Something in your mouth is swollen and cross with you, and you've spent the evening trying to work out whether the tooth or the gum started it. You've pressed the gum. You've tapped the tooth. You've asked someone to shine a torch in there and they've said "ooh" and nothing more useful. You're not imagining it, and you're not the only one trying to referee this from the sofa.
The short answer: a tooth abscess starts inside the tooth, at the tip of the root, when the nerve has died. A gum abscess starts in the gum pocket down the side of a tooth that is usually still alive. A tooth abscess tends to bring deep, throbbing toothache and a tooth that hurts to bite on; a gum abscess tends to bring a sore, swollen gum next to a tooth that may feel slightly raised or loose. Both are infections and both need a dentist, so the label matters less than the phone call. If you're near Harlow or Enfield, ring my emergency dentist team in Harlow or Enfield. Elsewhere, or out of hours, call NHS 111.
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 in the floor of your mouth
- you can't open your mouth properly because of the swelling
- you have signs of sepsis. The NHS lists these as: breathing very fast; being confused, having slurred speech or not making sense; blue, pale or blotchy skin (on black or brown skin this may be easier to see on the palms of the hands or soles of the feet); a very high or very low temperature, feeling hot or cold to the touch, or being shivery; a rash that does not fade when you press it
Swollen gum, throbbing tooth or a puffy face? 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, not your GP; the NHS is clear a GP can't give you dental treatment.
What's the difference between a gum abscess and a tooth abscess?
I'll keep this straight, because it's an infection. Both are pockets of pus. The difference is where the bacteria got in.
- Tooth abscess (the proper name is periapical abscess). Decay, a crack, a knock or a big old filling lets bacteria into the middle of the tooth. The nerve dies, the infection runs out of the end of the root, and pus collects in the bone at the tip.
- Gum abscess (periodontal abscess). The tooth is fine on the inside. The problem is a deep pocket between the gum and the root, usually from gum disease, that has got blocked and infected. Sometimes it's something jammed in there, like a bit of food or a stray bristle. The tooth itself is usually still alive.
Think of it as a burst pipe inside the wall versus a blocked drain outside it. Both end in a puddle, and the puddle is the bit you can see. Finding the pipe is my job.
What does a tooth abscess feel like?
Usually a deep, constant, throbbing ache in one tooth, worse when you bite or chew, and often the kind that keeps you awake. The tooth can feel tall, as if it meets its opposite number before the rest do. Tapping it makes you wince. Hot drinks may set it off. Cold, oddly, often does nothing, because the nerve that would have felt it has already died.
If it's been going on a while you may get swelling in the gum over the root, a bad taste, or a small spot on the gum that weeps. That spot is a drain, and I've written about it in dental abscess vs gum boil. Swelling of the face or jaw, swollen neck glands and a temperature are on the NHS list too. Some tooth abscesses are surprisingly quiet, which I cover in painless dental abscess.
What does a gum abscess feel like?
More of a gum problem than a tooth problem, at least at first. The gum beside one tooth goes red, shiny and puffy, and it's sore to touch. Pressing it may bring pus out from the gum edge, with a foul taste. The tooth can feel slightly raised, and it may be a bit loose. It's often tender to bite on too, so I won't pretend the two never overlap.
The clues that point me towards the gum are a history of bleeding gums or gum disease, a tooth that still feels cold normally, and a deep pocket I can measure down the side.
Can you tell which one you've got at home?
Not reliably, and I'd rather you didn't try for long. Symptoms overlap, a gum abscess can sit next to a tooth that's already dead, and the two can even join up. What I can do in the chair takes a few minutes:
- A cold test. A tooth with a dead nerve doesn't feel the cold. A tooth beside a gum abscess usually does.
- A gentle tap. A tooth abscess is often tender to tap.
- A pocket check. A blunt probe down the gum edge. A gum abscess usually comes with a deep pocket; a tooth abscess usually doesn't.
- An X-ray. A tooth abscess typically shows a dark shadow at the tip of the root. A gum abscess shows bone loss down the side.
That's it. No drama, no guessing, and you should leave knowing which one it is and what happens next.
Does the treatment differ?
Yes, which is the real reason the label matters, and why I want to be the one deciding it. The principle is the same for both: let the pus out and remove the cause.
- Tooth abscess: root canal treatment to clean out the dead nerve and seal the tooth, or removing the tooth if it can't be saved. Sometimes I'll drain the swelling first.
- Gum abscess: draining through the pocket and cleaning out whatever is stuck or built up on the root. If the tooth is too far gone with gum disease, it may need to come out.
Antibiotics don't replace either of those. The guidance I follow is clear that they're only needed alongside treatment when an infection is spreading or making you unwell. A course on its own might quieten things for a bit; the dead nerve or the pocket is still there when it ends. More in do you need antibiotics for a tooth infection?
When should you get an abscess seen?
As soon as you can, whichever kind you think it is. The NHS advice for a suspected dental abscess is to see a dentist urgently, and neither kind sorts itself out. While you wait, ibuprofen or paracetamol taken as the packet says, soft food, a soft brush, and nothing very hot or very cold. Please don't squeeze or try to burst it; I explain why in can you burst a tooth abscess yourself?
Call us today if:
- a tooth is throbbing, tender to bite on, or kept you awake
- the gum beside a tooth is swollen, sore or leaking pus, or the tooth feels loose or raised
- your face or jaw is swollen, or your neck glands are up
- you have a temperature or feel unwell with it
Reminder: trouble breathing, swallowing or speaking, swelling heading for your eye, neck or under your tongue, a mouth you can't open, or any of the NHS sepsis signs at the top of this page is 999 or A&E, not a dentist. See signs a tooth infection is spreading.
If you're near Harlow or Enfield, I'd much rather take a look and settle the gum-or-tooth question in five minutes than have you referee it from the sofa for another week. Ring your nearest Minti practice, say 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. An abscess needs examining in person to find the cause.
