An abscess is a pocket of infection with nowhere to go. In a tooth, that matters more than it does elsewhere in the body, because the infection starts inside a sealed chamber of hard tissue and the only ways out are through the tip of the root into the jaw, or out through the gum.
This is the dental emergency people most often try to wait out, usually because the pain settles down after a few days. That is exactly the wrong read. Here is what to look for and why the timing matters.
What it feels like
A deep, throbbing ache that is hard to localise. Early decay tends to give sharp, brief pain from something cold. An abscess gives a duller, more constant pain, and people frequently cannot say which tooth it is, or even confidently which jaw. That is because the tissue around the root tip is inflamed and it does not carry the precise positional information the tooth surface does.
The tooth feels tall or raised when you bite. A classic sign. Pressure has built at the root tip and pushed the tooth a fraction out of its socket, so it makes contact before the others. People say it feels like it is in the way.
Tenderness to touch or tapping. Tapping the tooth with a fingernail produces a distinct jolt that the neighbouring teeth do not.
Swelling. In the gum beside the tooth, or in the face, lip or under the jaw. Swelling means the infection has already moved out of the bone into soft tissue.
A sudden bad or salty taste. Often accompanied by the pain easing dramatically. That is pus draining through a small opening in the gum. The relief is real and the problem has not gone.
Feeling unwell generally. Fever, tiredness, swollen glands under the jaw. These mean your body is fighting the infection systemically, and they warrant the same day.
Why the pain stopping is not good news
This is the single most important thing on this page.
An abscess builds pressure. Pressure is what causes most of the pain. The moment that pressure finds an escape route, whether through a small channel in the gum or because the nerve inside has finally died, the pain drops away.
Nothing has been cured. The infection now has a stable route to keep discharging, and it will quietly continue eating away at the bone around the root. People come in months later with a tooth that stopped hurting in autumn and now cannot be saved, when in autumn it could have been.
If your toothache disappeared on its own and you noticed a strange taste around the same time, please have it looked at.
Why antibiotics are not the answer
We get calls asking for a prescription to tide someone over. It is a reasonable thing to ask and the honest answer is that it will not do what you want it to.
Antibiotics travel in the bloodstream. The centre of the infection is inside the tooth, in a chamber whose blood supply has been destroyed by the infection itself. No blood supply means no delivery route. The tablets reach the surrounding tissue and can knock back the spreading part of the infection, which is genuinely useful when the face is swelling, but they cannot reach the reservoir.
So the pattern is predictable: a course of antibiotics, real improvement over five days, then a return two or three weeks later. Sometimes twice. Each round tends to leave less tooth worth saving.
The definitive treatment is to deal with the inside of the tooth, either by cleaning and sealing it with root canal treatment, or by removing the tooth. Antibiotics have a supporting role. They are not the fix.
When it stops being a dental problem
Most abscesses are managed comfortably in a dental chair. A few are not, and it is worth knowing where the line is.
Go to a hospital emergency department, rather than waiting for a dental appointment, if you have:
- difficulty swallowing, or a feeling that your throat is closing
- any difficulty breathing
- swelling spreading up towards or closing your eye
- swelling tracking down into your neck or under your chin on both sides
- a fever alongside feeling genuinely unwell
- inability to open your mouth more than a couple of centimetres
Infections in the floor of the mouth and the spaces around the jaw can move quickly and compromise the airway. That is rare, and it is the reason nobody in dentistry treats facial swelling casually.
The emergency department at Tweed Hospital, or your nearest hospital, is the right place for those signs.
What we do
First, work out which tooth and how far it has gone. That means a look, a few simple tests including tapping and a cold test on the neighbouring teeth for comparison, and an X-ray. On an X-ray an established abscess usually shows as a dark shadow at the root tip where bone has been lost.
Then relieve the pressure, which is what actually stops the pain. Depending on the situation that might mean opening the tooth to let the infection drain, draining a soft tissue swelling, or removing the tooth.
Then decide the tooth’s future with you. Root canal treatment cleans and seals the inside so the tooth can stay. Extraction removes the source entirely. Which is better depends on how much sound tooth is left, where it sits, and what you want. You get an itemised quote before treatment starts, and if cost is the sticking point, say so, because it changes what we would suggest.
Do not wait it out
We are open Monday to Friday, 8:00am to 5:00pm, at Level 1, Tweed Arcade, 2 Queen Street in Murwillumbah. Ring (02) 6672 1980 as early in the day as you can, because emergency slots fill from the morning onwards.
You do not need to be an existing patient. We look after people from Uki, Pottsville, Kingscliff and across the Tweed Valley.
For what to do about other dental emergencies, including a knocked-out tooth, a broken tooth or a lost filling, see our emergency dentistry page.
Frequently asked questions
What does a dental abscess feel like? +
Usually a deep throbbing ache that is hard to pin to one tooth, a tooth that feels raised or tender when you bite, and often swelling in the gum or face. Some people also notice a bad taste, which is pus draining through a small opening in the gum.
Will antibiotics cure a dental abscess? +
No. Antibiotics can control infection that has spread into the surrounding tissue, but the source sits inside the tooth where the blood supply no longer reaches, so tablets cannot clear it. The infection settles for a while and then returns. The tooth itself has to be treated.
Can a dental abscess go away on its own? +
The pain often eases, which is not the same thing. Pain usually drops once the pressure finds a way out, either through a small channel in the gum or because the nerve has died. The infection carries on underneath.
When is a dental abscess a medical emergency? +
Go to a hospital emergency department if you have difficulty swallowing or breathing, swelling spreading towards your eye or down into your neck, a fever with feeling very unwell, or you cannot open your mouth properly. Those signs mean the infection is moving beyond where a dental chair can safely deal with it.
Can I drain it myself? +
No. Squeezing or lancing an abscess at home pushes infection into deeper tissue planes and risks making a manageable problem into a serious one.