Tooth Abscess (Abscessed Tooth)
A tooth abscess usually announces itself with a deep, throbbing ache that keeps you up at night, a tooth that hurts when you bite, and sometimes a swollen gum or cheek. Some people notice a pimple-like bump on the gum that leaks a salty, bad-tasting fluid. It's an infection, it won't heal by itself, and it's very treatable when it's caught before it spreads.
A tooth abscess is a pocket of pus from a bacterial infection, usually at the tip of a tooth's root after decay or a crack lets bacteria reach the nerve. It isn't contagious and won't heal on its own. Antibiotics can calm it. The fix is a root canal or extraction. See a dentist within a day or two. Facial swelling, fever, or trouble swallowing or breathing means the ER.
Not sure this is what you have? Answer five quick questions in our mouth spot checker. It compares what you see with more than 40 common conditions and tells you how soon to have it looked at.
- What an abscess tooth looks like
- How a tooth abscess forms
- Gum boil (parulis)
- Gum abscess vs. tooth abscess
- Tooth infection or something else?
- Causes and risk factors
- Tooth infection symptoms
- Can a tooth infection kill you?
- How long it lasts
- What helps until your appointment
- Over-the-counter pain relief
- Antibiotics for tooth infection
- Tooth abscess treatment
- Prevention
- Kids, pregnancy, and health conditions
- When to get care
- FAQ
What does an abscess tooth look like?
Often it doesn't look like much from the outside, at least early on. The tooth itself may look normal, or it may have a dark spot, a big old filling, or a crack. What gives it away is usually the gum and the way it feels:
- A swollen gum around the tooth, red and tender, sometimes shiny and tight.
- A small yellow or white bump on the gum near the root, like a pimple. That's a gum boil, and it's where the pus is draining out.
- A tooth that's darker or grayer than its neighbors, which can mean the nerve inside has died.
- In more advanced cases, swelling of the cheek, jaw, or under the chin, sometimes enough to change the shape of your face.
Here's what normal looks like for comparison: healthy gums are pink, flat against the teeth, and don't hurt when you press on them. A single tender, puffy spot next to one tooth is worth a call.
How a tooth abscess forms
A tooth is hard on the outside, but the center holds soft tissue called the pulp, which carries the nerve and blood supply. When decay, a deep crack, or a broken filling opens a path to the pulp, bacteria move in. The pulp gets inflamed, then dies. The infection then travels down the root canal and out the tip of the root into the jawbone, where the body walls it off as a pocket of pus. That's a periapical abscess, the most common kind of tooth abscess.
A second kind starts in the gums instead. In gum disease, the gum pulls away from the tooth and forms a deep pocket. If the opening of that pocket gets blocked by tartar or food, bacteria trapped inside form a periodontal abscess, or gum abscess. With this one, the nerve of the tooth is often still healthy.
Gum boil (parulis): the abscess's drain
A gum boil, or parulis, is a soft bump on the gum that may come and go, leak a salty or foul-tasting fluid when you press it, and then fill back up. It isn't a separate problem. It's the end of a narrow channel (a sinus tract) that the infection has tunneled through the bone so the pus has somewhere to go.
Two things about gum boils trip people up. First, once the abscess starts draining, the pressure drops and the pain often fades a lot. That makes it easy to put off care. Second, the bump can shrink and look healed for weeks. The infection at the root is still there, and it's still slowly damaging bone. A gum boil that keeps coming back is one of the clearest signs a tooth needs treatment.
Gum boils in children usually come from an infected baby tooth. In adults, they can also show up over a tooth that had a root canal years ago. Either way, an X-ray tells us which tooth is the source.
Gum abscess vs. tooth abscess
You can't always tell these apart at home, and sometimes both happen on the same tooth. The difference matters because the treatment is different.
| Tooth abscess (periapical) | Gum abscess (periodontal) | |
|---|---|---|
| Where it starts | Inside the tooth, at the tip of the root | In a deep gum pocket along the side of the root |
| Usual cause | Deep decay, a crack, or a failing filling or crown | Gum disease with trapped tartar, food, or a popcorn hull |
| Nerve of the tooth | Dead or dying | Often still alive |
| Where the swelling is | Lower on the gum, near the root tip, or a gum boil | Closer to the gumline, right next to the tooth |
| Feels like | Deep throbbing ache, often after weeks of sensitivity | Tender, puffy gum, tooth may feel loose or "high" |
| Typical treatment | Root canal treatment or extraction | Draining and deep cleaning of the pocket, sometimes gum treatment or extraction |
If your gums bleed easily and you've been told you have gum disease, read about gingivitis and early gum disease. Treating it is the main way to prevent gum abscesses.
