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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Tooth Abscess

An abscess may result when plaque eats through the tooth's outer protective enamel, allowing bacteria to invade the soft inner tissues.

What is it?

A tooth abscess is a pus-filled sac that forms in the tissues surrounding a tooth's root. It usually occurs when bacteria penetrate the hard outer layers of a tooth and spread to the pulp (the blood vessels and nerves that make up the soft core of each tooth), causing the pulp to die. The body's white blood cells' response to bacteria and dead pulp tissue results in pus accumulation, which may spread to the surrounding tissue at the root end and cause a painful abscess. Left untreated, the abscess may erode a channel through the jawbone to the gum or the skin of the face or neck, forming a boil. The boil may eventually burst, relieving pain. The abscess may also cause swelling in the side of the face or in the neck, severe pain, difficulty opening the mouth, and fever. Severe, untreated abscess-related jaw infections may extend beyond the jaw to involve important structures in the head and neck or more distant sites.

What Causes It?

  • The most common cause is tooth decay.
  • An abscess may result when gingivitis or periodontitis goes unchecked.
  • An abscess may develop after injury to a tooth.
  • Occasionally, tooth pulp dies spontaneously for no apparent reason, resulting in abscess formation.

Prevention

  • Practice careful oral hygiene (see Gingivitis). See a dentist at least once a year.
  • Have decay treated promptly (see Tooth Decay).
  • Undergo root canal treatment or extraction of the infected tooth before an abscess can form.

Diagnosis

  • Dental examination and x-rays.

How to Treat It

  • Rinse with warm salt water to ease pain until you can see a dentist.
  • An over-the-counter pain reliever can help reduce discomfort. Stronger analgesics may be prescribed.
  • The dentist may drill a small hole through the crown of the infected tooth into the pulp, to release the pus. The pulp cavity and root canals are cleaned out and disinfected (root canal procedure). After the infection has subsided, the cavity is filled and the tooth is fitted with a crown. (Severe infection must be drained surgically to prevent the spread of infection beyond the jaw.)
  • If the tooth cannot be saved, it will be extracted.
  • Antibiotics may be given to fight infection.

When to Call a Doctor

  • The pain of a tooth abscess usually prompts a visit to the dentist as soon as possible. But if pain eases as an abscessed boil bursts, or if swelling has spread to the face or neck, see a dentist immediately.