If you've landed here, something in your mouth has gone wrong: a throbbing tooth, a swollen face, a spot on the gum, a bad taste, or a feeling of being properly unwell that you suspect is coming from a tooth. You're not imagining it, and you're not the only one. Tooth infections are one of the most common reasons people ring my practices in pain. This page is the map. It tells you what an abscess is, what it feels like, what I do about it and, most importantly, when it stops being a dental problem and becomes a medical emergency.
The short answer: a dental abscess is a pocket of pus caused by bacteria, usually at the root of a tooth or in the gum beside it. It will not go away on its own, and antibiotics alone won't cure it. It needs a dentist to drain it and treat the source with root canal treatment or an extraction. If you think you have one, the NHS says to ask for an urgent dentist appointment or get help from NHS 111. Ring my emergency dentist team in Harlow or Enfield, or NHS 111 if we're closed or you're not local. If the swelling is affecting your breathing, swallowing, eye or ability to open your mouth, that's 999 or A&E, and the emergency signs below come first.
Call 999 or go to A&E, not a dentist, if:
- you're finding it hard to breathe, swallow or speak
- swelling is spreading towards your eye, down into your neck or under your tongue
- you can't open your mouth properly because of swelling
- you have signs of sepsis. The NHS says to call 999 or go to A&E if an adult "is breathing very fast", "is confused, has slurred speech, or is not making sense", "has blue, pale or blotchy skin", "has a very high or very low temperature, feels hot or cold to the touch, or is shivery", "has a rash that does not fade when you press it", or "has symptoms you're worried might be sepsis".
Toothache, swelling, a gum boil or a temperature? Call your nearest Minti practice and tell reception it's urgent. I keep same-day appointments for pain and swelling wherever I can.
- Nuffield Dental Practice, Harlow: 01279 424 038
- Church Langley Dental, Harlow: 01279 306 690
- Enfield Smiles, Enfield: 020 8804 4320
Evening, weekend, or nowhere near us? Call NHS 111. If you're struggling to breathe or swallow, or swelling is spreading to your eye or neck, that's 999 or A&E.
What is a dental abscess?
Bacteria get into a tooth through deep decay, a crack or an old injury. The nerve inside dies, and the infection escapes through the tip of the root into the bone. Or, less often, infection starts in a deep gum pocket beside the tooth. Either way, your body walls it off into a pocket of pus, and that pocket is the abscess. The NHS lists the symptoms as intense toothache or gum pain, a swollen face or jaw, redness in the mouth, sensitivity to hot and cold, a bad taste, difficulty chewing, swollen glands in the neck and a high temperature. The two types matter because they're treated differently, so I've explained them separately.
Periapical abscess: infection at the root of a tooth
The most common kind: infection at the tip of the root, from a dead nerve inside the tooth. A dentist checks the tooth and may use an X-ray to find the source.
Gum abscess vs tooth abscess
A gum abscess starts in the pocket beside a tooth; a tooth abscess starts inside it. They can look alike from the outside and need different treatment. A dentist can tell them apart by checking the tooth and gum, often with an X-ray.
Dental abscess vs gum boil
A gum boil is usually the visible end of an abscess: the spot where pus has found its way out. It's not a separate condition, and it doesn't mean the infection has gone.
What does a tooth infection look and feel like?
Abscesses are inconsistent. Some throb for days, some swell without pain, some leak quietly and go unnoticed until something else goes wrong. These are the patterns I'm asked about most.
Toothache with a swollen face
Swelling means the infection has moved beyond the tooth. It needs a dentist today, and if it's near the eye or under the jaw, it needs more than that.
Cheek swelling with no tooth pain
A swollen cheek with a tooth that doesn't hurt is still often a tooth: a dead nerve doesn't feel pain, but it can still cause an abscess.
Gum boil
A small spot on the gum that comes and goes, sometimes bursting with a foul taste. It's pus finding an exit, and the tooth behind it needs treating.
Pus and a bad taste from a tooth
A salty, metallic or foul taste on one side, especially on waking, often means an abscess is draining into your mouth.
Painless dental abscess
No pain is not the all-clear. Once the pressure is released or the nerve has died, an abscess can carry on in the bone without hurting.
Jaw swelling with toothache
Swelling along the jawline, particularly underneath it, is one I take seriously, because the lower back teeth sit close to the spaces that lead to the neck.
Roof of mouth swelling from a tooth
Upper teeth can drain towards the palate rather than the cheek, giving a swelling on the roof of the mouth that's easy to mistake for something else.
