Dental abscess and swollen gum: what to do and how it's treated

How to recognise a dental abscess, what helps until your appointment and what not to do, when antibiotics are needed, which signs mean an emergency and how it is treated at the clinic.

What is a dental abscess?

A dental abscess is an infection trapped in an enclosed space, at the tip of a tooth's root or in the gum around it. A small collection of pus forms and presses on the surrounding tissues: that is where the pain and swelling come from.

An abscess at the root tip starts from a tooth whose nerve has died. A gum abscess (periodontal) forms in a deep pocket between the gum and the tooth, in people with gum disease or where a piece of food has become lodged.

Symptoms of a tooth abscess

• throbbing pain that can spread to your ear or temple and gets worse at night;
• pain when you bite, and the tooth feels “higher” than the others;
• a swollen, red gum next to a tooth, sometimes with a small bump that leaks a bad-tasting fluid;
• a swollen cheek and tender glands under the jaw;
• sometimes a fever and feeling generally unwell.

When someone says they have a “swollen tooth”, it is usually the gum or the cheek next to a back tooth that is swollen.

A swollen gum isn't always an abscess, though: red gums along several teeth usually mean gingivitis, and a swelling behind the last tooth often comes from a wisdom tooth. These need a check-up too.

Why it happens

Most abscesses have an old problem behind them: a cavity left to reach the nerve, a tooth that hurt at some point and then “settled down”, a forgotten temporary filling or an unfinished root canal treatment. When the nerve dies, the pain may disappear, but the infection carries on. Other causes are cracks, old injuries and untreated gum disease, while uncontrolled diabetes and smoking increase the risk. In children, an abscess on a baby tooth is treated just as seriously, because the permanent tooth is forming underneath it.

What to do until your appointment

Call us during opening hours on 0772 022 100 and we'll tell you when we can see you. Until then:

• hold a cold compress against the outside of your cheek, 15 minutes at a time with breaks, with the ice wrapped in a towel;
• rinse your mouth with warm salt water, one teaspoon to a glass, several times a day;
• for the pain, take an ordinary anti-inflammatory (ibuprofen, for example) or paracetamol, following the doses on the leaflet, if you have no contraindications;
• sleep with your head raised and chew on the other side.

What not to do:

• don't apply heat: a warm compress can make the infection spread faster;
• don't burst or squeeze the abscess;
• don't take leftover antibiotics you have at home.

Antibiotics: when you need them

Antibiotics alone won't cure a dental abscess. As long as the source of the infection remains in the tooth or the gum, the abscess comes back once you finish the tablets. The main treatment is draining the infection and dealing with its cause.

Antibiotics are added only in certain situations, for example when you have a fever, when the swelling is spreading or when your immunity is weakened, and only on prescription from the dentist, who chooses the medicine and how long you take it for. Leftover antibiotics may be the wrong ones and can mask a worsening infection.

When it's an emergency

Call 112 or go to the nearest hospital emergency department if:

• you have a fever and the swelling is getting bigger by the hour;
• the swelling is spreading towards your eye or your neck;
• you find it hard to swallow or breathe;
• you feel very unwell.

These signs show that the infection is spreading and needs treatment without delay. Our clinic is open Monday to Friday from 09:00 to 20:00 and is closed at weekends. Outside opening hours, if these signs appear, call the emergency services; if they don't, call us on the next working day.

How a dental abscess is treated

An emergency visit costs 350 lei (450 lei for complex cases). The dentist examines the tooth and works out, usually with the help of an X-ray, where the infection is coming from. The first step is to drain it:

• through the tooth: the tooth is opened, the canals are cleaned and the laser sterilises them, reaching even the tiny side branches;
• through the gum: a soft swelling is opened with the laser through a small incision, without a scalpel (185 lei).

The root canal treatment is usually completed at the second visit; between visits, the canals are filled with calcium hydroxide (100 lei), which carries on disinfecting them. With a gum abscess, we clean out the pocket and then treat the gum disease. A tooth that can no longer be saved is extracted. In specific cases, the dentist may recommend an apicoectomy, when the infection persists after a properly done root canal treatment, or a cystectomy, when the X-ray shows a cyst. All of these are done under local anaesthetic.

What it costs

The cost depends on the number of canals (a molar usually has three or four). You receive the exact price in your written plan, after the examination.

How to prevent an abscess

Almost all abscesses can be prevented: have cavities treated while they are small, don't put off a tooth that “makes itself felt”, and don't leave a root canal treatment unfinished. A check-up and professional cleaning every 6 months catch problems early. After a knock to a tooth, ask for a check-up even if it doesn't hurt, and if you grind your teeth, wear a night guard, which prevents cracks.

Frequently asked questions