Tooth infection or something else?
Several problems feel or look a lot like an abscessed tooth. These are the ones we sort out most often.
| Condition | What's similar | Clues it's something else |
|---|---|---|
| Sinus infection | Ache in the upper back teeth | Several upper teeth hurt at once, worse when you bend over, with congestion. No swelling of the gum. |
| Cracked tooth | Pain when biting | A sharp zing when you bite or let go, often with cold sensitivity. A crack can lead to an abscess later. |
| Pericoronitis | Swollen, sore gum and bad taste | It's around a partly erupted wisdom tooth, under a flap of gum at the very back. |
| Pyogenic granuloma | A red bump on the gum | Bright red, bleeds easily, grows over weeks, usually not painful, no pus. |
| Canker sore on the gum | Sore spot on the gum | An open, shallow ulcer rather than a swollen bump. Canker sores rarely form on the gum attached to the teeth. |
| Dry socket | Severe throbbing pain | It starts 2 to 4 days after a tooth is pulled, in the empty socket. |
More on each: how sinus infections cause tooth pain, pericoronitis around wisdom teeth, pyogenic granuloma, canker sores, and dry socket after an extraction.
What causes an abscess tooth?
Every tooth abscess starts with bacteria getting somewhere they shouldn't be. The usual ways in:
- Untreated decay that eats through the enamel and dentin into the pulp. This is the most common cause.
- A cracked or broken tooth, including cracks you can't see, often from clenching, grinding, or biting something hard.
- A leaking or broken filling or crown that lets bacteria seep in underneath.
- A blow to the tooth, sometimes years earlier, that slowly killed the nerve.
- Gum disease, which creates deep pockets where a gum abscess can form.
Things that raise the odds: dry mouth, a sugary diet or frequent sipping of sweet drinks, smoking, skipped checkups, and conditions that weaken the body's defenses, such as poorly controlled diabetes. If you grind your teeth at night, a night guard can protect them from cracks.
Tooth infection symptoms
Tooth abscess symptoms range from barely noticeable to impossible to ignore:
- A throbbing toothache that may spread to the jaw, ear, or neck on the same side
- Pain when you bite or chew, or when you tap the tooth
- Sensitivity to hot and cold that lingers
- A swollen gum around the tooth, or a gum boil
- A bad taste or bad breath, or a sudden rush of salty fluid if it bursts
- Swelling in the face or cheek, or tender, swollen lymph nodes under the jaw
- Feeling run down, or a fever
Some abscesses cause no pain at all and show up only on an X-ray at a checkup. That's one reason regular dental exams with X-rays matter. And if a tooth that was killing you suddenly stops hurting, don't take it as good news. It often means the nerve has died, not that the infection is gone.
Signs a tooth infection is spreading
People often ask how to know if a decayed tooth is infecting the bloodstream. You can't feel bacteria in your blood, but you can watch for signs your body is fighting a spreading infection:
- Fever, chills, or feeling sick all over
- Swelling that's getting bigger, spreading toward the eye, down the neck, or under the tongue
- Trouble opening your mouth, swallowing, or breathing
- A fast heartbeat, confusion, or extreme tiredness
Any of those means you need care today, and trouble swallowing or breathing means the emergency room.
Can a tooth infection kill you?
It's rare, but yes, it can, and it's worth understanding how. Most tooth abscesses stay where they start. The danger comes when an infection spreads beyond the tooth into the spaces of the face and neck, or into the bloodstream. In one hospital study of serious deep neck infections, about two-thirds started from a tooth. A spreading infection under the jaw (sometimes called Ludwig's angina) can swell enough to block the airway. Infections from upper teeth can, very rarely, spread toward the eye or the brain.
There's no set timeline, so "how long until a tooth infection kills you" doesn't have a real answer. Some abscesses sit quietly for months. Others spread over a few days, especially in people with diabetes or weakened immune systems. What matters is noticing when it's moving. The warning signs are in the box above and in the red-flag list below.
As for a tooth infection spreading to the brain: brain abscesses are uncommon, and only a small share of them (around 2 to 5 percent in one review) come from teeth. Most people treated for them recover. It's a reason to get a tooth abscess treated, not a reason to panic.
How long does a tooth abscess last?
Until the source is treated. An abscess can flare, drain, quiet down, and flare again for months or years. Each flare can destroy more bone around the root, which can make the tooth harder to save. Once a dentist drains it and treats the tooth, pain usually improves a lot within a day or two, and swelling goes down over a few days.
