Could you have a tooth infection?

Something’s going on in your mouth, and you’re pretty sure it’s not good. You’ve got a toothache that comes and goes, or it happens only when you’re chewing. Maybe you’re super sensitive to hot or cold. Or your face is starting to look puffy and swollen.

You might be dealing with an abscess. That isn’t something to ignore. An abscess can cause serious, even life-threatening complications if you don’t get it treated. That’s per the Mayo Clinic.

Luckily, though, there are safe, effective treatments. Your best bet: Call your dentist right away.

“When there’s something going on in your mouth, you need to take care of it as soon as you can,” says endodontist Stefan Zweig, DDS. He’s the president of the American Association of Endodontists. “No amount of pain in your mouth is normal.”

We’ll show you what to look out for, what to expect and what to do.

What’s an abscess — and how did I get it?

“An abscess is an infection that begins deep inside your tooth and ultimately travels to the tissues surrounding the tooth,” explains Dr. Zweig. The infection happens in the innermost portion of your tooth, in a hollow area under the enamel and dentin (called the pulp space).

The space is filled with tissue called the pulp, which consists of nerves and blood vessels. The pulp runs all the way down the tooth’s root, connecting it to your jaw. The main purpose of the pulp is to nourish your tooth as it develops, Dr. Zweig explains.

But when bacteria make their way into the pulp, that means trouble. The area becomes inflamed, and the pulp starts to die. When bacteria enter the pulp, they start to feed off the dead pulp tissue. Certain bacteria leaving the tooth can cause an accumulation of pus. This is an abscess.

Why does this happen? The most common culprit of pulp death and inflammation is tooth decay. When you’ve got a cavity, bacteria that live happily and safely inside your mouth enter your tooth.

An abscess can start off as a cavity that goes deeper and deeper into your tooth if it’s left untreated, says Dr. Zweig. As bacteria approach the pulp, they enter it and start an infection. (An abscess can also start because of trauma to the tooth, such as breaking or dislodging a tooth during an accident.)

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What are the symptoms of an abscess?

The top sign of a dental infection is pain. It could be in the tooth itself or in the gum that surrounds it. Or you could feel a more general pain throughout your mouth and in your jaw. Other typical symptoms:

• Your tooth feels tender.
• You’re sensitive to heat or cold in your mouth.
• You feel pain when you touch or tap a tooth.
• You have swelling in your gums or face.
• Your gums seem red or start to bleed.
• The lymph nodes in your neck become swollen.
• You’ve lost your appetite and just don’t feel like yourself.
• You’re running a fever.

These symptoms won’t magically disappear on their own. If you don’t treat the infection, things could get worse. Some complications include:

• Cellulitis, a bacterial infection of your skin
• Difficulty swallowing and breathing
• Dehydration

If you have any of these symptoms, get help immediately. Can’t reach your dentist? Go to a doctor or an ER right away.

I think I might have a tooth infection. What should I do?

Don’t delay. At the first sign of a problem, call your dentist. Be prepared with a complete list of your symptoms, and let the dentist know you think it might be an abscess.

While you’re waiting to reach your dentist, you can try using over-the-counter pain relievers, such as acetaminophen (Tylenol^®). These might help — but don’t cancel the dentist. You need to get to the root of the problem.

How can the dentist treat my abscess?

Your dentist can treat your infection and make the pain go away. Here’s how:

• Root canal treatment. If there’s enough of the tooth structure left, your dentist can perform a root canal. “We go into the space where the pulp was and remove the pulpal remnants and disinfect the canal,” explains Dr. Zweig. “Then we seal it off and make sure no bacteria can get back in.” Your general dentist can take care of this, or you might be referred to a specialist.

• Antibiotics. If your dentist is concerned that your infection has spread, they may prescribe an antibiotic alongside the root canal treatment. Options include:

  • Penicillin
  • Amoxicillin
  • Azithromycin
  • Clindamycin

• Extraction. Occasionally the abscess may be so severe — and the cavity so large — that the tooth can’t be saved. If that’s the case, your dentist will need to remove it.

What can I do to keep it from happening again?

You’ve heard it before, and we’ll say it again: The best prevention is good dental care. Get regular checkups with your dentist. And brush and floss daily.

Additional source
Abscess basics: Mayo Clinic (2022). “Tooth abscess”