Tooth Infection (Abscess): Symptoms, Causes, Treatment, and More

Everyone has germs in their mouths. Bacteria cover the teeth, tongue, and every other surface of the mouth. But a healthy mouth has natural protection against infection. With good dental care, you’ll keep bad bacteria away and keep the risk of tooth infections at bay. When cracks appear in that armor — through cavities, gum disease, or dental trauma — bacteria can find their way in and start to cause trouble. 

Tooth infections are painful and can result in teeth needing to be pulled. Worse, they can cause very real health complications that extend far beyond the mouth. Dental infections can affect the tooth itself and the nearby gums. These pockets of infection are called abscesses. 

Let’s take a closer look at what to do if you think you have an infected tooth, and which treatments can get you fast relief. 

Tooth infection symptoms

Pain is one of the most common signs of a tooth infection. Other signs of a tooth infection include:

• Tooth sensitivity to hot- or cold-temperature foods

• Tooth sensitivity to pressure

• Redness or tenderness of the gums 

• Swelling of the mouth, jaw, or face

• Bad taste in the mouth

• Bad breath, even after brushing and rinsing

• Difficulty chewing

• Fever

Symptoms of a tooth infection can start small. But without treatment it can spread and become a bigger problem. Because teeth are connected to so many nerves, pain from an infected tooth can also extend into the jaw, face, and neck. 

The difference between an abscess and a tooth infection

Left untreated, a tooth infection can continue to grow and spread beyond the center of the tooth. This can lead to the formation of a pocket of pus, called an abscess, that becomes trapped in the tooth, jawbone, or gum tissue. 

Tooth infection stages

A tooth infection progresses through several stages to become an abscess:

1. Enamel decay: The sticky film (plaque) that forms on your teeth between brushing contains bacteria. Over time, these bacteria release acid, which can damage the enamel (outer layer) of the tooth.

2. Dentin decay: Bacteria break through the outer surface of the tooth and infect the layer underneath. This is a softer layer of the enamel, known as the dentin.

3. Pulp decay: The bacteria progress to the center of the tooth (called the pulp), which is even more vulnerable, and attack the nerve.

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Tooth abscess

A tooth abscess develops when a tooth infection invades the deep tissue in the root of the tooth or the surrounding gums. Pus from the infection can collect around the tooth’s root or in a pocket of gum tissue around the tooth. As the infection spreads, pressure from the trapped pus builds up on the inner walls of the tooth. This can cause intense pain. 

What does a tooth abscess look like?

A tooth or gum abscess is a pocket of pus that forms due to an infection. It can sometimes look like a pimple or fluid-filled bump on the gum, near the location of the infection. There may be other signs like:

• Redness

• Swelling

• Pain

• Drainage 

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Tooth infection causes

Tooth infections and abscesses are usually caused by bacteria getting into the tooth and surrounding tissues. This can happen if there’s damage to the natural protective defenses in the mouth. Tooth infections in particular, tend to surface as a result of:

• Cavities

• Gum damage (periodontal disease)

• Cracked tooth

Cavities and gum damage are both caused by a lack of good oral hygiene and the buildup of dental plaque on and around the teeth. 

Another less common cause of dental infections is when the wisdom teeth start to come in. When wisdom teeth grow, they’re typically only partially in the mouth. This leaves a flap of gum tissue that can trap food and bacteria and lead to a wisdom tooth infection. This is called pericoronitis and can be treated by your dental care provider.

When to pull a tooth due to infection?

Knowing the cause of the infection can help answer this question. There are two main situations that would require the tooth to be pulled due to infection:

• If the tooth is broken down and there’s very little of your natural tooth remaining

• If there’s gum damage and bone loss and the tooth has become very loose

Your dentist will evaluate your tooth infection and determine what treatment options are best to get your oral health back on track.

Risk factors for tooth infection

There are some factors that may increase your risk of developing a tooth infection. They include:

• Poor oral hygiene

• A diet high in sugar

• Untreated periodontal or gum disease

• Cracked teeth

• Large cavities that go untreated

• Previous trauma to your teeth

• Diabetes

• Weakened immune system

• Smoking

• Heavy alcohol use

• Being 65 years and older

• Infrequent dental checkups

Tooth infection treatment

Treatment for a tooth infection or abscess will depend on your symptoms and how far the infection has progressed. Some treatment options include: 

• Antibiotics: Antibiotic medications are commonly used to treat tooth infections and can provide temporary pain relief. Treatment may take a few weeks, or even months, depending on the severity of the infection.

• Incision and drainage: In some cases, you may need surgery to drain an abscess and remove dead tissue.

• Cavity filling: A hole in the tooth enamel caused by decay can be repaired by filling it. To do this, your dentist will drill out the damaged area and add a new filling.