Tooth abscess home remedies: what actually helps
We'll be straight with you: there's no home remedy that cures a tooth abscess. Salt water, clove oil, garlic, and turmeric can't reach an infection sealed inside a tooth and the bone around it. People search for "the strongest natural antibiotic for a tooth infection," but nothing you can buy or mix at home will clear it. What home care can do is keep you comfortable and keep things from getting worse until you're seen.
Until your appointment
- Call a dentist today. Most offices, including ours, hold time for urgent problems. Our emergency dental care page explains how same-day visits work.
- Take an over-the-counter pain reliever as the label directs. Ibuprofen tends to work well for tooth pain because it also fights inflammation. See the table below.
- Rinse with warm salt water (½ teaspoon of salt in a cup of warm water) a few times a day. If a gum boil is draining, this keeps the area clean.
- Use a cold compress on the outside of your cheek, 15 to 20 minutes on and then off, to ease swelling. Don't use heat on facial swelling.
- Sleep with your head propped up on an extra pillow. Throbbing often gets worse lying flat.
- Chew on the other side and stick to soft, lukewarm foods. Keep brushing and flossing gently, including around the sore tooth.
What not to do
- Don't try to drain a tooth abscess at home. Poking it with a needle or pin can push bacteria deeper, cause bleeding, and won't reach the source inside the tooth. Even when a gum boil drains on its own, the infection stays.
- Don't count on mouthwash. Listerine and other rinses can kill germs on the surface, but they can't reach an infection inside the tooth or bone.
- Don't take leftover or borrowed antibiotics. The wrong drug or a partial course can make the next infection harder to treat.
- Don't hold an aspirin or a crushed pill against the gum. It causes a chemical burn.
- Don't wait it out because the pain stopped. That's often the nerve dying.
Over-the-counter pain relief for a tooth abscess
These help with pain while you wait for treatment. None of them treat the infection.
| Option | What it does | Things to know |
|---|---|---|
| Ibuprofen (Advil, Motrin) or naproxen (Aleve) | Relieves pain and inflammation | Take with food, as the label directs. Ask your doctor or pharmacist first if you have stomach ulcers, kidney disease, or heart problems, take blood thinners, or are pregnant. |
| Acetaminophen (Tylenol) | Relieves pain | Follow the label. Watch for acetaminophen hidden in cold and flu products so you don't double up. |
| Ibuprofen and acetaminophen together | The pair often controls dental pain better than either alone | Sold as a combination product, or ask your pharmacist how to take the two safely together. |
| Numbing gels (benzocaine, such as Orajel) | Brief surface numbing | They don't reach a deep abscess, so expect limited help. Do not use benzocaine in children under 2. The FDA warns it can cause a rare, dangerous blood condition (methemoglobinemia). |
| Warm salt-water rinse | Keeps a draining area clean | Safe for most people, including during pregnancy. Swish and spit. |
Antibiotics for tooth infection: what they can and can't do
Antibiotics are the most misunderstood part of treating a tooth infection. They travel through the bloodstream, but the inside of a tooth with a dead nerve has no blood supply. So antibiotics can knock back an infection that's spreading into the gum, face, or body, but they can't clean out the source. Stop them without treating the tooth and the abscess usually comes back.
The American Dental Association's guideline says most people with a localized tooth infection don't need antibiotics at all when the tooth can be treated promptly. Antibiotics are recommended when there are signs the infection is spreading or affecting the whole body, like fever, swelling that's growing, or feeling unwell, or when someone's health puts them at higher risk.
When an antibiotic is needed, amoxicillin or penicillin is usually the first choice for a tooth infection. There are good alternatives for people allergic to penicillin. Your dentist or physician will pick the drug and the dose based on your health and allergies. If you're prescribed one, take every dose until it's gone, even after you feel better.
Tooth abscess treatment: what we do
The goal is to get rid of the infection and the thing feeding it. Here's what that looks like in our office:
- Find the source. We examine the area, test how the teeth respond, and take X-rays. Sometimes a 3D scan helps show the infection and the roots more clearly. Read about our digital X-rays and 3D imaging.
- Relieve the pressure. Draining the abscess, either through the tooth or through a small opening in the gum, often brings quick relief.
- Treat the tooth. If the tooth can be saved, root canal treatment removes the infected pulp, cleans and seals the inside of the tooth, and is usually followed by a crown to protect it. We do many root canals ourselves and refer to an endodontist (root canal specialist) for complicated ones.
