Dental abscess

Also called Tooth abscess, Dental infection

Infection at the root of a tooth. Antibiotics are not the treatment; drainage and dental work are, and spreading facial swelling is an emergency.

What it is

A collection of pus caused by bacterial infection, either at the tip of a tooth root from untreated decay, or in the gum.

It is extremely painful, and the pain is characteristic: severe, throbbing, often worse lying down and at night, and sometimes disturbing sleep for days.

**Antibiotics alone do not cure a dental abscess.** They may settle the swelling temporarily, and the infection returns until the source is dealt with, by draining the abscess, root canal treatment, or extraction. Repeated antibiotic courses without dental treatment is a common pattern and it drives resistance without solving anything.

The reason it belongs in a health library rather than only a dental one is that dental infection spreads. Infection tracking into the floor of the mouth, called Ludwig's angina, obstructs the airway. Infection can spread into the eye socket, the sinuses, the neck, and rarely to the brain as a brain abscess or to the bloodstream as sepsis. People die of dental infections in the UK every year.

Access to NHS dentistry is a genuine barrier, and people therefore present late, to GPs and emergency departments that cannot treat the cause. Knowing the emergency dental route in your area, usually through NHS 111, is practical and important.

Signs you might notice

Severe, throbbing toothache, often worse at night and on lying down.

Pain on biting, and sensitivity to hot and cold.

Swelling of the gum, face or jaw.

A bad taste, or discharge of pus.

A loose tooth.

Fever and feeling unwell.

**999 or A and E immediately:** swelling closing the eye; swelling under the tongue or in the floor of the mouth; difficulty swallowing, speaking or breathing; a raised tongue; drooling; fever with a rapidly spreading facial swelling; or confusion. These indicate spreading infection.

Same-day dental assessment for any facial swelling with toothache.

Difficulty opening the mouth is a warning sign of deep spread.

How it can affect day-to-day life

Access is the central problem. Many people cannot register with an NHS dentist, and the pathway when in pain is unclear. NHS 111 can arrange emergency dental care, and knowing that in advance is genuinely useful information.

Painkillers used properly, paracetamol and ibuprofen together at full dose where suitable, are more effective than either alone and get people through until treatment.

Repeated courses of antibiotics from a GP for recurring dental pain is a pattern that should prompt a push for definitive dental treatment.

For people in care settings, dental pain often presents as refusing food, agitation, holding the face, or a sudden change in behaviour, and mouth care and dental review are frequently neglected. Untreated dental pain is a recognised cause of distress in people with dementia and learning disability.

Dental treatment before cancer treatment, before heart valve surgery and before starting bisphosphonates matters, because doing it afterwards carries higher risks.

Supporting someone well

Get dental treatment, not just antibiotics. The abscess needs draining or the tooth treating.

Know the emergency dental route: NHS 111 can arrange urgent care.

Use paracetamol and ibuprofen together at full doses where suitable, rather than one alone.

Do not put aspirin against the gum; it burns the tissue.

Rinse with warm salt water.

**Treat facial swelling, difficulty swallowing or breathing, or a swelling under the tongue as an emergency.**

For anybody who cannot report pain, consider the mouth when behaviour changes, and arrange dental review.

Get dental work done before cancer treatment, heart valve surgery or bisphosphonates.

Register with a dentist and attend regularly; this is prevention that works.

Where to get help

A dentist, urgently. NHS 111 can arrange emergency dental care where there is no dentist.

999 or A and E for spreading facial swelling, difficulty swallowing or breathing, or fever with confusion.

A GP practice can provide antibiotics as a holding measure but cannot treat the cause.

Oral Health Foundation run a dental helpline and publish guidance on accessing care.