Common Symptoms of an Infected Tooth
Tooth infection symptoms can appear suddenly or develop gradually over days to weeks. Some infections cause severe pain from the start. Others build slowly, with mild discomfort that worsens over time. Here are the most common symptoms.
Throbbing or Pulsating Pain
The most recognizable symptom of a tooth infection is a deep, throbbing pain that pulses in rhythm with your heartbeat. The pain may be constant or come and go. It often intensifies when you lie down because blood pressure to the head increases in a horizontal position. Over-the-counter pain relievers may dull it temporarily but typically do not eliminate it.
Swelling in the Face, Jaw, or Gums
Swelling is a sign that the infection has spread beyond the tooth into the surrounding tissues. You may notice swelling in the gum near the affected tooth, in the cheek, along the jawline, or under the eye depending on which tooth is infected. Upper teeth tend to cause swelling in the cheek or below the eye. Lower teeth often cause swelling along the jaw or under the chin.
Sensitivity to Hot and Cold
An infected tooth often becomes extremely sensitive to temperature. Hot food or drinks typically cause a sharp, lingering pain that lasts well after the stimulus is removed. Cold sensitivity may also occur. If sensitivity to heat lingers for more than 30 seconds after you remove the hot food or drink, that strongly suggests pulp involvement.
Pimple or Bump on the Gum
A small, pimple-like bump on the gum near the painful tooth is called a fistula (also known as a gum boil or parulis). This bump is a drainage point for pus from the infection at the root tip. It may come and go and may release a salty or foul-tasting fluid when it drains. A fistula on the gum is a reliable sign that an abscess has formed.
Other Symptoms to Watch For
- Fever: A temperature above 100.4 F (38 C) can indicate the infection is affecting your body systemically.
- Bad taste or bad breath: Pus draining from the infection causes a persistent foul taste in the mouth that brushing does not resolve.
- Pain when biting or chewing: Pressure on the infected tooth pushes on the inflamed tissue at the root tip, causing sharp pain.
- Tender or swollen lymph nodes: The lymph nodes under the jaw or in the neck may become swollen and tender to touch.
- Tooth discoloration: An infected tooth may darken to a gray or brownish color as the pulp tissue inside dies.
- Loose tooth: The infection can erode the bone around the root, causing the tooth to feel slightly mobile.
When a Tooth Infection Is an Emergency
Most tooth infections are painful but not immediately life-threatening. However, certain warning signs mean you should seek emergency care without delay. A dental infection that spreads can become dangerous rapidly.
Go to the Emergency Room If You Experience
A condition called Ludwig's angina occurs when infection from a lower tooth spreads into the floor of the mouth and throat. This can compromise the airway and requires immediate hospital treatment. While rare, it is the reason that significant swelling from a tooth infection should always be evaluated urgently.
- Swelling that spreads to the floor of the mouth, throat, or neck (this can obstruct breathing)
- Difficulty swallowing or opening your mouth fully (trismus)
- Difficulty breathing
- High fever above 101 F (38.3 C) with facial swelling
- Swelling around or below the eye
- Confusion, rapid heart rate, or feeling very unwell (signs of systemic infection)
What Causes a Tooth Infection?
A tooth infection starts when bacteria reach the pulp inside the tooth. Several pathways can lead to this.
- Deep cavity: Untreated tooth decay that penetrates through the enamel and dentin into the pulp chamber.
- Cracked or fractured tooth: A crack that extends into the pulp allows bacteria to enter.
- Trauma: A blow to the tooth can damage or kill the pulp, even if the tooth appears intact on the outside.
- Failed previous dental work: Old fillings or crowns that leak can allow bacteria to reach the pulp.
- Gum disease: Severe periodontal disease can create a pathway for bacteria to infect the tooth through the root tip.
Types of Tooth Abscesses
A periapical abscess forms at the tip of the tooth root when the pulp dies and bacteria multiply at the root end. This is the most common type and the kind that endodontists treat with root canal therapy. A periodontal abscess forms in the gum tissue alongside the tooth root, typically related to gum disease. The symptoms can overlap, and a dentist or endodontist can determine the type through examination and X-rays.
Home Care Before Your Appointment
Home remedies do not cure a tooth infection. They can only manage discomfort until you receive professional treatment. If you cannot see a dentist or endodontist immediately, the following measures may help.
- Over-the-counter pain relief: Ibuprofen (Advil, Motrin) reduces both pain and inflammation. Acetaminophen (Tylenol) can be alternated with ibuprofen for additional pain control. Follow package dosing instructions.
- Saltwater rinse: Dissolve half a teaspoon of salt in 8 ounces of warm water and rinse gently. This can help draw pus toward the surface and provide temporary relief.
- Cold compress: Apply an ice pack wrapped in a cloth to the outside of your cheek for 15-20 minutes at a time to reduce swelling.
- Elevate your head: Sleep with an extra pillow to keep your head elevated, which can reduce throbbing.
- Avoid hot food and drinks: Heat increases blood flow to the infected area and typically worsens pain.
What Not to Do
Do not apply aspirin directly to the gum or tooth. This causes a chemical burn to the tissue. Do not attempt to drain an abscess yourself, as this can spread the infection. Do not ignore worsening symptoms while waiting for an appointment. If pain or swelling increases significantly, seek urgent care.
How a Tooth Infection Is Treated
The only way to eliminate a tooth infection is to remove the source of bacteria. Antibiotics alone cannot cure the infection because they cannot penetrate the dead pulp tissue inside the tooth.
Root Canal Treatment
Root canal treatment removes the infected pulp, cleans and disinfects the canal system inside the tooth, and seals it to prevent reinfection. The tooth is then restored with a crown. This is the preferred treatment when the tooth can be saved. An endodontist, a specialist in treating the interior of teeth, typically performs root canals on infected teeth, especially complex cases.
Tooth Extraction
If the tooth is too damaged to save, extraction removes the infection along with the tooth. After healing, the missing tooth can be replaced with a dental implant, bridge, or partial denture. An oral surgeon or general dentist typically performs extractions.
The Role of Antibiotics
Antibiotics may be prescribed to help control the spread of infection, particularly if there is facial swelling, fever, or signs of systemic involvement. However, antibiotics treat the surrounding infection, not the source inside the tooth. They are a supplement to dental treatment, not a replacement for it. The infection will return if the tooth is not treated.
Treatment Cost for an Infected Tooth
Treatment costs depend on the type and location of the tooth and the complexity of the infection. Costs vary by location and provider.
An emergency exam with X-rays typically costs $100 to $300. Root canal treatment ranges from $700 to $1,500 for the root canal itself, with an additional $800 to $1,500 for the crown. Extraction costs range from $150 to $400 for a simple extraction or $200 to $600 for a surgical extraction.
Most dental insurance plans cover a significant portion of root canal treatment and extractions. Emergency exams are generally covered as well. If you need a dental implant to replace an extracted tooth, that is a separate cost and may or may not be covered by your plan.
When to See an Endodontist
An endodontist is a dentist with 2 to 3 years of additional specialty training in diagnosing and treating infections inside the tooth. While general dentists perform root canals, an endodontist is the specialist to see when the infection is severe, the tooth has complex anatomy, or a previous root canal has failed.
If you are experiencing symptoms of a tooth infection, the first step is to contact a dentist or endodontist promptly. Many endodontists keep same-day or next-day openings for emergency cases. You do not always need a referral; many endodontists accept patients directly.
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