1st Revision: 
2nd Revision: A tooth abscess is an infection in a tooth that leads to the formation of pus. Whilst it can be painful, it can be treated by a dentist and in most cases will heal completely.1
A tooth abscess occurs when bacteria enter the tooth cavity and lead to the development of an infection. This can cause a significant amount of pain and complications if it is left untreated. After diagnosis, a dentist is typically able to treat a tooth abscess by performing a root canal treatment.2
Tooth abscesses are relatively common and the development of a tooth abscess is easily preventable through the steps mentioned below in this article.
Overview
A tooth abscess occurs when an infection leads to the build up of pus inside a tooth. This can be very painful and needs to be treated by a dentist. Treatment typically involves a root canal procedure.
Causes of a tooth abscess
A tooth abscess can form when acids produced by bacteria in the mouth attack the teeth and the gums, leading to gum disease and tooth decay. Gum disease and tooth decay allow bacteria access into the tooth or gum, leading to an infection within a tooth.
A tooth abscess can also occur when there has been an injury to a tooth, the gums, or to the mouth. Similarly, it can be caused by undergoing some types of chemotherapy or radiotherapy. In rare cases, a tooth abscess can form when a tooth hasn’t developed properly.
Signs and symptoms of a tooth abscess
Signs and symptoms of a tooth abscess can include a type of aching or throbbing pain around a tooth or gum. This pain can arrive suddenly and gradually get worse. The pain can also spread to the rest of the face and neck on the side of the infected tooth.
It is important to note, however, that a tooth abscess can exist even in the absence of pain. Some other signs of a tooth abscess include redness or swelling in the face, a loosened or discoloured tooth, a newfound sensitivity to hot or cold food and drink, and bad breath or a bad taste in the mouth.
If an infection is particularly bad, a mouth ulcer or pimple can form on the roof of the mouth or close to the site of the tooth abscess.
Management and treatment for a tooth abscess
A tooth abscess can be properly treated by a dentist, who should be consulted as soon as possible. Whilst waiting for treatment, it is possible to manage pain by taking painkillers such as paracetamol, ibuprofen, or a combination of both if necessary (children under the age of 16 should not take both). If stronger painkillers are required, it is possible to take co-codamol. Co-codamol contains both codeine and paracetamol, and as such it should not be taken at the same time as additional paracetamol.
To manage the pain, very hot and very cold food and drink should be avoided if they are suspected to be making the pain worse. Likewise, it is recommended to try eating on the opposite side of the mouth to the tooth abscess, and to eat soft foods. Soft foods include scrambled eggs, yogurt, or porridge. When brushing your teeth, use a soft toothbrush and avoid flossing around the tooth with the abscess.
A dentist will treat the tooth abscess by draining away the pus in the infected tooth. If there is a problem with the tooth, the dentist may perform a root canal or in extreme circumstances remove the tooth. During a root canal treatment, the dentist will drill into the infected tooth in order to drain away the pus. The dentist will then clean away the remaining infection inside of the tooth, which may involve drilling further into the tooth. In the next stage of a root canal treatment, the dentist will fill the remaining hole in the tooth, and file it down so that it matches the other teeth. In some cases, the dentist may prescribe antibiotics to reduce the infection.
Diagnosis
A dentist is able to diagnose a tooth abscess using an assessment that includes a combination of methods. They will first ask about the symptoms that a person may be experiencing. They will then assess where the pain appears to be originating from, and where there is tenderness of a tooth, or area of the gum. During examination, they might pay particular attention to any signs of swelling of the gum, or altered appearance of the tooth. A dentist may also decide to perform an x-ray, which will expose how much of the tooth or gum is infected, and the areas that it is originating from.1
Risk factors
People who are at high risk for developing a tooth abscess include those who eat a diet that is high in sugar. Eating a diet high in sugar provides an ideal environment for bacteria to feed off. This process produces acids that damage the teeth and gums, and can lead to tooth decay, gum disease, and a resultant tooth abscess.
Other risk factors for developing a tooth abscess include a lack of dental hygiene. Insufficient brushing, or not brushing teeth for long enough can allow a build up of plaque. It is also essential to floss at least once a day, to clean away plaque from areas of the mouth that are difficult to reach with a toothbrush alone. People who have a ‘half-erupted’ tooth, such as a wisdom tooth that has not yet come through are also at risk of developing a dental abscess. This is because bacteria can get trapped which can lead to an infection. For the same reason, people who have a habit of grinding their teeth are also predisposed to developing a tooth abscess.1
Complications
Left untreated, a tooth abscess can become extremely painful, and risk the spread of infection to the intracranial sinuses. It can also lead to the loss of the tooth. For this reason, the sooner a tooth abscess is treated, the better.1
FAQs
How can I prevent a tooth abscess?
Tooth abscesses are easily preventable by following a routine of regularly cleaning teeth. This involves brushing twice a day and using floss once a day. Disposable toothbrushes and toothbrush heads should be replaced every three months. These steps help to clean plaque off of the teeth and avoid a buildup of bacteria on the toothbrush. Plaque is a film of bacteria that produces acid when they feed off sugars in the food that people eat.
How common are tooth abscesses?
Tooth abscesses are a fairly common condition. They are particularly common in populations of people who eat a diet high in sugar, and in those who have a poor dental hygiene regime.
When should I see a doctor?
It is recommended that individuals with a suspected tooth abscess see a dentist as soon as possible. This is because even when an individual is not in pain, it is possible for the infection to spread to other parts of the body, and for the problem to become more difficult to treat, the longer it is left. In some cases, this means that the patient might lose their tooth.
Summary
In summary, the development of a tooth abscess is a relatively common medical condition and is preventable in the majority of cases. Regardless of the cause of the tooth abscess, it is essential that treatment is carried out as soon as possible. Treatment typically includes a root canal procedure to drain the pus out of the tooth, and to remove the infection . In the period after the treatment, a patient may have to avoid certain foods for a short amount of time.
