Most dental problems can wait a few days. A spreading infection cannot. The distinction matters because the early stages of an abscess can feel like an ordinary toothache, and the point at which it becomes serious can arrive quickly.
What an abscess is
An abscess is a collection of pus caused by bacterial infection. In dentistry it usually arises in one of two ways. A periapical abscess forms at the tip of the root when bacteria reach the pulp through deep decay, a crack or trauma, the pulp dies, and infection spreads into the surrounding bone. A periodontal abscess forms in a gum pocket alongside the tooth, typically where gum disease has created a deep pocket that becomes blocked.
Either way, the infection sits in a confined space and builds pressure, which is what produces the characteristic severe, throbbing pain.
Signs to act on
- Severe, persistent, throbbing pain, often worse lying down.
- Pain on biting, or a tooth that feels raised or longer than its neighbours.
- A tender, swollen area of gum, sometimes with a small pimple-like spot that discharges.
- A sudden foul taste, which often accompanies relief from pain as the abscess drains. The relief is not resolution.
- Swelling of the face, jaw or under the eye.
- Fever, feeling generally unwell, or swollen glands in the neck.
- Sensitivity to hot that lingers, sometimes with relief from cold, which is a recognised pattern in an infected pulp.
Go to hospital, not the dentist, if
Some presentations are beyond what a dental practice can safely manage and need an emergency department. In Canberra that is the emergency department at Canberra Hospital in Garran.
- Difficulty breathing or swallowing, or a changed voice.
- Swelling that is spreading down the neck or up toward the eye.
- Inability to open the mouth more than a couple of centimetres.
- High fever with confusion, rapid heartbeat or feeling seriously unwell.
- Swelling under the tongue or in the floor of the mouth.
These indicate infection spreading through the tissue planes of the face and neck, which is uncommon but genuinely dangerous. Nobody will think you overreacted.
Why antibiotics alone are not the answer
This is the most common misunderstanding. Antibiotics reduce the bacterial load in the surrounding tissue, which can settle swelling and buy time. They do not reach into a dead pulp chamber or a sealed abscess cavity in useful concentrations, because there is no blood supply to carry them there.
The infection returns, often within weeks, and each course of antibiotics without definitive treatment contributes to resistance while delaying the work that actually resolves it. Antibiotics are an adjunct, prescribed where there is spreading infection, systemic involvement or a medical reason. The treatment is drainage and removal of the source.
What treatment involves
The dentist will examine the tooth, test whether the pulp is vital and take an x-ray to locate the infection and assess the bone. From there:
- Drainage, either through the tooth or through the gum, which relieves the pressure and usually the pain, often immediately.
- Root canal treatment, where the tooth is restorable. The infected pulp is removed, the canals cleaned and sealed, and the tooth restored afterwards. See what root canal treatment involves.
- Extraction, where the tooth cannot be restored. This removes the source directly. Replacement options are discussed once the infection has settled.
- Deep cleaning of the pocket, for a periodontal abscess, sometimes with further gum treatment afterwards.
Managing symptoms before you are seen
Take your usual over-the-counter pain relief as directed on the packet. Rinse with warm salt water. Keep your head elevated when sleeping, which reduces the throbbing. Use a cold compress on the outside of the face for swelling. Do not apply heat to the outside of the face, do not hold aspirin against the gum, and do not attempt to lance the swelling yourself.
What it costs
An emergency examination at Civic Gentle Dental Care starts from $70 to $110, with x-rays at $52 each as needed. Treatment depends on what is required: root canal treatment ranges from $1,200 to $2,000 excluding the final restoration, and extraction ranges from $275 to $600. Costs are quoted before treatment proceeds. Current fees are on our price list, with more on emergency dental care in Canberra and on tooth extraction.
Common questions
The pain stopped on its own. Am I in the clear?
No. Pain often stops when the pulp tissue dies or when an abscess drains. The infection is still present and will progress. This is one of the more dangerous points to relax.
Can an abscess heal without treatment?
No. The source of infection has to be removed. An abscess that appears to settle has usually established a drainage path rather than resolved.
Will I definitely lose the tooth?
Not necessarily. Many teeth with abscesses are saved with root canal treatment. Whether yours can be depends on how much sound structure remains and the state of the supporting bone.
Should I finish a course of antibiotics if the pain has gone?
Follow the instructions you were given, and keep the appointment for definitive treatment regardless of how you feel.
Booking an appointment in Canberra City
Civic Gentle Dental Care is a dentist in Canberra City at Suite 8, Level 3/161 London Circuit, a short walk from the Canberra Centre. To arrange an appointment, call (02) 6247 0224 or send us a message through our contact page.
This article is general information only and is not a substitute for individual dental advice. Whether a treatment is suitable for you, and what it will involve, can only be determined after an examination by a dentist. Any prices mentioned are estimates drawn from our current price guide and are not a quote.