What is a dental abscess and what causes it?

A dental abscess is a collection of pus (purulent fluid) that accumulates at the root tip of a tooth or between the gum and the tooth, caused by a bacterial infection.

This condition, resulting from the body's defense response to infection, is usually characterized by severe throbbing pain and localized swelling. Clinical case analyses show that the primary causes of abscesses are untreated deep tooth decay, cracked teeth, or advanced gum disease.

When bacteria reach the pulp tissue, the innermost layer of the tooth, they initiate an inflammatory process, and the infection tends to spread outside the tissue, into the jawbone. Untreated abscesses can lead not only to tooth loss but also to systemic risks as the infection enters the bloodstream.

What are the Symptoms of a Tooth Abscess and What Signals Does the Body Give?

The symptoms of a tooth abscess are a set of physical symptoms that vary depending on the severity and location of the infection. The most common symptom is severe, throbbing pain that starts in the gums and radiates to the ear, neck, or jawbone. This pain usually starts suddenly and intensifies when lying down or when pressure is applied. As the clinical picture progresses, the body's immune system begins to give regional and systemic responses to fight the infection.

The main physical symptoms indicating the presence of an abscess are:

• Throbbing Pain: A continuous, pulsating pain sensation caused by increased pressure at the root tip of the tooth.
• Facial and Gum Swelling: Visible edema on the cheek or pimple-like swellings called "fistula openings" on the gums as a result of the infection spreading to the soft tissues.
• Heat Sensitivity: Extreme sensitivity and tingling that lasts for minutes when the tooth comes into contact with hot or cold foods. 
• Swollen Lymph Nodes: Tenderness and enlargement of lymph nodes located under the jaw or in the neck due to infection.
• Bad Taste and Odor in the Mouth: A metallic taste caused by pus material spreading into the mouth if the abscess ruptures or leaks.
• Fever and Weakness: Systemic weakness resulting from the body's fight against the infection.

How to Treat a Tooth Abscess and What Clinical Treatment Methods Include?

A tooth abscess is not a self-healing tissue injury, but an active infection requiring medical intervention. The primary goal of treatment is to eliminate the source of infection by draining the accumulated pus and protecting the surrounding bone tissue. Protocols applied in dental clinics are determined according to the location of the abscess (gum or root tip) and the rate of spread. Temporary home remedies only suppress pain; they do not stop bacterial activity in the root.

The basic treatment steps applied in a clinical setting are:

• Drainage Procedure: The accumulated pus is removed by making a small incision in the abscessed area or by accessing it from inside the tooth. This procedure aims to relieve pain immediately by reducing pressure on the tissue. 
• Root Canal Treatment (Endodontics): If the infection originates from the pulp tissue inside the tooth, the root canals are cleaned, disinfected, and sealed with watertight filling materials to keep the tooth in the mouth. 
• Antibiotic Treatment: If there is a risk of the infection spreading to the jawbone or other parts of the body, an appropriate dose of antibiotics is prescribed to support the immune system. 
• Tooth Extraction: If the structural integrity of the tooth is compromised to the point that it cannot be preserved and the infection foci cannot be cleaned, extraction of the tooth becomes necessary to stop the spread of infection. 
• Periodontal Treatment: If the abscess originates from the gums (gum abscess), the deposits in the gum pockets are cleaned and the root surface is smoothed.

What Happens If a Tooth Abscess Is Left Untreated, and What Are the Possible Risks?

If a tooth abscess is left untreated, the infection will not stop; on the contrary, it tends to spread to surrounding tissues, the jawbone, and throughout the body via the circulatory system. While spontaneous rupture of the abscess may temporarily reduce pain, this does not mean healing; the focus of infection remains active at the root tip. Untreated chronic abscesses cause irreversible damage over time, leading to extensive destruction of the jawbone and tooth loss.

The main complications that can occur if a tooth abscess is neglected are:

• Jawbone Loss: The infection erodes the alveolar bone holding the tooth, causing cyst formation and decreased bone density in the area.
• Fistula Formation: Pus finds a way out through the gum; this is a sign of a persistent bad taste in the mouth and chronic infection. 
• Sinusitis: Abscesses in the back teeth of the upper jaw, being very close to the sinus cavities, can cause inflammation of these cavities (odontogenic sinusitis). 
• Ludwig's Angina: A life-threatening condition that causes difficulty breathing, resulting from the spread of infection from the lower jaw teeth to the floor of the mouth and neck area. 
• Sepsis: Although rare, bacteria entering the bloodstream can create a risk of systemic infection affecting the entire body and threatening vital organ functions.

Controlling the infection before it reaches these stages is essential for both saving the tooth and preserving overall health.