Dental Abscess Treatments and Medications

When a tooth decides to be a problem, it can be a real pain. Coming on suddenly and with little warning, a dental abscess can seriously interfere with daily life. Pain medication and some home remedies might calm the pain, but it will take a visit to the dentist to fix the problem. Fortunately, taking care of a tooth abscess is a routine, everyday procedure for dentists and endodontists. Most people will leave their first visit well on the way to recovery.

What is a dental abscess?

A dental abscess is a swelling filled with pus in or around a tooth that is caused by a bacterial infection. There are various types of abscesses.

• Tooth infection: The infection and swelling can begin inside a tooth.

• Periapical abscess: The infection spreads to the tissue below the tooth.

• Periodontal abscess: The infection builds up in a tooth's surrounding tissues.

• Pericoronal abscess: The infection builds up in the gum tissues covering a tooth that hasn't fully emerged.

• Gingival abscess (gum abscess): The infection spreads to the gums themselves.

No matter what the type, an abscess usually hurts. The pain can come on quickly and become unbearable in a day or two. In most cases, tooth pain is what drives a patient to seek treatment.

A tooth abscess can range from a minor infection to a severe and even life-threatening infection that has spread to other parts of the face or body. While most tooth abscess treatments are outpatient, some end up in an emergency room. More than half of dental-related emergency room visits are due to dental abscesses. The most severe infections may require hospitalization.

The most common type of tooth abscess is a periapical abscess. The infection begins when a cavity or crack in the tooth reaches the pulp cavity. Bacteria on the surface of the tooth infect the soft tissue inside the tooth, called the pulp, consisting of blood vessels and nerves. The immune system kicks in, and the infected area swells up. The pressure against the inner tooth causes a toothache.

At this stage, the infection is not an abscess. The infection will gradually make its way through the root canal, eventually killing the tissue and emerging from the bottom, or apex, of the tooth. From there, it infects the bone and tissue at the apex of the root, causing a periapical abscess.

Once the infection has colonized the bone and tissues around the bottom of a tooth, it can spread to the jaw bone, the midface, the sinuses, or the neck and become a much more serious, health-threatening condition. It's crucial to stop these infections early.

How is a dental abscess diagnosed?

Most dental abscesses are due to tooth decay. Many of the risk factors for tooth decay, or dental caries, are also the risk factors for dental abscesses:

• Poor oral health or hygiene

• Lack of dental care follow-up

• An unrepaired cracked tooth

• Immune suppression

• Dry mouth

• Teeth grinding

• Methamphetamine abuse

Other risk factors include gum disease, periodontal disease, or a partially erupted tooth.

The pain—sometimes severe pain—caused by abscessed teeth motivates people to seek help. The dentist will do a physical examination of the affected tooth. The tooth or tissues will be painful and sensitive to touch. The dentist will also look for swelling, redness, fever, and other symptoms such as facial redness, lockjaw, swollen lymph nodes, and difficulty swallowing. If there is trouble breathing or any mental changes, the infection may be a medical emergency.

The initial visit will usually include a periapical X-ray of the tooth to confirm the diagnosis. In particular, an X-ray can help differentiate a tooth abscess from other conditions, such as periodontitis. Depending on the symptoms, the dentist might also X-ray the head and neck to ensure the infection has not spread. No other tests are necessary.

If the infection is more complicated or the patient has a fever and other symptoms, the abscess will require antibiotics. The dentist or healthcare professional will prescribe antibiotics. In a rare occasion that a patient does not respond to the antibiotic, the doctor may perform a blood test to determine the nature of the infection and the body's response to it. They might also order a CT or MRI scan.

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Dental abscess treatment options

Most dental abscesses will be treated immediately after diagnosis. An uncomplicated abscess will usually only require drainage to provide relief from the pain. Complicated abscesses may require more complex procedures and medications to control the underlying infection. If the infection spreads to the sinuses or neck, a surgeon may need to treat the condition.

Incision and drainage

Except for infections within the tooth, most abscesses are treatable by incising the swollen area, draining the pus, and rinsing the area with a saline solution. This procedure will usually provide immediate symptom relief. Over-the-counter pain relievers can manage the pain while the body fights the infection. Antibiotics are often prescribed in tooth infection treatment. After the incision and drainage, the patient will need to still address the underlying cause of the infection.

Root canal

For patients with an infected tooth, a dentist or endodontist will perform a root canal treatment. In this procedure, the practitioner makes an access in the crown of the tooth, removes dead tissue and bacteria from inside of the tooth, cleans and fills the root canals, and restores the tooth with a restoration. A root canal can save the tooth while eliminating the infection. There will be follow-up dental checkups where the dentist uses X-rays to ensure the infection is gone. The procedure successfully clears the tooth infection and abscess 86%–98% of the time.

Medications

For more severe infections, the dentist will prescribe antibiotics to control the underlying bacterial infection in addition to drainage or a root canal. Prescription pain relievers can help manage the pain.

Tooth extraction

If the tooth infection is severe or not treatable with antibiotics or a root canal or the tooth is unrestorable, the dentist may remove the affected tooth to prevent the risk of more serious infection.

Dental abscess medications

Antibiotics for tooth infections

Antibiotics are used sparingly for dental abscesses because of the risk of generating drug-resistant bacteria. They will usually be used for abscesses with complications or if the patient has a fever or trouble breathing. Mostly, however, it will depend on the dentist or endodontist. The antibiotic prescribed will depend on the type of bacteria causing the infection. Amoxicillin is the most popular antibiotic for tooth infections. It's often used with clavulanic acid to increase its effectiveness against bacteria. However, patients are just as likely to be prescribed penicillin, clindamycin, or azithromycin. Relief from pain and swelling will be noticeable in a day or two, but it takes three to seven days to treat the infection completely.

Pain relief medications

Over-the-counter NSAIDs, such as ibuprofen, naproxen, or aspirin, are often enough to provide substantial pain relief. Unlike opioids, NSAIDs reduce the swelling that causes the pain. Prescription NSAIDs can treat more severe pain. Opioids are only very rarely used, usually after operative procedures for dental abscesses.

RELATED: Is Tylenol an NSAID?

What is the best medication for a dental abscess?

Drug treatment for dental abscess focuses on eliminating the infection or relieving pain. Antibiotics for tooth infections are tailored to the type of bacteria causing the infection. Over-the-counter or prescription NSAIDs can adequately manage pain both before and after treatment.

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Best medications for dental abscess