Tooth Abscess • Causes & Symptoms
Gum Disease

What is a Tooth Abscess?

A tooth abscess is a dental condition that develops as the result of a tooth infection that creates a collection of pus at the area around a tooth root or in the gums. Tooth abscesses can be caused either due to untreated tooth decay or due to advanced gum disease (periodontitis). They are the most common reason many patients visit their dentists with intense toothache.

How a tooth abcess is formed ?

An abscess is actually a result of the immune system’s effort to contain an infection and prevent it from spreading to other areas. The body sends white blood cells to the area of the infection to fight the bacteria. During this process pus forms, which is an accumulation of fluid, living and dead white blood cells, liquified dead tissue and live and dead bacteria.

If the pus is collected in a small, contained space with no way for pus to drain, it forms a pocket of infected liquid that is called an abscess. In the mouth, abscesses form around the root tips of a tooth or in the gum tissue surrounding the teeth. As pus is accumulated, the pressure increases and the abcessed tooth often becomes increasingly more painful.

Sometimes the tooth infection spreads even more causing a swollen face or forming a visible bump on the gum overlying the root (gumboil). The swollen area can rupture, allowing the pus to drain in the mouth. Once the abscess ruptures, the pain often decreases significantly, but the infection remains and dental treatment is still necessary.

As a tooth abcess develops, the infection can spread into the ligaments that secure the tooth to the jawbone and the jawbone itself. The bacteria and the immune system’s response cause rapid destruction of connective tissues around the tooth and into the jawbone, and bone loss may occur. This causes teeth to become loose and may lead to tooth loss.

Types of tooth abscess

There are 3 common types of dental abscess based on the area of the mouth where they form:

  • Periapical abscess - A periapical abscess that forms around the edge of the root (apex) of an infected tooth is the most typical form of tooth abscess. It usually originates from infected pulp tissue due to tooth decay. If this tooth root infection goes untreated (the diseased tissue in the pulp is not removed) pus can begin to build up around the root of the tooth forming an abscess. The infection can spread to the bone surrounding the root.
  • Periodontal abscess - A periodontal abscess is usually referred as gum abscess. In this case, the infection comes from outside the tooth instead of from within. It is usually caused by an infection in the pocket between the teeth and gums. This may happen either when food particles get trapped between the gum and tooth or in cases of periodontal disease, when bacteria build up in deep pockets under the surface of the gums.
  • Pericoronal abscess, is a special form of tooth abscess that is related mostly with partially impacted wisdom teeth, and develops when the tissue covering a partially erupted tooth becomes inflamed and infected (pericoronitis).

Causes of tooth abscesses

All types of tooth abscesses are the result of a pre-existing infection in the mouth. The pus formation that characterizes an abscess is a side-effect of the ‘battle’ of the body’s immune system with the bacteria that have caused the infection. Pus is actually a mixture of living and dead white blood cells and bacteria, cell fluids, and liquified dead tissue. The initial infection may be caused by:

  • Tooth decay. A periapical tooth abscess develops when tooth decay in a tooth is not treated until it finally reaches and infects the dental pulp. The bacterial infection causes the inflammation and finally the death of the dental pulp tissues. As the bacteria grow and multiply they reach beyond the end of the root canals, infect the surrounding tissues and form a tooth abcess around the root tip.
  • Trauma - Cracked tooth. Other conditions such as a tooth injury (crack) or weakened dental restorations may also allow bacteria to reach the centre of the tooth and infect dental pulp, with similar effects in abscess formation as tooth decay.
  • Periodontal disease. Severe gum disease causes the gums to pull away from the teeth, creating deep pockets of space between the teeth and gums. Periodontal pockets allow bacteria to enter deep between teeth and the surrounding gums and bone. If the infection is not treated, a periodontal abscess will develop.

Tooth Abscess Symptoms

An abscess is typically painful, and it appears as a swollen area that is warm to the touch. The skin surrounding an abscess typically appears pink or red. The main symptoms associated with a tooth abscess are usually:

  • a severe, persistent and continuous toothache.
  • swelling of the face

Other tooth abscess symptoms include:

  • Pain when chewing.
  • Sensitivity of the teeth to heat, cold or pressure.
  • Visible boil in the gums near a tooth (gum boil)
  • Pus drainage in the mouth
  • Foul taste in mouth and bad breath (a result of pus drainage)
  • Redness and swelling of the gums, jaw or face
  • Difficulty fully opening the mouth or swallowing.
  • Swollen lymph nodes in the neck.

Although the formation of a tooth abscess is always followed with intense toothache, it may be developing for a long time before the tooth pain starts, revealing its existence.

As more pus is accumulated, the pressure increases and the abscess becomes increasingly more painful. Sometimes the pus finds a way through the tissue to the surface forming a visible bump on the gum overlying the root (gumboil). The boil can then rupture, allowing the pus to drain in the mouth. If such a drainage channel (fistula) is formed, the abscess becomes chronic.Every time the abscess is drained into the mouth, the pain often decreases significantly, but the infection remains and dental treatment is still necessary. Otherwise the tooth absess will gradually worsen as the infection continues to spread and destroy periodontal tissues.

Tooth Abscess without Pain. If the nerve at the root of the tooth dies as a result of infection, the toothache may stop. However, this doesn't mean the tooth infection has healed; the tooth abscess symptoms will gradually worsen as the infection continues to spread and destroy periodontal tissues. Therefore, if you experience any of the above listed symptoms of tooth abscess, it is important to see a dentist and get tooth abscess treatment even if the pain subsides.

Severe tooth abscess symptoms such as fever, chills, nausea, vomiting, or diarrhea, mean that the tooth infection has spread to other tissues or organs. The condition may become life-threatening; see your doctor immediately.

The cost of dental treatments can be significant and many patients may not afford it if they are not covered by their dental insurance. Learn how to choose a dental insurance plan that will provide the best dental treatment to you and your family.

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