If swelling from a sore tooth is spreading towards your eye or down your neck, or you are finding it hard to swallow, breathe or open your mouth, go to a hospital emergency department or call 000 now. Those are signs a dental infection is moving beyond the tooth. If none of them apply, see a dentist as soon as possible. What you cannot do is wait for it to settle by itself, because an abscess does not heal without treatment of its source.
Signs that mean hospital, not a dental appointment
- Swelling that is spreading across the cheek, under the jaw, into the neck or up towards the eye
- Difficulty breathing, swallowing or speaking normally
- Being unable to open your mouth more than a little
- Fever with shivering, a racing heart, confusion or feeling very unwell, which can be signs of sepsis
These are uncommon but serious, because a spreading dental infection can narrow the airway or enter the bloodstream. When unsure, be seen urgently rather than waiting for a booking.
How the infection forms and why it stays
Bacteria reach the inside of a tooth through deep decay, a crack or a broken filling, or they collect in a deep gum pocket beside the root. The body walls the infection off and pus builds up in a closed space. That trapped pressure is what makes the pain throb and what makes biting on the tooth so sore.
As long as infected tissue remains inside the tooth or pocket, bacteria keep feeding the abscess. That is why it can quieten down and then flare again weeks later. Infections that start inside the tooth and those that start in the gum are managed a little differently; our guide to a gum abscess versus a tooth abscess explains the difference.
What it tends to feel like
A deep, throbbing ache that may spread to the ear, jaw or temple is typical, along with pain when you bite or tap the tooth. There may be a tender lump on the gum, a swollen face on that side, a salty or foul taste, or swollen glands under the jaw. Some people simply feel run down.
Pain that suddenly stops can be misleading. Sometimes the abscess has burst and is draining, which relieves the pressure. Sometimes the nerve inside the tooth has died. In both cases the infection is still present.
Looking after yourself until you are seen
Over-the-counter pain relief, taken as the packet directs and checked with a pharmacist if you have other health conditions or take other medicines, can make the wait more bearable. Warm salt water rinses keep the area clean. Chew on the other side and avoid very hot, cold or sweet food. Do not hold an aspirin against the gum, as it can burn the tissue, and do not squeeze or pierce the swelling yourself. Then call a dentist and describe the swelling so you can be triaged appropriately.
Antibiotics have a smaller role than many people expect
A common belief is that a course of antibiotics will clear an abscess. Dental prescribing guidance, such as that of the Scottish Dental Clinical Effectiveness Programme, advises draining an abscess and removing the cause first, and keeping antibiotics for infections that are spreading or making you generally unwell, for example with a fever, particularly when drainage cannot be achieved straight away. Even then, they work alongside treatment of the tooth, never in place of it. Taking antibiotics that are not needed brings side effects and contributes to resistance without fixing the cause.
Treatment removes the source
The first step is usually to release the pressure, either by opening the tooth or by draining the swelling through the gum. Relief often follows quickly. An X-ray helps show where the infection started and how much bone around the root is involved.
If the tooth can be kept, root canal treatment cleans out the infected pulp and seals the inside of the tooth, and a crown is often recommended afterwards for a back tooth. If the tooth is too broken down or the support around it is lost, removing it takes away the infection. Our article on root canal versus extraction sets out how that choice is usually made. For a gum abscess, cleaning out the pocket is the main treatment.
Questions patients ask about abscesses
Can I just wait until my next check-up?
No. Even if the pain eases, the infection persists and can spread or damage the bone around the tooth. Arrange to be seen promptly.
Will I definitely be given antibiotics?
Not necessarily. Many abscesses are managed by draining and treating the tooth without antibiotics. They are prescribed when the infection is spreading or you are generally unwell.
Is it safe to have treatment while the area is swollen?
Usually yes. Releasing the pressure is often the quickest way to reduce pain and swelling. Your dentist will decide what is safe on the day based on how far the infection has spread.
If you have a swollen or throbbing tooth, contact us as soon as possible so we can find you a time. Our guide to dental emergencies covers other urgent problems, and our current offers page has details on visiting us.
This article is general information and not a substitute for individual dental or medical advice. If you have signs of a spreading infection, seek urgent care.
