Tooth abscess: how to identify, treat, and prevent

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January 17, 2019

Will that tooth pain goes away or is it a tooth abscess which requires attention from your dentist? learn how to identify, treat, and prevent a tooth abscess.

Are you in the worst tooth pain of your life? Is your gum swollen and sore to the touch? Are you unable to sleep, or even sit still? Have you taken painkillers, but to no avail? Hours later, are you still writhing in pain, unable to eat and barely able to think?

Sounds like a tooth abscess, alright. To say that an abscessed tooth can be painful is an understatement. Untreated tooth abscesses can be agonizing and quite possibly the worst pain you’ve ever felt.

The good news? Most abscessed tooth pain can be remedied quickly and with a lot less pain than you’re suffering through right now.

In fact, the most painful part of treating an abscessed tooth is getting yourself to the dentist. But the dentist is exactly where you need to be—as soon as possible— to get rid of the pain and also get rid of the underlying infection causing it.

While you’re making that emergency appointment for your dentist, let’s talk about what an abscessed tooth is, what causes it, and how it’s treated, so you know what to expect at your appointment.

What is a tooth abscess?

A tooth abscess is an infection within the tooth. The pain from an abscess can hit you quite suddenly. Although the pain seems to out of nowhere, a tooth abscess has likely been in the making for years.

What’s the difference between a tooth abscess and a gum abscess?

Tooth abscess (periapical): This is when the abscess occurs inside of the tooth.

Gum abscess (periodontal): This is when the abscess is between the tooth and the gum. Especially for those with gingivitis or severe gum disease, food can get trapped between the gum and the tooth. An invasion of bacteria then leads to an infection.

How do i know if i have an abscessed tooth?

Pain. Not sure if you have an abscessed tooth or not? If you truly have an abscess, you won’t be wondering what’s wrong with your tooth…you’ll know that something is very wrong. The pain is that intense. It’ll start out slow, maybe, as a dull throb, but it amps up very quickly.

The telltale symptoms of an abscessed tooth is pain that you can’t ignore. The pain can vary from an annoying, but tolerable, throbbing pain to a shooting pain that brings you to your knees, the emergency room, or both.

This pain may also be accompanied by one or several other symptoms, such as:

  • Sensitivity to cold or hot
  • General malaise
  • Swollen upper or lower jaw
  • Swollen lymph nodes in the neck or under your jaw
  • Fever
  • Bad breath
  • Bitter taste (often described as salty)
  • A draining sore on the gum
  • Painful chewing or biting
  • Ache in the bone around your affected tooth

What causes an abscessed tooth?

So, what forces conspired together to create your agonizing tooth infection?

There are two main causes that can lead to a dental abscess. The first (and most common) cause is severe tooth decay. This tooth decay is most always related to a poor diet consisting of high sugar, processed foods, and refined carbohydrates.

The second cause of tooth abscess is physical trauma to the tooth. If the tooth absorbs a blow, and is subsequently chipped or broken, it’s vulnerable to infection.

An untreated cavity, chip, or crack in your teeth can “open the door” for bacteria to enter inside of your dental pulp, which is in the center of your tooth. The dental pulp contains everything vital to the “life” of your tooth, such as blood vessels and nerves.

When bacteria gets into the pulp, it leads to swelling, inflammation, and pus. This eventually causes pressure to build up, which is why you feel throbbing or sharp pain. When the abscess is drained, the pain will dissipate almost immediately. However, pain relief does not mean that you’re free and clear. The infection is still there and needs to be addressed.

How do you treat an abscessed tooth?

Not sure what you should expect when you go to the dentist to treat your dental infection?

First, the dentist will do a physical examination of your tooth. Abscessed teeth are usually accompanied by red, swollen gums. He or she will also probe the offending tooth gently. You will feel slight discomfort but the good news is that your pain is almost over.

Your dentist typically will take an X-ray of the bone surrounding the abscess to check for bone loss at the tip of the root of the tooth—this is what verifies that you do, indeed, have an abscess, and something else causing all that pain.

The dentist’s main goal in treating your tooth abscess is to get rid of the infection and prevent the tooth from needing to be extracted.

The dentist will likely prescribe a round of antibiotics to fight the infection. To combat the pain, your dentist may recommend ibuprofen. For particularly acute pain, your dentist may also write a prescription for a stronger painkiller.

