- First we identify the source: a gum pocket or a root tip
- The core treatment is draining and cleaning the pocket
- Antibiotics are needed only in certain situations
A gum abscess is a localised collection of pus in the tissues around a tooth. It usually shows up as a red, tense, painful swelling next to a tooth that grows quickly. Touching the tooth and biting hurt, and the tooth may feel slightly raised and loose.
Even if the abscess bursts by itself and the pain eases, the underlying cause does not go away and the abscess comes back. Proper treatment starts with finding out where it comes from. This page covers the emergency; long-term treatment of the underlying disease is on the gum disease treatment page.
Gum abscess or tooth abscess?
The two common abscesses in the mouth look alike from the outside, but their sources and treatments are different.
| Periodontal (gum) abscess | Periapical (root-tip) abscess | |
|---|---|---|
| Source | A deep gum pocket | The root tip of a tooth whose nerve has died |
| Typical history | Known gum disease, or a foreign object lodged in the pocket | Deep decay, a large filling, or a tooth that has taken a knock |
| Is the tooth alive? | Usually yes | No, it has lost its vitality |
| Where the swelling is | Usually closer to the gum margin | Usually level with the root tip |
| Treatment | Draining and cleaning the pocket | Root canal treatment or extraction |
To tell them apart, a pocket measurement, a vitality test on the tooth and an X-ray are assessed together. Sometimes both problems occur in the same tooth, and then both root canal and gum treatment are needed. An abscess coming from the root tip is treated with root canal treatment; cleaning the gum pocket will not clear it.
Why does a gum abscess form?
- Advanced periodontitis. The most common cause. The entrance to a deep pocket narrows or closes, and the pus inside cannot drain out.
- A foreign object trapped in the pocket. A popcorn husk, a bit of seed shell, a fragment of toothpick or a toothbrush bristle can cause an abscess even when the gum is healthy.
- Incomplete cleaning. If tartar is left deep down while the gum margin tightens and closes over it, an abscess can develop. That is why, on teeth with deep pockets, it matters that cleaning is thorough and checked afterwards.
- Poorly controlled diabetes and conditions that weaken the immune system. These increase the risk of an abscess and make it more likely to come back.
Which symptoms mean you should get help straight away?
An abscess that stays within the mouth is urgent, but it can usually be dealt with by a dentist the same day or the next. If you have any of the following, the infection may be spreading and you need treatment the same day, from the nearest dentist if you are not in İzmir:
- Swelling spreading to the cheek, under the eye, under the jaw or into the neck
- Fever, shivering, or feeling generally unwell
- Being unable to open your mouth
- Swelling that grows rapidly over a few hours
- Difficulty swallowing or breathing
If you have difficulty swallowing or breathing, do not wait for a dentist: go straight to a hospital emergency department. Do not try to burst the abscess at home with a needle or anything sharp, do not put aspirin on the gum (it burns the tissue) and do not apply a hot compress to your face. A cold compress on the outside of the face and a painkiller will help you manage until you are seen.
How is it treated?
- Numbing. Local anaesthetic is given to the area. Anaesthetic can take a little longer to work in inflamed tissue, so we do not rush.
- Drainage. The pus is usually drained through the pocket itself or, if necessary, through a small cut in the gum. Once the pressure is released, the pain usually eases quickly.
- Cleaning the pocket. Tartar, any foreign object and inflamed tissue are cleaned out of the pocket, and the area is rinsed. This is the real treatment: to stop the abscess coming back, its source has to be removed.
- Review. The area is checked again a few days later.
In a very inflamed area, part of the deep cleaning may be left for the next visit, once the swelling has gone down. In the first few days, gentle rinsing with warm salt water and keeping the area clean with a soft brush help it heal.
When are antibiotics needed, and when not?
Most patients assume an abscess will clear up with antibiotics. In fact, antibiotics cannot penetrate an abscess well enough until it has been drained, and they do not remove the tartar in the pocket. Used on their own, they make the swelling go down for a while, and then the abscess comes back in the same place.
Antibiotics are added to treatment when there are general symptoms such as fever and feeling unwell, when the swelling is spreading into the surrounding tissues, when the abscess cannot be drained adequately or when the patient's immunity is weakened. An abscess that is confined to the mouth and has been drained and cleaned often does not need antibiotics. Unnecessary use carries a risk of side effects and of resistance, so do not start treating yourself with antibiotics left over at home.
What happens to the tooth once the abscess has gone?
An abscess shows that there is a deep pocket and bone loss around the tooth. Once the emergency has passed, we reassess the tooth with pocket measurements and an X-ray. If there is enough bone support, the tooth can be saved with deep cleaning and, if needed, surgical treatment. For a tooth that has lost most of its support and keeps producing abscesses, extraction may be the right decision, and we discuss that openly too. When patients come to our clinic in İzmir with an abscess, our priority on the first day is to bring the pain and infection under control; we then make the long-term plan together. The cost depends on the scope of the treatment needed; you receive a written, itemised quote after the examination.
Common questions
Will a gum abscess go away on its own?
An abscess can burst and drain by itself, and the pain may ease; but because the deep pocket or foreign object underneath stays where it is, it usually comes back in the same place. Each time it does, the bone loss around the tooth can increase. Even if it has burst and you feel better, you need an examination.
Can I treat an abscess with antibiotics alone?
Antibiotics on their own are not a lasting treatment. They reduce the swelling temporarily but do not clean out the source in the pocket. In situations such as fever, spreading swelling or weakened immunity, they are used together with drainage and cleaning. Do not start antibiotics you have left over at home without asking a dentist or doctor first.
Can a tooth be taken out while there is an abscess?
Sometimes, yes. Removing a tooth that cannot be saved can be part of the treatment, because it lets the pus drain. If there is widespread swelling and fever, the infection may need to be brought under control first. The decision depends on the state of the tooth and how far the infection has spread.
My face has swollen up. What should I do?
If the swelling is spreading to your cheek or under your eye, you need to be seen by a dentist the same day, the nearest one if you are not in İzmir. If you have a fever, difficulty swallowing or breathing, or cannot open your mouth, go straight to a hospital emergency department without waiting. These signs can mean the infection has spread beyond the mouth.
Does a gum abscess come back?
If its source is not cleaned out, yes. An abscess is often a sign of underlying periodontitis; once that tooth and the rest of the mouth have had gum treatment and regular check-ups are in place, the risk of it coming back drops markedly.
Should I use heat or cold on an abscess?
A cold compress on the outside of the face can ease pain and swelling. Applying heat to the face is not recommended, because it can encourage the infection to spread outwards. Inside the mouth, gentle rinsing with warm salt water is soothing.
Not sure if this is right for you?
Send us a photo. We will tell you honestly what you need — and what you do not.