Can a tooth infection make you ill, or spread?
I'll keep this whole section straight. Most abscesses stay local. Some don't, and the ones that spread are the reason the emergency signs sit near the top of this page.
Can a tooth infection make you feel ill?
Yes. Once your immune system is fighting the infection, you can get a temperature, swollen glands, tiredness and a general feeling of being unwell. That's a same-day appointment.
Tooth infection and fever
A temperature with a bad tooth means the infection is affecting your whole body, not just the tooth. What it means and when it's an emergency.
Swollen lymph nodes with a tooth infection
Tender glands under the jaw are your body's filters at work. Usually a dental appointment, not an ambulance, but worsening swelling or trouble swallowing needs urgent help.
How a tooth infection spreads
The routes an untreated abscess can take: into the cheek, towards the eye, under the jaw, into the neck, and rarely into the bloodstream.
Can a tooth infection spread to your ear?
Usually it's referred pain: the tooth, jaw and ear share nerves, so a bad back tooth feels like earache. True spread to the ear is rare. A dentist can check where the pain starts.
Toothache spreading to your ear, jaw and head
Pain that travels from one tooth across the side of your face is common and usually a nerve mix-up rather than infection on the move, but it still needs the tooth found. Read why toothache can spread to the ear, jaw and head.
Can a tooth infection spread to your neck?
It can, and this is the dangerous one. Swelling under the jaw and into the neck can narrow the airway within hours. If breathing or swallowing is affected, call 999.
Swelling under the tongue
Swelling in the floor of the mouth that pushes the tongue up is an emergency sign, not a wait-and-see one.
What should you not do with a dental abscess?
Two things come up often. Please don't squeeze, pop or lance an abscess yourself. It doesn't reach the infection at the root, and it can push it further into the tissue.
Can you burst a tooth abscess yourself?
The short version is no: contact a dentist to treat the source.
Dental abscess popped
If it's burst on its own, the relief is real but the infection isn't gone. Contact a dentist promptly even if the pressure eases.
Do you need antibiotics for a tooth infection?
Less often than people expect. The guidance I follow says antibiotics aren't indicated for a dental abscess unless there are signs of spreading infection or symptoms affecting your whole body, such as a temperature. When they are needed, they're added alongside drainage or extraction, never instead of it. Antibiotics can't get inside a dead tooth or drain pus.
Do you need antibiotics for a tooth infection?
The dentist decides whether they're needed after examining how far the infection has spread.
Can antibiotics cure toothache?
A course of tablets can quieten symptoms while the source of infection remains.
Tooth infection without antibiotics
Waiting does not treat the source of an abscess.
Dental infection after antibiotics
Finished the course and it's back? That's expected when the tooth was never treated.
How is a dental abscess treated?
Get the pus out, then deal with the source. That means draining the abscess through the tooth or through a small cut in the gum, under local anaesthetic, and then root canal treatment to save the tooth or an extraction if it can't be saved. Which one depends on what I find when I look, and I won't promise either over the phone.
Dental abscess treatment: what will the dentist actually do?
The choice between drainage, root canal treatment and extraction depends on what I find when I examine the tooth.
When should you get help for a dental abscess?
The NHS wording is simple: ask for an urgent dentist appointment or get help from NHS 111 if you think you have a dental abscess, and don't go to a GP, because they can't give dental treatment. Call us today if:
- a tooth is throbbing, tender to bite on, or keeping you awake
- there's a gum boil, pus, or a bad taste
- your gum, cheek or jaw is swollen but you can breathe, swallow and open your mouth normally
- you have a temperature, swollen glands, or feel unwell
- an abscess has burst, or has come back after antibiotics
When should you go to A&E for a dental abscess?
Most abscesses need an urgent dentist, not A&E. The NHS emergency signs are listed at the top of this page.
If any of the emergency signs at the top apply, that's 999 or A&E, straight away. While you wait to be seen, the NHS advice is paracetamol or ibuprofen at the doses on the packet, soft food and no chewing on the sore side.
If you're near Harlow or Enfield, I'd much rather take a look and get the infection out at the source than have you spend another night reading this page and hoping it settles. Ring your nearest Minti practice, tell us it's urgent, and we'll do our best to see you the same day. Anywhere else, or out of hours, call NHS 111.
This article is general information, not a diagnosis. A dental abscess needs examining in person, and spreading swelling needs emergency care.