• Removal of the tooth pulp: Inflammation of the tooth pulp can be treated by removing the pulp from the upper part of the tooth.

• Root canal: If there’s severe decay, the complete root and pulp will need to be removed.

• Extraction: In some cases, if there’s too much damage to the tooth for it to be saved, your dentist will remove the tooth. 

Best antibiotics for tooth infections

Amoxicillin is the one of the most commonly prescribed antibiotics for tooth infections. However, dentists usually have a few different antibiotic choices that they might use for tooth infections and abscesses. You’ll likely take antibiotics for 7 to 10 days to decrease the amount of infection around the tooth.

Penicillin antibiotics

Penicillin antibiotics include:

• Penicillin 

• Amoxicillin

• Amoxicillin / potassium clavulanate (Augmentin)

Amoxicillin is usually the first choice for a tooth infection treatment. If your tooth infection is more serious, your dentist may prescribe a combination of amoxicillin and potassium clavulanate (Augmentin). This combination is stronger and more effective against tooth infections.

Clindamycin

In some cases, the bacteria causing your tooth infection can be resistant to amoxicillin. If so, your dentist may prescribe clindamycin for your tooth infection. Or, if you have a penicillin allergy, you might be prescribed this medication instead.

Metronidazole

Metronidazole, when combined with amoxicillin, is very useful for treating a tooth infection. The downside is how it interacts with some common things, including:

• Alcohol

• Blood thinners

• Anti-seizure medications

• Medications used to treat alcoholism

Let your prescriber know about all the medications you’re taking. And you’ll want to avoid all alcohol or alcohol-containing products (like mouthwash, for example) while taking metronidazole. Consuming alcohol with metronidazole can make you seriously ill.

Cephalexin

Cephalexin belongs to a class of antibiotics called cephalosporins. It isn’t typically the first-choice antibiotic for tooth infections. But, it can be effective in fighting tooth infections. It has a similar structure to penicillin, though. So, you may not be able to take cephalexin if you have a penicillin allergy.

Doxycycline

Doxycycline is effective in treating tooth infections caused by gum or periodontal disease. However, it may cause some stomach upset. Certain types of doxycycline are best taken with food to help prevent nausea. 

Azithromycin

Azithromycin (Zithromax) is a great alternative antibiotic to use for tooth infections if there’s a penicillin allergy. Most other antibiotics are taken several times throughout the day. However, azithromycin is typically taken once a day. It’s most effective against mild to moderate tooth infections. 

Are there any over-the-counter antibiotics for tooth infections?

Antibiotics for tooth infections require a prescription from a healthcare professional. Over-the-counter (OTC) medications may help with managing tooth infection pain, though. 

Commonly used OTC pain-relief medications include: 

• Ibuprofen (Advil, Motrin)

• Naproxen

• Acetaminophen (Tylenol)

Home remedies for tooth infection

There are no known natural antibiotics for tooth infection. However, there are some natural home remedies that may provide relief until you can see your dental care provider. Steps you might try to lower pain and swelling on your own at home include:

• Rinsing your mouth with warm salt water

• Applying baking soda paste to the tooth

• Rinsing with diluted hydrogen peroxide

• Using cold compresses 

• Using herbal treatments, such as clove oil, vanilla extract, peppermint, or garlic paste on the tooth

Remember, if you experience tooth infection symptoms, it’s important to see a dentist as soon as possible. While these home remedies can reduce discomfort and pain, a tooth infection is unlikely to go away without treatment.

How can I tell if my tooth infection has spread?

It’s possible for a tooth infection to spread to other areas of the body. Some examples include:

• Face

• Jaw

• Neck

• Bloodstream

• Brain (rarely)

Symptoms of a tooth infection spreading to other parts of the body include:

• Fever

• Chills

• Skin redness 

• Swelling in your neck or face

• Pain when opening your mouth

• Pain when touching your jaw or face

• Sore throat

• Change in your voice

• Stiff neck

• Changes in mood or vision

• Confusion and extreme drowsiness

• Severe pain

• Overall feeling of being unwell

If you experience any of the above symptoms, get medical help or visit the emergency room right away. Any untreated infection in the body can cause a life-threatening reaction called sepsis. 

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Written by:

Megan N. Freeland, PharmD, RPh

Megan began her career as a public health pharmacist and transitioned into healthcare copywriting and content marketing as the CEO of StockRose Creative, LLC. As a public health pharmacist, Megan supported the Centers for Disease Control and Prevention (CDC) in medication safety, health communications, and regulatory affairs. After receiving her Bachelor of Arts in Spanish from Emory University and her doctorate degree in pharmacy from Mercer University, she completed fellowship training in drug information and health communications.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Shari L. Grigsby-Young, DDS

Dr. Grigsby-Young is a general dentist who was born and raised in Dayton, Ohio. She completed her undergraduate studies at Xavier University of Louisiana.

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