- Remove it if it can't be saved. Some teeth are too broken down or have lost too much bone. Taking the tooth out removes the infection. Our extraction aftercare instructions cover the first few days.
- Treat a gum abscess by draining it and cleaning out the pocket, then treating the gum disease behind it.
- Prescribe medicine when it's warranted, including antibiotics if the infection is spreading, and give you a clear plan for pain.
- Coordinate care when an infection is severe. If it's spreading into the neck or affecting your breathing, the right place is a hospital, and we'll send you there and talk with the team that sees you.
Afterward, we'll talk about replacing a missing tooth with an implant or a bridge. See our page on dental implants. If dental visits make you anxious, tell us. There are ways to make treatment easier.
How to prevent a tooth abscess
- Get cavities filled while they're small. A small filling now prevents a root canal later.
- Don't ignore a tooth that's sensitive for weeks, especially if hot or cold pain lingers.
- Brush twice a day with fluoride toothpaste and clean between your teeth daily. Ask us to check your technique at your next cleaning.
- Cut back on sipping sugary or acidic drinks through the day.
- Wear a mouthguard for contact sports, and a night guard if you grind.
- Keep up with cleanings and checkups so tartar and gum pockets are dealt with early.
- Get a cracked tooth or broken filling fixed soon, even if it doesn't hurt.
Tooth abscess in kids, pregnancy, and people with health conditions
Children
Baby teeth get abscesses too, usually from decay. A gum boil over a baby tooth, facial swelling, or a child who won't eat on one side should be seen promptly. An infected baby tooth can affect the adult tooth forming underneath it. For pain, use children's acetaminophen or ibuprofen dosed by weight or age as the label directs, and skip benzocaine gels in children under 2.
Pregnancy
Treating a tooth infection during pregnancy is safe and much better than leaving it. Dental X-rays, numbing, and root canals or extractions can all be done when needed. Acetaminophen is usually the preferred pain reliever. Ibuprofen and other NSAIDs are generally avoided from about 20 weeks on unless your obstetrician says otherwise. Tell us you're pregnant so we can coordinate with your OB.
Diabetes, weakened immunity, and cancer treatment
Infections can move faster and heal slower when diabetes isn't well controlled, during chemotherapy, after an organ transplant, or with other immune problems. Get seen sooner rather than later. See how diabetes affects the mouth. If you've had radiation to the head and neck, pulling a tooth in the radiated area carries extra risk to the jawbone, so planning matters. We work closely with oncology teams through our head and neck cancer dental care. If you take bone-strengthening drugs for osteoporosis or cancer, read about osteoporosis medications and dental care. For heart conditions, joint replacements, or complex medical histories, our care for medically complex patients coordinates with your physicians.
When to see a dentist or go to the ER for a tooth infection
Make an appointment (within a day or two) if:
- A tooth throbs, hurts to bite on, or keeps you up at night
- You have a gum boil or a bump on the gum that comes and goes
- A swollen gum around one tooth doesn't settle in a day or two
- You notice a bad taste or salty drainage near a tooth
- A tooth that hurt for a while has suddenly gone quiet or turned darker
Get care today, or go to the ER, if:
- Facial swelling is spreading, especially toward the eye or down the neck
- You have trouble swallowing, breathing, or opening your mouth (call 911 or go to the ER)
- Swelling under the tongue or chin is lifting the tongue
- You have a fever, chills, a fast heartbeat, or feel very sick
- You're confused, very drowsy, or have a severe headache with a stiff neck
- You have diabetes, a weakened immune system, or are on chemotherapy and any swelling appears
Tooth abscess FAQ
What is an abscess tooth?
An abscessed tooth is a tooth with a pocket of pus caused by a bacterial infection. Most start inside the tooth, when decay or a crack lets bacteria reach the nerve, and the infection collects at the tip of the root. Others start in a deep gum pocket. Either way, it needs treatment from a dentist to clear up.
How do I know if I have an abscess tooth?
Common signs are a throbbing toothache, pain when you bite, a swollen or tender gum next to one tooth, a pimple-like bump on the gum, and a bad taste. Some abscesses don't hurt and only show up on an X-ray. A dentist can confirm it with an exam and X-rays.
Will a tooth abscess go away on its own?
No. The pain may come and go, and a gum boil may drain and shrink, but the infection at the root stays and keeps damaging bone. It goes away only when the source is treated with a root canal, an extraction, or treatment of the gum pocket.
How can I get rid of a tooth abscess?
A dentist drains the infection and treats the tooth. That usually means root canal treatment to save the tooth or removing the tooth if it can't be saved. Antibiotics are added when the infection is spreading. Pain relievers and salt-water rinses help you stay comfortable until then.
