Dental Abscess and Toothache: Why Pain Stopping Is Not Good News

In short

A dental abscess does not go away on its own, and the toothache easing can mean the pressure has found a way out rather than that the infection has gone. Antibiotics buy time; the tooth still has to be treated.

Emergency if: Difficulty breathing, speaking or swallowing, extensive swelling in the mouth, swelling of the neck or around the eye, inability to open the mouth, or a painful eye or changed vision — go to an emergency department now.

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What an abscess is

A dental abscess is a build-up of pus in a tooth or the surrounding gum, caused by bacterial infection. It usually follows tooth decay that has reached the soft centre of the tooth, a cracked or injured tooth, or gum disease, and it needs urgent treatment by a dentist.

The single most important thing to know is that a dental abscess will not go away on its own. It is a walled-off pocket of infection, and pockets of pus do not resolve because the body cannot clear them from the inside.

What it feels like

The classic picture is intense, continuous toothache or gum pain — often described as gnawing, throbbing or shooting — that does not let up. Alongside it there may be sensitivity to hot and cold, pain on chewing, a bad taste in the mouth, redness inside the mouth or over the face and jaw, difficulty opening the mouth, swollen glands in the neck and a raised temperature.

Sometimes a small pimple-like swelling appears on the gum over the tooth. That is the abscess finding a route to drain, and it is often the moment the pain suddenly improves.

Why the pain easing can mislead

When pressure inside the tooth is relieved, the toothache can stop. The infection, however, remains active and continues to spread, destroying tissue as it goes. This is the trap: the symptom that was driving you to seek help disappears, and the problem underneath quietly gets worse.

The same logic applies to a course of antibiotics that settles things down. Antibiotics can control the spread and make you feel better, but they do not remove the source. Treatment means dealing with the tooth itself.

What treatment actually involves

A dentist drains the pus, under local anaesthetic so it should not hurt. Depending on the tooth, that is followed by root canal treatment to clear and seal the inside of the tooth, or by removing the tooth. Painkillers for a few days afterwards are usual, and antibiotics may also be given — as an addition to the procedure, not instead of it.

Treated promptly, the infection is usually cleared and the tooth can often be saved. A general doctor cannot provide dental treatment, so an abscess needs an urgent dental appointment or an emergency dental service rather than a general practice.

Managing pain while you wait

Take paracetamol or ibuprofen, staying within the recommended dose — taking more will not work better and can be genuinely dangerous. Anyone under sixteen should not take aspirin. Eat soft foods such as soup, yoghurt, scrambled egg or mashed potato, chew on the other side, and avoid anything very hot, very cold or sweet.

Rinsing with warm salt water can ease things, made by dissolving about half a teaspoon of salt in a glass of warm water and spitting it out; children should not do this in case they swallow it. Never put aspirin directly onto the tooth or gum — it burns the soft tissue and causes ulcers. Keep brushing with a soft brush.

When it becomes an emergency

Infection from a tooth can spread into the tissues of the face, jaw and neck, and occasionally further into the bloodstream. Go to an emergency department immediately if you are finding it hard to breathe, speak or swallow, if there is a lot of swelling in the mouth, if you cannot open your mouth properly, if your neck or the area around your eye is swelling, or if an eye becomes painful or your vision changes.

Short of that, see a dentist for toothache lasting more than two days, toothache that painkillers are not controlling, or pain with a raised temperature, pain on biting, red gums or a bad taste. Swelling of the cheek or jaw always warrants same-day dental attention, because it means the infection is no longer confined to the tooth.

When to act

Routine — see a doctor

Mild toothache with no swelling or fever: pain relief, soft food and a dental appointment, since decay found early is far simpler to treat.

Same-day — call promptly

Suspected abscess, toothache lasting more than two days or not controlled by painkillers, pain with fever, or swelling of the cheek or jaw — arrange urgent dental care.

Emergency — act now

Difficulty breathing, speaking or swallowing, extensive swelling in the mouth, swelling of the neck or around the eye, inability to open the mouth, or a painful eye or changed vision — go to an emergency department now.

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