Abscessed Tooth: What You Need to Know
An abscessed tooth can cause throbbing pain. However, treatment may reduce your symptoms in a few days. Left untreated, an abscessed tooth can lead to potentially severe complications.
A tooth abscess is a pocket of pus from a bacterial infection. Abscesses can occur in different places around a tooth for different reasons and affect the involved tooth, the surrounding bone, and sometimes adjacent teeth.
Gingival: This is an abscess on the gums. It does not usually affect the tooth or supporting structures.
Periapical: This is an abscess at the tip of a tooth’s root. A periapical abscess is an infection that forms at the tip of the root.
Periodontal: This is an abscess on the gum next to the root of a tooth. It might also spread to the surrounding tissue and bone. 
Signs, Symptoms, and Causes
Anything that creates an opening for bacteria to get into the tooth or surrounding tissues can lead to a tooth infection. Causes include:
Severe tooth decay: A cavity, or tooth decay, is the destruction of the hard surfaces of the tooth. This occurs when bacteria break down sugars in food and drink, creating acid that attacks the enamel.
Broken, chipped, or cracked teeth: Bacteria can seep into any opening in a tooth and spread to the pulp.
Gum disease (periodontitis): Gum is an infection and inflammation of the tissues around the teeth. As gum disease progresses, the bacteria gain access to deeper tissues.
The main symptom of an abscessed tooth is throbbing pain near a tooth or in your gums. The pain usually comes on suddenly and gets worse over time.
If your tooth is infected, your pain may be:
Pain that radiates to your ear, jaw, or neck
Pain that gets worse when you lie down
Pain when chewing or biting
Gnawing or throbbing.
Sharp or shooting.
Other oral symptoms of infection include:
Facial redness and swelling
Swollen, red gums
Tooth sensitivity to hot or cold temperatures
discolored or loose teeth
Foul-smelling bad breath
bitter or foul taste in your mouth
Swollen area in the upper or lower jaw.
Open, draining sore on the side of the gum.
In addition, you may experience more generalized symptoms like:
Tender or swollen lymph nodes in your neck or under your jaw
General discomfort, uneasiness, or ill feeling.
These factors may increase your risk of a tooth abscess:
Poor dental habits and care. Not taking proper care of your teeth and gums — such as not brushing your teeth twice daily and not flossing — can increase your risk of dental problems. Problems may include tooth decay, gum disease, tooth abscess, and other dental and mouth complications.
A diet high in sugar. Frequently eating and drinking foods rich in sugar, such as sweets and sodas, can contribute to dental cavities and develop dental abscesses.
Dry mouth. Having a dry mouth can increase your risk of tooth decay. A dry mouth is often related to health conditions, aging, and medications.. 
In addition to examining the tooth and surrounding tissue for signs of infection, your dentist may:
Recommend an X-ray. This can help identify sources of dental disease that may have led to the infection. Your dentist can also use X-rays to determine if the infection has spread and may affect other areas.
Recommend a CT scan. If the infection has spread to other areas within the neck, this will help to identify the extent of the infection.
Tap and press on your teeth. A tooth with an abscess is often sensitive to touch or pressure.
Thermal tests. These tests will help your dentist determine the health of your pulpal tissues. 
Treatment for an abscessed tooth focuses on clearing up the infection and relieving pain. Depending on your symptoms, your dentist might start with a dental X-ray. This will help them see whether the infection has spread to other areas.
Depending on the type and severity of your abscess, treatment options include:
Draining the abscess. Your dentist will make a small cut in the abscess to drain the pus. They’ll follow up by cleaning the area with a saline solution.
A root canal procedure. A root canal involves drilling into the affected tooth to drain the abscess and remove any infected pulp. Next, your dentist will fill and seal the pulp chamber, which holds the pulp, and the root canal. They may also cap your tooth with a crown to strengthen it. A crown procedure is usually done during a separate appointment.
Tooth extraction. If your tooth is too damaged, your dentist might remove it before draining the abscess. Your dentist may pull the tooth if it can’t be saved and drain the abscess.
Antibiotics. If the infection has spread beyond the abscessed area or you have a weakened immune system, your dentist might prescribe oral antibiotics to help clear the infection.
Removal of the foreign object(s). If a foreign object in your gums causes your abscess, your dentist will remove it. They’ll finish up by cleaning the area with a saline solution.
If you can’t get in to see your dentist immediately, you can take an over-the-counter anti-inflammatory drug, such as ibuprofen (Advil, Motrin), to help with the pain. Rinsing your mouth with warm salt water may also help. 
Avoiding tooth decay is essential to preventing a tooth abscess. Take good care of your teeth to avoid tooth decay:
Drink water that contains fluoride.
Brush your teeth for two minutes at least twice daily with fluoride toothpaste.
Use dental floss or a water flosser to clean your teeth daily.
Replace your toothbrush every 3 to 4 months or whenever the bristles are frayed.
Eat healthy food, limiting sugary items and between-meal snacks.
Visit your dentist regularly for checkups and professional cleanings.
Consider using an antiseptic or a fluoride mouth rinse to add an extra layer of protection against tooth decay. 
In most cases, complications only occur if the abscess is left untreated. However, complications can occur, even after seemingly effective treatment, but this is very rare. Possible complications include:
Dental cysts: A fluid-filled cavity may develop at the bottom of the tooth’s root if the abscess is not treated. This is called a dental cyst. There is a significant risk that the cyst will become infected. If this happens, the patient will need antibiotics and possibly surgery.
Osteomyelitis: The bacteria in the abscess gets into the bloodstream and infects the bone. The patient will experience an elevated body temperature, severe pain in the affected bone, and possibly nausea. Typically, the affected bone will be near the site of the abscess. However, as it may have spread into the bloodstream, any bone in the body may be affected. Treatment involves either oral or intravenous antibiotics.
Cavernous sinus thrombosis: The spread of bacteria causes a blood clot to form at the cavernous sinus, a large vein at the base of the brain. Cavernous sinus thrombosis is treated with antibiotics and sometimes surgery to drain the sinus. In some cases, the condition can be fatal. This is a very rare complication.
Ludwig’s angina: This is an infection of the floor of the mouth when the dental abscess bacteria spread. There is swelling and intense pain under the tongue and in the neck. In severe cases, the patient may find it hard to breathe. Ludwig’s angina is a potentially fatal condition. Patients are treated with antibiotics. People with severe Ludwig angina may require a procedure to open the airway if breathing problems exist.
Maxillary sinusitis: The bacteria spread into small spaces behind the cheekbones, called the maxillary sinuses. This is not a serious condition, but it can be painful. The patient may develop a fever and have tender cheeks. Sometimes, the condition resolves on its own. Depending on the severity, the doctor may prescribe antibiotics. 
An abscessed tooth should clear up within a few days of treatment. Even if it seems to drain, following up with your dentist is important to ensure the infection doesn’t spread to another area.
You can reduce your risk of an abscessed tooth by practicing good oral hygiene and having regular dental checkups every six months.
See your dentist promptly if you have any signs or symptoms of a tooth abscess.
If you have a fever and swelling in your face and can’t reach your dentist, go to an emergency room. Also, go to the emergency room if you have trouble breathing or swallowing. These symptoms may indicate the infection has spread deeper into your jaw, throat, neck, or other body areas.
You should prepare a list of questions to ask your dentist, including:
What’s likely causing my symptoms and condition?
Which tests do you recommend?
What is the best course of action?
Is there an alternative to the primary?