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:

• Periapical abscess: infection of the dental pulp (usually following caries, trauma or a deep restoration) collecting at the root apex

• 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

• Sensitivity to hot or cold

• A foul taste or discharge

• Halitosis

• 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.

Primary care offers 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

• Immunocompromise (e.g. diabetes, oral steroids, chemotherapy)

Source: NICE · SDCEP