Toothache and dental abscess: causes and when to seek urgent care

Toothache can range from a brief twinge to severe, throbbing pain. Sometimes it points to a simple problem such as a small cavity, and sometimes to an infection that needs urgent treatment. This article explains the common causes, what a dental abscess is, how it is treated and when to seek emergency help, using information from the NHS, the US National Institute of Dental and Craniofacial Research (NIDCR) and MedlinePlus.

1. Introduction

A dental abscess is a pocket of pus caused by infection in a tooth or in the gum ^{[1, 4]}. The NHS stresses that it needs urgent dental treatment and will not clear up on its own ^[1]. It is important not to ignore pain that is severe or that comes with swelling or fever.

2. Causes and risk factors

Toothache has many possible causes, and tooth decay is one of them. The NHS explains that decay can cause toothache and sharp sensitivity to hot, cold or sweet things, and that a tooth or gum can become infected, leading to an abscess ^[2]. MedlinePlus lists other tooth problems, including broken or chipped teeth and impacted teeth (teeth that fail to break through the gum on time, most often wisdom teeth), and names tooth pain as a symptom of tooth disorders ^[4].

The NHS lists these causes of a dental abscess ^[1]:

• A tooth that has not fully come through the gum
• Tooth decay or gum disease
• An injury to the teeth, gums or mouth
• Radiotherapy or chemotherapy for cancer

Not cleaning the teeth well, and frequent sugary food and drink, raise the risk of the decay that often lies behind these problems ^{[2, 3]}.

3. Signs and symptoms

The NHS describes these signs of a dental abscess ^[1]:

• Severe toothache or gum pain
• Redness inside the mouth, or on the face or jaw
• Sensitivity to hot or cold food and drink
• A bad taste in the mouth
• Difficulty opening the mouth or chewing
• A swollen face or jaw, and swollen glands in the neck
• A fever

NIDCR adds that an abscess can cause pain, facial swelling and fever ^[3]. The NHS stresses that an abscess will not clear up without treatment, so it needs to be seen by a dentist ^[1].

4. Diagnosis and tests

A dentist asks about your symptoms, looks at the teeth and gums and may probe the teeth. MedlinePlus explains that dentists diagnose tooth problems through questions, a visual check, probing and sometimes X-rays ^[4]. NIDCR notes that dentists may use X-rays to detect decay ^[3].

5. Treatment and management

Treatment is given by a dentist, and the right choice depends on the cause.

Dental treatment

The NHS explains that a dentist drains the pus, using local anaesthetic to numb the area. If a tooth problem caused the abscess, you may need root canal treatment, which MedlinePlus says is used for infections that reach the pulp, the soft tissue in the centre of the tooth, or the tooth may have to be taken out ^{[1, 2, 4]}. Painkillers and sometimes antibiotics may be prescribed for a few days afterwards ^[1]. Decay without an abscess may need a filling or other care ^{[2, 3]}.

While you wait for an appointment

The NHS says that painkillers can help ease the pain while you wait, that children under 16 should not take aspirin, and that you should never take more than the recommended amount, because more does not work better and can be dangerous. Ask a pharmacist or doctor if you are unsure what is suitable for you. It also suggests eating soft foods such as soup, scrambled eggs or yoghurt, brushing gently with a soft toothbrush and avoiding very hot or cold food and drink ^[1]. These steps only ease discomfort. They do not treat the infection.

6. Prevention and self-care

• Brush at least twice a day with fluoride toothpaste, and spit out the extra without rinsing with water ^{[1, 2]}.
• Clean between your teeth daily with floss or interdental brushes ^{[1, 2]}.
• Replace your toothbrush every 2 to 3 months ^[1].
• Limit sugary food and drink, and avoid smoking and tobacco ^{[2, 3]}.
• Have regular dental check-ups so problems are caught early ^{[1, 2, 3]}.

7. Special groups

The NHS lists radiotherapy and chemotherapy as risk factors for a dental abscess ^[1]. NIDCR advises that, if possible, people see a dentist for a full exam about one month before starting cancer treatment ^[5]. The NHS advises seeing a dentist as soon as possible if you think your child has tooth decay ^[2], and children under 16 should not take aspirin ^[1].

8. When to see a doctor

See a dentist urgently if you think you have an abscess. The NHS notes that a general doctor cannot provide dental treatment, and that if you have no dentist or cannot get an emergency appointment, people in the UK can call NHS 111 ^[1]. Elsewhere, contact your local urgent dental or health service.

The NHS advises going to a hospital emergency department or calling for emergency help if you have trouble breathing, speaking or swallowing, a swollen or painful eye, sudden vision problems, significant swelling inside the mouth, or difficulty opening the mouth. The NHS advises not to drive yourself in this situation and to bring a list of the medicines you take ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Toothache can be caused by decay, and severe pain with swelling, fever or a bad taste can mean an abscess, which needs urgent dental treatment. A dentist can drain the infection and treat its cause, and emergency symptoms such as trouble breathing or swallowing need immediate help. Good daily cleaning, less sugar and regular check-ups lower the risk.