Even mild pain should never be ignored

It’s hard to imagine how a toothache could turn deadly—but it can. Even mild or moderate discomfort (for example, pain while chewing…sensitivity to hot and cold…and/or redness and swelling of the gums) can quickly turn into a potentially serious condition, known as an abscess, a pus-filled infection inside the tooth or between a tooth and the gum. Though the pain may be merely annoying in the beginning, within a day or so, it can turn into the intense, throbbing pain or sharp, shooting pain that is the telltale sign of an abscess.

Dangerous trend: The number of Americans hospitalized for dental abscesses is on the rise. According to the most recent data, hospitalizations for periapical abscesses (infections at the tip of the tooth root) increased by more than 40% over an eight-year period.

No one has a precise explanation for the trend, but some experts speculate that the high cost of dental insurance is preventing many people from seeking routine dental care and perhaps delaying treatment when a problem occurs. Medicare does not cover routine dental care, and many private health insurance plans offer very limited coverage.


If there’s a breach in a tooth’s protective enamel—from tooth decay, a chip or even gum disease, for example—you’re at risk for an abscess. Some cracks can be taken care of with bonding or a crown (see below). Some don’t need treatment at all because they don’t go through to the tooth pulp (the soft tissue inside the tooth). But if bacteria get inside the tooth, an abscess can form.

Other signs to watch for: In addition to the symptoms described earlier, other red flags of a dental abscess may include persistent foul breath, a swollen face, jaw and/or neck glands and a fever.

Once the pain kicks in, people who have dental abscesses will often describe it as the worst they’ve ever experienced. If you’ve ever had a root canal (see below), you might have had an abscess.

  • Get help immediately. An abscess will not go away on its own. Worse, the infection can spread as quickly as overnight (in some cases, however, it can take years to spread). An abscess can cause death when the infection spreads to the brain or heart or when swelling cuts off the airway.

When to be especially suspicious: If you have pain in one of your back teeth. They’re the ones that do most of the chewing, and they’re also the ones that are harder to reach with dental floss and a toothbrush. If you crunch something hard, such as a popcorn kernel, piece of ice or even an almond, a back tooth is the one most likely to be cracked.


Your dentist can diagnose an abscess in just a few minutes. All he/she has to do is gently tap on the suspected tooth with a small metal device and see if you wince. A tooth abscess will be very sensitive to pressure. An X-ray will confirm if there’s a pus-filled pocket near the tooth root.

You might be given penicillin or another antibiotic if the infection has spread beyond the tooth. In addition, your dentist will treat the abscess in one of three ways…

  • Incision and drainage. If the abscess is between the tooth and the gum, your dentist will make a small incision, drain out the pus and clean the area with saline. The pain will start to diminish almost immediately. Your dentist also can drain an abscess that occurs inside a tooth, but this won’t cure it—the infection will probably come back.
  • Root canal. This is the most widely used treatment for an abscess near the tooth root. Your dentist will drill into the infected area, scrape away damaged tissue and drain the pus. After that, the canal will be filled with sealant, and the tooth will be crowned (a porcelain or metal cap is put over the tooth). If you get a root canal, there’s a good chance that the tooth will survive. The drawback is cost. Root canals usually are done by an endodontist (a dentist with advanced training). Expect to pay from $300 (for a front tooth) to $2,000 for a molar. The crown is an additional $500 to $3,000 (prices depend on where you live and whether you go to a specialist or your regular dentist).
  • Extraction. This is the most permanent treatment for a deep abscess. It costs about $75 to $300 to remove a tooth—and once the tooth is gone, the abscess goes away with it.

Some patients save money by choosing not to replace an extracted tooth. But there are health risks associated with not replacing a tooth, such as increased chance of additional decay and infection, bone loss, poor chewing function and speech disturbances.

Better: Replace the tooth with an implant (at least $2,400) plus a crown ($500 to $3,00)…or a bridge (at least $1,100).

If you can’t see a dentist immediately: Consider going to an ER if you have severe pain and/or swelling. If you are having trouble breathing, go to an ER right away.


If you take care of your teeth, there’s a good chance that you’ll never have an abscess.

In addition to regular brushing and flossing and avoiding a lot of sugar-filled foods and drinks…

  • Use fluoride toothpaste. It remineralizes tooth enamel and makes it stronger. This is particularly important for older adults, whose receding gums can expose parts of the tooth and leave it vulnerable to decay.

Also helpful: A fluoride mouth rinse. There are many brands in drugstores. They strengthen the enamel and reduce tooth decay.

  • Don’t slack off on dental visits. Most people should have dental checkups and cleanings every six months. If you smoke or have gum disease, diabetes or any other condition that increases your risk for dental problems, it’s usually a good idea to schedule even more frequent dental visits.