Potential treatments

Root canal: Your dentist will attempt to save your tooth with a root canal treatment. During this treatment, the root canal of your tooth is cleaned and disinfected.  The dentist will then seal the tooth’s pulp and root canals, and “cap” the tooth with a crown.

Extraction: a root canal is not advisable if it is not possible to restore the tooth. If that is the case, a tooth extraction must be performed.

Can i “wait it out”?

You’re probably wrestling with yourself on whether you need to go to the dentist, or if you could just tough it out and wait for the pain to subside.

The last thing you want to do is “wait it out”. The pain associated with your tooth infection may stop because the pulp in the root of your tooth has died. But that doesn’t stop the infection. Even without pain, the infection will continue to spread. And in its wake, it will destroy the surrounding tissue, leading to even bigger problems.

How to get out of pain while you’re waiting? You can try my 3-3-3 method for tooth pain (using 200mg tablets of Advil). Keep in mind that this method does not cure an abscess—you will still need to see your dentist immediately so that you can get on an antibiotic as soon as possible, even if the pain goes away!

That’s why it’s still crucial to visit a dentist if you suspect an abscessed tooth infection— even if you’re not experiencing any more pain. Abscesses don’t go away on their own. This infection will continue to spread, and may eventually corrupt other teeth or worse.

Are there any home remedies for an abscessed tooth?

Tooth abscesses cannot be treated at home. You will need to seek proper dental treatment to get rid of the infection, although these home remedies can help alleviate the pain temporarily:

  • Take over the counter pain killers for temporary relief until your dental appointment. Don’t exceed the daily amount unless directed by your dentist.
  • Sleep (if you can) with your head elevated so that you relieve some of the pressure and thus have less pain. I highly recommend keeping your head elevated with a wedge pillow like this one.

What happens if i don’t treat a dental abscess?

Even if the pain subsides, you should always see the dentist to get a tooth abscess checked out.

When ignored, teeth infections can lead to dire consequences. Even though you may not feel it, the infection is still there and can spread quickly to the rest of your body. One rare but serious tooth abscess complication is sepsis, a life-threatening infection that can be caused by allowing your tooth infection to go unchecked. Just don’t risk it.

How do i prevent a tooth abscess?

The best prevention against dental abscess is diet first, along with good oral hygiene.

  1. A cavity-preventing diet: Good diet means eating a whole foods diet that minimizes or eliminates processed foods and refined carbohydrates (for more details on what kind of diet prevents decay and abscesses, read my article How to Never Get a Cavity: Remineralization 101). Even if you’re an expert flosser and brusher, your diet can still make you prone to cavities (and dental abscesses)! Remember, it’s diet first, and oral hygiene second.
  2. Proper technique: As for good oral hygiene, when was the last time you checked in on your flossing and brushing routine? Make sure you’re using proper technique for both (see my videos on how to floss and how to brush—you may be surprised that your technique could use an update!)
  3. Prevent tooth trauma: What do I mean by “tooth trauma”? Trauma to the tooth is anytime the tooth gets hit—a fall off a bicycle, getting knocked in the face, etc. Wear a mouthguard during exercise, don’t do anything with your teeth that’s not chewing (never try to rip open packaging with your teeth!) and try to avoid situations where you can get bopped in the face (common ones include concerts, or even holding up a wine glass to your mouth and getting bumped at a cocktail party.) After tooth trauma, I always recommend my 3-3-3 method even if you don’t have any pain! The 3-3-3 method reduces inflammation inside the tooth, which is what is responsible for killing the pulp. The pain can often come later, after it’s too late. By doing the 3-3-3 preventatively after trauma to the tooth, you may be able to prevent damaging the pulp, and thus, causing a tooth abscess. And always see your dentist immediately after tooth trauma! The sooner, the better, to prevent irreversible damage to the tooth.
  4. Regular check-ups: Your dentist or hygienist may notice warning signs that you can’t see for yourself—so make sure you’re seeing your dentist for regular check-ups and teeth cleanings.

Final thoughts

Pain in the mouth always indicates a problem—and these problems don’t go away on their own. Fortunately, this is the kind of problem that can be treated quite easily.

If you suspect a dental abscess, don’t wait—seek help immediately. The sooner you get things checked out by your dentist, the sooner you can get back to your life. You will feel like yourself again, promise!

Dr. Mark Burhenne

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