Signs and treatment of an abscessed tooth

Teeth don’t normally hurt. They may ache when you expose them to something very cold or sleep with your jaw clenched. But that’s different than a throbbing pain that won’t stop, or swollen, tender gums around a tooth. If that’s what’s going on, you may have an abscessed tooth.¹

“An abscess is a pocket of pus around teeth. It’s caused by an infection that creates inflammation and swelling around the tooth or gum,” says Irina Kessler, D.D.S., co-founder of New York Family Dental Arts in New York City.

An abscessed tooth needs to be treated quickly. In most cases, a dentist can stop the pain by treating the infection and saving the tooth. But left untreated, an abscessed tooth can lead to complications, including blood infections.¹

Here’s what to know if you think you have an abscessed tooth.

Your teeth have layers. The outer layers (enamel and dentin) are hard. They protect the softer inner layer (pulp) made up of blood vessels and nerves.²

But as tough as these outer layers are, they may still get damaged. Tooth decay can eat away at enamel and form small holes, or cavities. You can bite down on something hard or clench or grind your teeth and develop cracks.

Cavities and cracks give bacteria an opening to get inside the teeth and down into the inner layer. “When this starts to happen, the nerve begins to die and infection starts,” says Dr. Kessler. The gum and tissues swell because they’re inflamed. And pus — a mixture of white blood cells, dead tissue and bacteria — builds up.³

A common way for an abscess to develop, though, is via a large cavity, explains Dr. Kessler.³ And cavities may be easy to miss in their earliest stages, she adds.

“Cavities don’t actually hurt. This is why we take X-rays every 6 months (in our practice), as these images help us spot decay that’s developing,” Dr. Kessler explains. This is yet another reason to get regular dental checkups.

The combination of pus and swollen, inflamed tissue can give you a toothache. But this type of toothache may come with a lot of other symptoms, including:^{1, 3}

• Pain, usually all the time (the pain may be throbbing, sharp or shooting)
• Pain when chewing your food
• Swollen gums or a swollen bump (similar to a pimple) on the gum covering the abscessed tooth
• A strange or bitter taste in your mouth
• A fever, as your body fights the infection
• Swelling in the glands of the neck or along the jawline (if you see swelling, you should call the dentist immediately, Dr. Kessler says)

The dentist will have several goals, explains Dr. Kessler. They will check the tooth, ease the pain and possibly refer you to a specialist if needed — and hopefully save the tooth, she notes.

The dentist will examine your teeth and gums, looking for inflammation. The dentist will also recommend an X-ray, notes Dr. Kessler. That helps them see the extent of the decay or damage and what parts of the tooth have been infected.¹

Sometimes you only need an over-the-counter pain reliever such as acetaminophen or ibuprofen. But the dentist also may recommend antibiotics to clear up the infection, notes Dr. Kessler.³

The dentist may refer you to an endodontist, a specialist in infected teeth and roots, to treat the underlying source of the abscessed tooth. There are a few treatment options, depending on the damage:

• A root canal is when an endodontist cleans out the bacteria and infected tissue and nerve. Then they fill and seal the empty spaces in the root canal.⁴ After that, a dentist may put a crown over the tooth to keep bacteria away and save the tooth.^5,6
• If the infection is widespread or severe, the endodontist will cut into the gum to drain the pus.¹
• If the tooth is really infected or damaged, the dentist will remove it. But this is not common.¹

The good news is that most cases of tooth abscess can be avoided with regular dental checkups, Dr. Kessler explains. "With regular observation, cleaning and X-rays, you can keep your mouth healthy," she says.