A tooth infection can cause a fever, and when it does, the infection has usually spread past the tooth into the surrounding tissue or is affecting your body more widely. An abscess that stays at the root tip tends to hurt without making you feel generally sick. A raised temperature, chills or a feeling of being unwell alongside dental pain means you should be seen the same day, not at the next convenient appointment.
Call Triple Zero (000) straight away if you notice
- Difficulty breathing, noisy breathing, or a sense that your throat is tightening.
- Difficulty swallowing, drooling because swallowing hurts, or a muffled or changed voice.
- Hard swelling under the jaw on both sides, or a tongue that feels lifted and pushed back.
- Swelling that is closing an eye, an eye that bulges, or double vision.
- Confusion, shaking chills, rapid breathing, clammy or blotchy skin, or passing very little urine.
Do not wait for a practice to return your call, and do not start an old leftover course of antibiotics to see how the night goes. These signs mean the airway or your circulation may be at risk.
Go to a hospital emergency department the same day if your mouth will not open more than a finger or two, if facial swelling is getting bigger, or if you have a fever with dental pain and cannot get a dental appointment that day. The NSW Health public dental brochure also directs people with facial or neck swelling to the nearest emergency department. For nurse advice at any hour, the healthdirect helpline is 1800 022 222, and NSW Public Dental Services can be reached on 1800 679 336 to make an appointment.
What a temperature tells you about the infection
Inside a tooth, an infection begins in the pulp, the soft tissue in the centre. When the pulp dies, bacteria can collect at the tip of the root and form an abscess. While it stays there, the problem is local: a tooth that aches or throbs, is tender to bite on, and may have a small lump on the gum beside it.
Fever is the body's response to infection that has moved beyond that point. Along with it you may notice swelling of the cheek or jaw, tender glands in the neck, tiredness and a general feeling of being run down. At this stage pus is spreading through the tissue spaces around the jaw, and those spaces connect with each other and with the neck. That is why the urgency rises so sharply once you feel feverish.
There is no safe temperature below which waiting is fine. A mild reading and a high one lead to the same advice: dental pain plus fever needs an examination that day.
How spreading dental infections become dangerous
Infections from lower back teeth can track down into the floor of the mouth and the space under the jaw. When both sides and the area under the tongue are involved, the condition is called Ludwig's angina. The swelling becomes firm, the tongue is pushed up and back, and swallowing and breathing become difficult. The main danger is to the airway, which is why it is treated in hospital, sometimes with surgical drainage and airway support.
Not being able to open your mouth properly, called trismus, is another warning sign. It usually means the infection has reached the chewing muscles at the back of the jaw, and it can make both treatment and breathing more difficult.
Upper teeth carry a different risk. Infection can spread up towards the eye, causing swelling of the eyelid and the tissue around the eye. Rarely it can reach the veins behind the eye. A swollen, bulging or painful eye, or any change in vision, needs emergency care immediately.
Matching symptoms to how quickly to act
| What you notice | Likely meaning | What to do |
|---|---|---|
| Brief twinge with cold that fades within seconds | Sensitive dentine or mild pulp irritation | Routine dental appointment |
| Throbbing ache, often worse lying down, no swelling or fever | Inflamed pulp that is unlikely to recover | See a dentist within a day or two |
| Tooth sore to bite on, small gum swelling, no fever | Abscess confined to the tooth area | Same day or next day dental visit |
| Swollen face or jaw with fever or feeling unwell | Infection spreading into the tissues | Dentist the same day, or the emergency department if none is available |
| Mouth will not open more than a finger or two | Spread into the muscle spaces | Emergency department now |
| Swelling under the jaw on both sides, drooling, breathing or swallowing trouble, eye swelling, confusion | Airway, eye or whole body involvement | Call Triple Zero (000) |
Antibiotics slow the spread but do not remove the cause
The source of a dental infection is physical: a dead or dying pulp, and a pocket of pus. Removing it means draining the abscess and either cleaning out the inside of the tooth with root canal treatment or taking the tooth out. When antibiotics are given without that treatment, the symptoms often settle for a while and then return once the course ends.
For infections that stay around the tooth, antibiotics add little. A 2024 Cochrane review by Cope and colleagues looked at adults with painful infections at the root tip and localised abscesses. It found that an antibiotic given before root canal cleaning made little to no difference to pain or swelling, and the evidence for antibiotics after treatment was very uncertain. The reviewers found no trials of antibiotics used on their own without dental treatment.
Spreading infection with fever or facial swelling is different. In that situation a dentist or doctor may prescribe antibiotics alongside drainage and treatment of the tooth, particularly if the dental procedure cannot be done straight away. If a dentist decides antibiotics are not needed for a localised abscess, that reflects current evidence and the effort to limit antibiotic resistance. Our article on antibiotics for a tooth infection explains when they help.
What happens if you go to hospital
An emergency department focuses on the airway, the spreading infection and your pain. Staff may give antibiotics through a drip, organise scans, drain a collection surgically and admit you if needed. They generally do not fix the tooth itself, so you will still need to see a dentist or a public dental clinic afterwards to remove the source. Knowing this in advance can save frustration.
Public dental care in NSW is free for children under 18 with a Medicare card and for adults who hold a Pensioner Concession Card, Health Care Card or other eligible Commonwealth concession card. Our guides to when to go to hospital for a dental problem and dental emergencies after hours and on public holidays go through the options in more detail.
Related problems we cover separately
If swelling is your main concern, our article on facial swelling from a spreading dental infection explains where it tends to travel. For the local problem and how it is treated, see tooth abscess signs and treatment.
Questions about fever and tooth infections
Can a tooth abscess clear up without treatment?
Not reliably. Pain often eases when pus drains out through a small opening in the gum, which can feel like recovery. The infected tissue inside the tooth is still there, so the abscess usually returns, sometimes with more swelling.
Should I take paracetamol or ibuprofen to bring the fever down?
Over-the-counter pain relief, taken as directed on the pack, can make you more comfortable while you arrange care. It does not treat the infection, and lowering your temperature should not be taken as a sign that it is safe to wait.
Can a tooth infection lead to sepsis?
It is uncommon, but it can happen. A dental infection with fever plus confusion, shaking chills, fast breathing or blotchy skin should be treated as a medical emergency. Call Triple Zero (000).
Getting seen today
If you have a toothache with a fever but none of the emergency signs above, arrange to be examined the same day. At Lumi Dental in Melrose Park we can assess the tooth, drain an abscess where that is appropriate and explain the options before any treatment. You can book online, read how urgent visits work on our emergency dentist page, or see current deals for new patients.
Sources
- Cope AL and colleagues. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database of Systematic Reviews, 2024
- NSW Health: Public dental services brochure
- healthdirect: Contact us (24 hour helpline)
This article is general information only and is not a diagnosis or personal advice. Dental infections vary enormously and only an in person examination can tell you how serious yours is. Please see a dental or medical professional about your own situation, and call Triple Zero (000) if you have trouble breathing or swallowing.
