Tooth abscess
A tooth abscess is a painful condition characterized by a pus-filled sac that forms either within the tooth or in the surrounding gum tissue, often due to bacterial infection. There are two primary types of tooth abscesses: one involving the tooth’s pulp and the other located between the tooth and gum. The condition typically arises from factors such as severe tooth decay, cracks in the tooth, or trapped food that leads to infection. Symptoms may include intense tooth or gum pain, swelling, fever, and bad breath, but these can overlap with other dental issues.
Diagnosis is conducted through a thorough examination by a dentist, often involving X-rays to assess the extent of the infection. Treatment can include performing a root canal to remove the abscess, draining the infection, or, if damage is severe, extracting the tooth. Preventive measures are crucial and involve maintaining good dental hygiene practices, such as brushing with fluoride toothpaste, flossing, and regular dental checkups. Left untreated, a tooth abscess can result in serious complications, including tooth loss and the spread of infection to surrounding tissues.
Tooth abscess
- ANATOMY OR SYSTEM AFFECTED: Mouth, teeth, tissue
- ALSO KNOWN AS: Dental abscess
Definition
A tooth abscess is a sac of pus (infected material) in a tooth or the gums. There are two types of tooth abscesses: abscess of the pulp (the blood and nerve supply inside the tooth) and abscess between the tooth and gum.
Causes
A tooth abscess is caused by bacteria. It begins when bacteria invade and infect a tooth, resulting in pus buildup. When the pus is unable to drain, an abscess results. Conditions that allow bacteria to invade a tooth include severe tooth decay and a break or crack in a tooth that lets bacteria invade the pulp. Food or other foreign matter that becomes trapped between the tooth and gum may lead to a bacterial infection in the area around the tooth.
Risk Factors
Factors that increase the chance of developing a tooth abscess include the buildup of tartar or calculus beneath the gum line; poor fluoride application to teeth through fluoridated water, toothpaste, or mouthwash; poor dental hygiene (leading to cavities and periodontal diseases); and malnutrition, including severe vitamin and mineral deficiencies.
Symptoms
A person with the following symptoms should not assume he or she has a tooth abscess. These symptoms may be caused by other conditions: throbbing or lingering pain in a tooth or gum area; pain when biting on a tooth; spontaneous tooth pain; redness, tenderness, or swelling of the gums; fever; swollen neck glands; tooth discoloration; bad breath or foul taste in mouth; and an open, draining sore on the gums. If left untreated, complications of tooth abscess include the loss of the tooth and surrounding tissue or bone and the spread of the infection to surrounding tissue or bone.
Screening and Diagnosis
A dentist will ask about symptoms and medical history and will perform a detailed examination of the patient’s teeth and gums. The dentist will test for pain and sensitivity by lightly tapping on the tooth, stimulating the tooth nerve with heat or cold, stimulating the tooth nerve with a low electrical current, and sliding a probe between the tooth and gum to measure gaps or tissue loss. The dentist will also take an X-ray of the tooth and surrounding bone.
Treatment and Therapy
Treatment for a tooth abscess includes the following:
Removal of the abscess with a root canal. If an abscess results from tooth decay or a break or crack in the tooth, the tooth and surrounding tissue are numbed and a hole is drilled through the top of the tooth. Pus and dead tissue are removed from the center of the tooth, and the interior of the tooth and the root (nerve) canals are cleaned and filled with a permanent filling. A crown is then placed on the tooth to protect it. If an abscess results from infection between the tooth and gum, then the abscess is drained and thoroughly cleaned. The root surface of the tooth is cleaned and smoothed. In some cases, surgery to reshape the gum is done to prevent recurrence of infection.
Tooth extraction. Removal of the tooth may be required if tooth decay or tooth infection are too extensive for filling or root canal treatment; if the break or crack in the tooth is too severe to be repaired; or if the infection or loss of tissue or bone between the tooth and gum is severe. If the tooth is extracted, it will be replaced with a partial bridge, denture, or tooth implant.
Medication. Antibiotics are prescribed to fight residual infection of the tooth or gums. Also, the dentist could recommend nonprescription pain relief drugs (such as ibuprofen or acetaminophen) and warm salt-water rinses.
Prevention and Outcomes
To help reduce the chance of getting a tooth abscess, one should practice proper dental hygiene that includes brushing teeth with fluoride toothpaste after meals (or a minimum of twice per day), daily flossing between teeth and gums, getting regular dental checkups (every six months), and getting regular professional teeth and gum cleaning (every six months).
Bibliography
Langlais, Robert P., and Craig S. Miller. Color Atlas of Common Oral Diseases. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2009.
Porter, Robert S., et al., eds. The Merck Manual Home Health Handbook. 3d ed. Whitehouse Station, N.J.: Merck Research Laboratories, 2009.
Sutton, Amy L., ed. Dental Care and Oral Health Sourcebook. 3d ed. Detroit: Omnigraphics, 2008.
"Tooth Abscess." Medline Plus, 31 Mar. 2024, medlineplus.gov/ency/article/001060.htm. Accessed 4 Feb. 2025.
Whitworth, John M. Rational Root Canal Treatment in Practice. Chicago: Quintessence, 2002.