How long until a tooth infection kills you?
There's no set timeline, and deaths from tooth infections are rare. The danger comes when an infection spreads into the neck, airway, or bloodstream, which can happen over days in some people. Watch for spreading facial swelling, fever, and trouble swallowing or breathing. Any of those means the emergency room right away.
What is the strongest natural antibiotic for a tooth infection?
There isn't a natural remedy that cures a tooth infection. Garlic, clove oil, turmeric, and salt water can't reach an infection sealed inside a tooth and the jawbone. Salt-water rinses and cold compresses can help you feel better while you wait to be seen, but the infection needs dental treatment.
Is amoxicillin good for a tooth infection?
Amoxicillin is one of the usual first-choice antibiotics for a tooth infection that's spreading, and penicillin is another. Antibiotics only calm the infection, though. Without a root canal or extraction, it usually comes back. Many localized abscesses don't need antibiotics at all when the tooth is treated right away.
How long does a tooth abscess last with antibiotics?
Most people notice the pain and swelling start to ease within 2 to 3 days of starting an antibiotic. But the antibiotic doesn't remove the source, so the abscess usually returns weeks or months later if the tooth isn't treated. Take the full course as prescribed and keep your appointment to fix the tooth.
Can I drain a tooth abscess at home?
Please don't. Poking a gum boil with a needle or pin can push bacteria deeper, cause bleeding and more swelling, and still leaves the infection inside the tooth. If a gum boil bursts on its own, rinse with warm salt water and call a dentist.
How do I get rid of a swollen face from a tooth infection?
Facial swelling from a tooth infection goes down once the infection is drained and the tooth is treated, often with antibiotics as well. Until then, a cold compress on the cheek and sleeping with your head raised can help. Avoid heat. If the swelling is spreading toward your eye or neck, or you have a fever, get care the same day.
Will Listerine kill a tooth infection?
No. Mouthwash can kill bacteria on the surface of your teeth and gums, but it can't reach an infection inside a tooth or in the bone at the root. It's fine to use for fresher breath, but it won't treat an abscess.
Can a tooth infection cause headaches or make you sick?
Yes. Pain from an infected tooth often spreads to the jaw, ear, temple, or head, especially from upper back teeth. A tooth infection can also cause fever, swollen glands, and a general sick feeling. A fever, severe headache, or stiff neck with a tooth infection needs medical care right away.
Can a sinus infection cause tooth pain?
Yes. The roots of the upper back teeth sit right under the sinuses, so sinus pressure can make several upper teeth ache at once. It also works the other way: an infected upper tooth can cause a sinus infection. If one tooth hurts more than the rest, or the pain outlasts the cold, have it checked.
What is a gum abscess, and how is it treated?
A gum abscess is a pocket of pus in the gum beside a tooth, usually from gum disease or something stuck under the gum, like a popcorn hull. Treatment is draining it and cleaning out the pocket, then treating the gum disease behind it. Antibiotics are added if the infection is spreading or your health puts you at higher risk.
Think you have a tooth abscess?
If you're in the Jacksonville area and have a throbbing tooth, a gum boil, or swelling that's starting, call us. We hold time for urgent problems and will tell you honestly whether you need us today or the ER right now.
Related conditions
Sources
- Lockhart PB, Tampi MP, Abt E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American Dental Association. J Am Dent Assoc. 2019;150(11):906–921.
- Brizuela M, Daley JO. Oral Facial Infection of Dental Origin: A Guide for the Medical Practitioner. StatPearls. National Library of Medicine; updated 2025.
- Yousefi Y, Meldrum J, Jan AH. Periodontal Abscess. StatPearls. National Library of Medicine; updated 2023.
- Treviño-Gonzalez JL, Maldonado-Chapa F, González-Larios A, et al. Deep neck infections: demographic and clinical factors associated with poor outcomes. ORL J Otorhinolaryngol Relat Spec. 2022;84(2):130–138.
- Burgos-Larraín LF, Vázquez-Portela Á, Cobo-Vázquez CM, et al. Brain complications from odontogenic infections: a systematic review. J Stomatol Oral Maxillofac Surg. 2022;123(6):e794–e800.
- U.S. Food and Drug Administration. Risk of serious and potentially fatal blood disorder prompts FDA action on oral over-the-counter benzocaine products. 2018.
This page is for general education and isn't a diagnosis. Every mouth is different. If you have a sore you're worried about, see your dentist or physician. Photos marked Wikimedia Commons are used under their listed licenses and may have been cropped or resized.