is extensive. Extraction is done under local anesthesia. The empty socket heals in a few weeks, after which your dentist can place a dental implant to replace the missing tooth.
Antibiotics like penicillin and amoxicillin are prescribed for 7-10 days to help the body fight the bacteria and prevent the infection from spreading to the surrounding teeth and beyond. Antibiotics are especially necessary for people with a weak immune system and may be prescribed even when the infection is limited to an abscessed tooth. You should complete the recommended course of antibiotics even if your toothache goes away before you’ve finished all the pills.
Can a tooth abscess go away on its own?
A tooth abscess will NOT go away without treatment. You may experience a sudden relief in pain if the abscess ruptures, but you still require professional dental treatment. Without treatment, the infection can spread to the jaw and other parts of the head and neck. It can also lead to sepsis, a life-threatening infection that spreads throughout the body. People with a weak immune system (for example, those with HIV/AIDS or those on chemotherapy) are at even greater risk of the infection spreading.
Is a tooth abscess an emergency?
Yes, a tooth abscess is an emergency. The sooner you get treatment, the better the chances of saving your tooth. Also, an untreated tooth abscess can spread to the surrounding teeth, jaw, head and neck, and throughout the body, causing a serious, life-threatening infection.
What are the symptoms of a tooth infection spreading?
The symptoms of a tooth infection spreading to the rest of the body include fever, chills, sweating, dehydration, flushing, fatigue, face swelling, difficulty breathing, difficulty swallowing, increased heart rate, lightheadedness, and fast breathing rate. 4
If you experience any of the above-listed symptoms, you should seek emergency dental care or go to the nearest emergency room.
How to prevent a tooth abscess?
You can avoid developing a tooth abscess by taking good care of your gums and teeth. Preventing tooth decay is the most important step you can take to prevent a tooth abscess.
- Brush your teeth twice a day.
- Floss to clean between the teeth once a day.
- Replace your toothbrush at regular intervals (every 3-4 months).
- Limit sugary foods and drinks.
- Avoid snacking between meals.
- Wear a mouthguard while playing contact sports to avoid cracked teeth and injuries.
- Visit a dentist for regular dental checks every 6 months.
How much does it cost to treat a tooth abscess? Is it covered by dental insurance?
The cost of your tooth abscess treatment will depend on what treatment is recommended by your dentist. It can vary based on which tooth is affected as well as dental treatment costs in general in your geographical area. As a guideline, average costs for tooth abscess treatments are listed below:
- Root canal on a front tooth: $1,000 to $1,500
- Root canal on a back tooth: $500 to $1,500
- Routine tooth extraction: $150 to $250
- Complex tooth extraction: $300 to 500
- Dental crown: $500 to $2,000
- Dental implant: $1,500 to $2,000
You may need to pay out-of-pocket for some things such as antibiotics or a dental implant. However, your dental insurance plan will likely cover at least a part of the cost of your tooth abscess treatment. Many dentists offer easy payment plans for patients who do not have dental insurance. This allows you to get timely treatment for a tooth abscess and make deferred payments over time.
Home remedies for tooth abscess
A tooth abscess is a serious condition that should be treated by a dentist. An untreated abscess can lead to life-threatening complications. However, some tooth abscess home remedies can help relieve discomfort while you wait for your dental appointment. Remember that while these home treatments may ease some of your symptoms, they do not treat the underlying infection. 5 You should see a dentist as soon as possible to get definitive treatment to eliminate the tooth infection.
Saltwater or baking soda rinse: Mix half a teaspoon of table salt or baking soda in half a cup of warm water and rinse your mouth with the solution. Swish it around in your mouth for 2-5 minutes and then spit it out. You can do this 2-3 times a day.
Cold compress: Put some ice cubes in a towel and hold it against your skin on the affected side of the mouth to relieve toothache. You can do this several times a day for 15 minutes at a time.
Essential oils: Clove oil, thyme oil, and oregano oil have been used since ancient times to relieve toothache. You can purchase these essential oils at a drugstore or online. They are believed to have antibacterial, anti-inflammatory, and antioxidant properties and can help relieve the swelling and pain from an abscessed tooth. Mix a few drops of the essential oil in a carrier oil (this is necessary to avoid irritation from the essential oil). Apply it to the affected area with a Q-tip or cotton ball. Leave it on for around 10 minutes and then rinse your mouth. You can do this up to 3 times a day. You can also make a mouthwash from clove oil or thyme oil by mixing a few drops in a glass of water.
Hydrogen peroxide: You can reduce plaque and bleeding gums in the mouth and fight bacterial infections with a solution of 3% hydrogen peroxide mixed in water. Swish the solution around in your mouth and spit. Do NOT swallow any of the hydrogen peroxide solution. You can swish-and-spit multiple times a day if you find you are getting relief from tooth abscess symptoms.
Oil pulling: Many people swear by oil pulling, which is believed to remove toxins from the gums and teeth. However, there is no strong scientific evidence to support that it works. You can try it though to see if it helps your tooth pain from a tooth abscess. To perform oil pulling, you can use sesame oil, raw coconut oil, or olive oil. Do it first thing in the morning on an empty stomach. Put 1 tablespoon of the oil in your mouth and swish it around vigorously for up to 20 minutes. Do NOT swallow the oil. Spit it out in a garbage can to avoid clogging your pipes.
When to see a dentist
As noted, an abscessed tooth is a serious condition that can lead to life-threatening complications like sepsis if left untreated. If you suspect you have a tooth abscess, you should see a dentist as soon as possible.
Express Dentist is a nationwide network of leading dental care providers. You can call our toll-free line on 1-844-593-0591 at any time of the day or night and speak to a partner dentist in your area.
Express Dentist has partnered with hundreds of leading dental care specialists from coast-to-coast in the United States. We bring you high-quality dental care where you need it, when you need it. Our exhaustive directory of emergency dentists means you can find 24-hour dentists near you for dental emergencies like a tooth abscess.
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Access to emergency dental care has never been this smooth before. Call Express Dentist on 1-844-593-0591 and connect with a top-rated dentist in your area today. Our toll-free 24-hour hotline is open for emergency dental referrals and instant access to dental experts with decades of experience. Note that you can get emergency dental care for a tooth abscess even if you don’t have dental insurance (this will incur an out-of-pocket cost).
About the author
Dr. Greg Grillo
Dr. Greg Grillo DDS studied at the University of Washington where he received a bachelors degree with Honors and later attended dental school on the same campus. Following school Dr. Greg served in the United States Navy as a dental officer. During this time he received advanced training in specialty areas of dentistry while also treating families of members of the military.
As well as sharing valuable information on dentistry and oral health, Dr. Greg remains a practicing dentist to this day. He works with families in the Okanogan Valley where he lives with his wife and three children.
- Mayo Clinic. Tooth Abscess. Available online. Accessed on March 22, 2021.
- Sanders JL, Houck RC. Dental Abscess. [Updated 2020 Aug 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available online. Accessed on March 22, 2021.
- Robertson DP, Keys W, Rautemaa-Richardson R, Burns R, Smith AJ. Management of severe acute dental infections. BMJ. 2015 Mar 24;350:h1300. doi: 10.1136/bmj.h1300. PMID: 25804417. Available online. Accessed on March 22, 2021.
- Healthline. What Are the Symptoms of Tooth Infection Spreading to Your Body? Available online. Accessed on March 22, 2021.
- Healthline. 10 Home Remedies for a Tooth Abscess. Available online. Accessed on March 22, 2021.