Symptoms

Signs and symptoms of a tooth abscess include:

• Severe, persistent, throbbing toothache
• Sensitivity to hot and cold temperatures
• Sensitivity to the pressure of chewing or biting
• Fever
• Swelling in your face or cheek
• Tender, swollen lymph nodes under your jaw or in your neck
• Sudden rush of foul-smelling and foul-tasting fluid in your mouth and cessation of pain if the abscess ruptures

When to see a doctor
See your dentist promptly if you have any signs or symptoms of a tooth abscess. If you have a fever and swelling in your face and you can't access your dentist, go to an emergency room. Fever and swelling may indicate that the infection has spread deeper into your jaw and surrounding tissue or even to other areas of your body.

Causes

A tooth abscess occurs when bacteria invade the dental pulp — the soft, innermost part of the tooth that contains blood vessels, nerves and connective tissue.

Bacteria enter through either a dental cavity or a chip or crack in the tooth and spread all the way down to the root. The bacterial infection causes swelling and inflammation. The tight space within which the inflammation occurs forces pus into a pocket (abscess) at the tip of the root.

Risk factors

The following factors may increase your risk of a tooth abscess:

• Inadequate dental hygiene. Not taking proper care of your teeth and gums — such as not brushing and flossing your teeth twice a day — can increase your risk of tooth decay, gum disease, tooth abscess, and other dental and mouth complications.
• A diet high in sugar content. Frequently consuming foods rich in sugar, such as sodas and sweets, can contribute to dental cavities and in turn to a tooth abscess.
• An underlying health problem. Having a medical condition that weakens your immune system, such as diabetes or an autoimmune disease, can increase your risk of a tooth infection and tooth abscess, as well.

Complications

A tooth abscess won't go away without treatment. If the abscess ruptures, the pain may decrease significantly — but dental treatment is still needed. If the abscess doesn't drain, the infection may spread to your jaw and to other areas of your head and neck. It may even lead to sepsis — a widespread, life-threatening infection.

If you have a weakened immune system and you leave a tooth abscess untreated, you're even more at risk of a spreading infection than is someone with a healthy immune system.

Tests and diagnosis

In addition to examining your tooth and the surrounding area, your dentist may conduct one or more of the following tests:

• Tapping on the affected tooth. A tooth that has an abscess at its root is generally sensitive to touch or pressure.
• X-ray. An X-ray of the aching tooth can help identify an abscess. X-rays or other imaging tests, such as a CT scan, may also be used to determine whether the infection has spread, causing abscesses in other areas.
• Lab tests. In some cases, knowing what bacteria are causing the infection may help target treatment, especially if first line antibiotics aren't successful.

Treatment and drugs

The goal of treatment is to drain the abscess and eliminate the infection. To accomplish this, your dentist may:

• Perform a root canal. This procedure can help eliminate the infection and save your tooth. To do this, your dentist drills down into your tooth, removes the diseased central tissue (pulp) and drains the abscess. The tooth's pulp chamber and root canals are filled and sealed. Your dentist then caps the tooth with a gold or porcelain crown. A restored tooth can last a lifetime if cared for properly.
• Extract the affected tooth. If the affected tooth can't be saved, your dentist will pull (extract) the tooth and drain the abscess to get rid of the infection.
• Prescribe antibiotics. If the infection is limited to the abscessed area, antibiotics may not be necessary. But if the infection has spread to nearby teeth, your jaw or other areas, your dentist will likely prescribe antibiotics to stop the spread of the infection. Antibiotics may also be recommended if you have a weakened immune system.

Lifestyle and home remedies

While the area is healing, your dentist may recommend the following steps to help ease discomfort:

• Rinsing your mouth with warm salt water
• Taking over-the-counter pain relievers as needed

Prevention

Avoiding tooth decay is essential to preventing a tooth abscess. The key to avoiding tooth decay is taking good care of your teeth. This includes:

• Using fluoridated drinking water
• Brushing your teeth at least twice a day with a fluoride toothpaste
• Using dental floss or an interdental cleaner to clean between your teeth on a daily basis
• Replacing your toothbrush every three or four months, or whenever the bristles are frayed
• Eating a balanced diet, and limiting sugary foods and between-meal snacks
• Visiting your dentist for regular checkups and professional cleanings
• Considering using an antimicrobial or fluoride mouth rinse to add an extra layer of protection against tooth decay