A dental abscess is a pocket of pus at the root of a tooth or in the gum, usually from deep decay or gum disease that lets mouth bacteria reach the pulp and bone. Draining the source is the key treatment, since the infection can spread to the face and deep neck spaces.
Key symptoms
- Severe, throbbing toothache that may spread to the jaw or ear
- Pain on chewing or tapping the tooth
- Swelling of the gum or face
- Bad taste or pus in the mouth
- Fever in more serious cases
What you find on exam
- Tooth tender to tapping, deep cavity or broken tooth
- Gum swelling or a draining sinus near the root
- Facial swelling, tender lymph nodes
- Mouth opening, floor of the mouth and swallowing to look for spread
- Vital signs
Tests
- Dental X-ray: dark area at the root tip
- CT of the face and neck with contrast if swelling spreads, trismus or airway concern
- Blood count and cultures if systemically ill
Treatment basics
- Urgent dental care: drainage, root canal or extraction
- Antibiotics if swelling spreads or fever: amoxicillin or penicillin VK, azithromycin if allergic
- Pain control with ibuprofen plus acetaminophen
- Admission for IV antibiotics and surgical drainage if it spreads to deep spaces
Red flags
- Trismus, trouble swallowing or breathing
- Swelling of the floor of the mouth or neck, raised tongue
- Swelling near the eye, or fever with a toxic appearance
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.