Periapical Abscess

A periapical abscess is a pocket of infection (pus) around your tooth root. This type of dental abscess forms when harmful bacteria from your mouth invade your tooth pulp — the innermost part of your tooth. The bacteria can find their way in if you have a cavity or a crack in your tooth. The infection can spread all the way to the tip of the root and into the surrounding tissues.

Left untreated, a periapical abscess can spread to other parts of your body and cause serious, life-threatening complications. If you think you have an abscess, you should seek care immediately.

Symptoms of a periapical abscess

Symptoms may include:

• Severe, throbbing toothache
• Pain that radiates to your ear, neck or jaw
• Pain when chewing or biting
• Sensitivity to heat and cold
• Bad breath or a bad taste in your mouth
• Swollen lymph nodes in your neck or under your jaw
• Facial swelling
• Fever

Abscesses can also rupture (burst). If this happens, you may feel relief coupled with a sudden rush of foul-tasting fluid. But this doesn’t mean the infection has gone away. You should still call a dentist.

Most of the time, a periapical abscess hurts. But some people never develop pain. If you have other symptoms — like fever, bad breath or swelling — schedule an appointment with your dentist.

How long does it take to form?

The answer is different for everyone. Some abscesses can form in just one or two days. Others may develop for weeks or months before you notice symptoms.

If you notice any changes in your mouth or feel like something isn’t quite right, see a dentist right away.

Periapical abscess causes

Bacteria cause a periapical abscess. They can enter your tooth pulp through a cracked tooth or cavity. The infection can spread to the tip of your tooth root and into surrounding tissues.

Risk factors

You’re more likely to develop a periapical abscess if you have:

• Poor oral hygiene
• Dry mouth
• Lots of sugary foods and drinks in your diet

Complications of this condition

Left untreated, a periapical abscess can damage your tooth to the point where it can’t be saved. Eventually, infections can spread to your jaw and other areas of your head and neck. In some cases, the infection can even get into your blood and cause sepsis, a life-threatening condition.

This is why it’s important not to dismiss symptoms.

How doctors diagnose this condition

Dentists use visual exams and imaging to diagnose periapical tooth abscesses. You may need a:

• Dental exam: A dentist will examine your teeth and gums. They may also tap gently on the affected tooth to see if it’s sensitive to pressure.
• Dental X-rays: Your dentist will take dental X-rays of your abscessed tooth. These images can tell them how far the infection has spread.
• Dental CT scan: In some cases, your dentist may request a CT scan, especially if they think the infection may have spread to your neck. A dental CT gives your dentist a 3D view of your mouth.

How is a periapical abscess treated?

Treatment depends on how far the infection has spread. Options include:

• Antibiotics: Dentists often prescribe antibiotics to keep abscesses from spreading. But antibiotics won’t keep the infection from coming back. You’ll still need to treat the tooth.
• Incision and draining: Your dentist will incise (cut) and drain the abscess. Then, they’ll flush it with a sterile saline solution. They may place a small rubber drain in the incision, so any remaining pus can flow out. (You may notice a strange taste while the drain is in place.)
• Root canal therapy: You may need a root canal to save your tooth. Your dentist or endodontist will remove the infected tooth pulp and drain the infection. They’ll disinfect the inside of your tooth and seal it with a filling material. You may also need a dental crown to protect the tooth.
• Tooth extraction: If the infection is too severe to save your tooth, your dentist may need to pull it. They’ll talk to you about replacement options, like dental bridges and dental implants.

Can antibiotics cure periapical abscess?

No. Antibiotics can’t reach all the places in your root canal system where bacteria can hide out. This means they can’t treat the entire infection. The only way to get rid of a periapical abscess is to remove all the infected tissue.

Generally, dentists prescribe antibiotics if the infection has spread or if you’re immunocompromised (have a weakened immune system).

When should I see my dentist?

Schedule an appointment with a dentist right away if you have symptoms of a periapical abscess. The sooner you treat the issue, the better the chance of saving your tooth.

When should I go to the ER?

Seek emergency medical care if you develop:

• A high fever (above 101 degrees Fahrenheit or 38.3 degrees Celsius)
• Nausea or vomiting
• Severe pain that doesn’t get better with medicine
• Trouble breathing or swallowing
• Facial swelling that’s spreading upward toward your eye or downward toward your neck

How long does it take for a periapical abscess to heal?

Healing time is different for everyone. But for most people, it takes about a week for an abscess to heal completely after treatment. Pain relief usually happens much faster. You may start to feel better as soon as the abscess drains or within a day or so.

In the meantime, taking over-the-counter NSAIDs for pain, like aspirin and ibuprofen, can help.

How long can a periapical abscess go untreated?

There’s no hard-and-fast rule. It could take a few weeks — or sometimes, even months — for a periapical abscess to worsen. But putting off treatment can significantly increase your risk of developing serious, life-threatening complications, like sepsis.

What is the difference between a periodontal abscess and a periapical abscess?

While a periapical abscess forms inside your tooth, a periodontal abscess forms in your gums. Periapical abscesses are the most common type of dental abscess.

Is it possible to get a periapical abscess after root canal treatment?

Though it doesn’t happen that often, it’s possible. Reinfection can occur if bacteria enter your tooth during treatment or if too much time passes before placing a crown. A tooth that’s been treated with a root canal can also become reinfected if there’s a root fracture.

If this happens, your dentist may recommend a second root canal or a tooth extraction.

Is it possible to have a periapical abscess with sinus symptoms?

Yes. If your abscessed tooth is close to your maxillary sinuses (the hollow space behind your nose), the infection could spread to your sinus cavity. This is why it’s important to contact a dentist at the first sign of trouble.