What Is a Dental Abscess and What Should I Do?

A dental abscess is a bacterial infection that produces a pocket of pus in or around a tooth, and it is one of the most common dental emergencies we treat at Townsville Dental Clinic. Left untreated, a dental abscess will not resolve on its own and can lead to serious, potentially life-threatening complications. The Australian Dental Association classifies dental abscesses as urgent conditions requiring same-day assessment. According to data from the Australian Institute of Health and Welfare (2023), dental conditions including abscesses account for over 70,000 potentially preventable hospitalisations in Australia each year — many of which could have been avoided with earlier intervention.

Types of Dental Abscess

Periapical Abscess

A periapical abscess forms at the tip (apex) of the tooth’s root. It typically begins as untreated tooth decay that penetrates through the enamel and dentine into the pulp (nerve chamber). Once bacteria reach the pulp, they cause infection and tissue death (necrosis). The infection then spreads through the root canal system and exits at the root tip, forming an abscess in the surrounding bone.

Common causes:

• Deep, untreated tooth decay
• Trauma to the tooth (even years earlier)
• A cracked or fractured tooth
• Failed or leaking previous dental work

Periodontal Abscess

A periodontal abscess forms in the gum tissue beside a tooth root. It develops when bacteria become trapped in a deep periodontal pocket — the space between the tooth and gum that deepens as gum disease progresses. Periodontal abscesses can also occur when a foreign object (such as a popcorn husk or broken bristle) becomes lodged beneath the gum line.

Common causes:

• Advanced gum disease (periodontitis)
• Foreign body trapped under the gum
• Incomplete scaling leaving bacteria in a deep pocket

Symptoms to Watch For

Dental abscess symptoms can develop rapidly or build over days:

• Severe, throbbing toothache — often described as the worst toothache the patient has experienced
• Pain radiating to the jaw, ear, temple, or neck on the affected side
• Sensitivity to hot and cold — heat sensitivity is particularly associated with abscess
• Pain on biting or pressing on the tooth
• Facial swelling — cheek, under the jaw, or around the eye
• Gum swelling — a red, tender lump on the gum near the tooth
• Fistula — a small pimple-like bump on the gum that may drain pus
• Foul taste in the mouth
• Fever and general malaise
• Swollen lymph nodes under the jaw or in the neck

When to Go to Hospital

Go to the emergency department immediately if you experience:

• Swelling spreading to the floor of the mouth, throat, or around the eye
• Difficulty breathing or swallowing
• High fever (above 38.5°C) with rapidly worsening swelling
• Inability to open the mouth (trismus)
• Feeling generally unwell — confusion, rapid heart rate, dizziness

These signs may indicate a spreading infection such as Ludwig’s angina (a life-threatening infection of the floor of the mouth) or orbital cellulitis, both of which require hospital-based treatment.

How We Treat Dental Abscesses

Emergency Appointment

At Townsville Dental Clinic, we prioritise dental abscesses as same-day emergencies. The first appointment focuses on pain relief and infection control:

1. Clinical examination and X-ray to identify the source tooth and extent of infection
2. Drainage — either through an incision in the gum or by opening the tooth to access the infected root canal
3. Antibiotics — prescribed when infection has spread beyond the tooth (facial swelling, fever, lymph node involvement). Amoxicillin is the first-line antibiotic; metronidazole is added for severe infections or used as an alternative for penicillin-allergic patients
4. Pain management — ibuprofen and paracetamol taken in alternating doses provide effective pain relief

Definitive Treatment

Once the acute infection is controlled, the underlying cause must be addressed:

• Root canal treatment — removes the infected pulp tissue, cleans and disinfects the root canal system, and seals the tooth. This saves the tooth and is the preferred option when sufficient tooth structure remains
• Extraction — necessary when the tooth is too badly damaged, has a vertical root fracture, or the patient elects not to proceed with root canal treatment
• Periodontal treatment — for periodontal abscesses, deep cleaning of the affected pocket and ongoing gum disease management

What Happens If You Do Not Treat an Abscess?

Untreated dental abscesses can lead to:

• Osteomyelitis — infection spreading to the jawbone
• Cellulitis — soft tissue infection spreading through facial planes
• Ludwig’s angina — floor of mouth infection that can obstruct the airway
• Sepsis — a life-threatening systemic response to infection
• Brain abscess — extremely rare but documented in cases of prolonged untreated dental infection

These complications are preventable with timely treatment.

Related Services

• Emergency Dentistry
• Root Canal Treatment

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