Dental Abscess

🧭 When to suspect

A dental (odontogenic) abscess is a localised collection of pus arising from bacterial infection of a tooth or its supporting structures. Two patterns dominate in primary care: a periapical abscess – infection of the dental pulp (usually following caries, trauma or a deep restoration) collecting at the root apex – and a periodontal abscess within a periodontal pocket. The classic presentation is rapid-onset, severe, constant, throbbing pain in a tooth or gum, often worse on lying down and disturbing sleep, frequently with localised gum or facial swelling.

Raise suspicion when pain radiates to the ear, jaw or neck on the affected side, or there is sensitivity to hot or cold, a foul taste or discharge, halitosis, or a tender swelling on the gum (a "gum boil" or parulis) – sometimes with a discharging sinus. Fever, malaise or facial swelling signal spreading infection and a higher-risk patient.

The key primary-care principle is that the GP's role is recognition, analgesia, safety-netting and urgent onward referral to a dentist – not definitive treatment. Definitive care (drainage, root canal or extraction) is dental. Antibiotics are reserved for spreading or systemic infection, or high-risk patients, and never substitute for drainage. Above all, exclude the airway and sepsis red flags that turn a dental problem into an emergency admission.

Risk factors include poor oral hygiene, dental caries, periodontal disease, recent dental treatment or trauma, smoking, a high-sugar diet, and immunocompromise (e.g. diabetes, oral steroids, chemotherapy).

Source: NICE · SDCEP