Toothache and Dental Abscess
Toothaches are typically caused by dental caries (cavities) and periodontal diseases like gingivitis. Shockingly, 25% of people over age 60 in the United States have lost all of their teeth — typically due to both cavities and gingivitis. While it’s well known that dental caries and gingivitis cause pain and discomfort, many don’t know that they can break down the barrier between bacteria in the mouth and the rest of the body.
It is not uncommon for patients with cavities or gingivitis to develop serious infections of the deep tissues of the head and neck. Some also develop bacteria in their blood that infects heart valves (endocarditis), prosthetic devices, the spine, and other organs. Often, teeth are weakened by these infections and have a break event after biting down on something hard. The resulting broken tooth causes severe pain and often breaks down the barrier between the bacteria of the mouth and the rest of the body. An infection like this typically becomes an abscess before spreading throughout the body. That’s why it’s so important to receive antibiotic treatment right away when abscesses first form.
Dr. Kingsley’s Bedside Diagnosis
Dentists will not pull teeth or perform any procedures until you have finished a 2-week course of antibiotics. Because of this, it’s best to schedule your appointment with your dentist for 2 weeks from now and then see your local telemedicine doctor for a 2-week prescription of clindamycin.
What is a Tooth Abscess?
A tooth abscess is formed in three ways:
- A defect in enamel from a cavity, a dental procedure, or a traumatic tooth fracture (i.e., being punched in the face or catching a ball with your face)
- Local spread of infection from a nearby abscessed tooth
- A bloodstream infection that seeds the oral cavity and forms an abscess
Once the infection has taken hold, there is a rapid buildup of pressure inside the rigid periapical space within the gums. This pressure becomes so strong that it compresses blood vessels. Without blood flowing to nearby tissue, the tissue begins to die, and pus forms.
When Does a Tooth Abscess Become Dangerous?
Tooth abscesses can be dangerous, and they are nothing to trifle with. There are two main reasons that a tooth abscess can be harmful:
- Infections spread within tissue planes. Bacteria can easily traverse along tissue planes, as there is very little resistance. This is dangerous because tissue planes take bacteria to deep tissues of the head and neck. Abscesses can grow very quickly in these areas, making their way into the airways in the neck and obstructing all airflow to the lungs. Retropharyngeal abscesses and peritonsillar abscesses are two life-threatening infections caused by tissue plane infection.
- Infections seed the bloodstream. Seeding the bloodstream means that serious, life-threatening infections become possible. When large amounts of pathogenic bacteria float in the bloodstream, it’s only a matter of time before they spread to other organs. This may cause a brain abscess, spinal abscess, endocarditis (a fatal disease in the heart), as well as other organ infections.
For the very serious reasons above, we always recommend that patients receive antibiotic therapy to prevent complications.
Many patients wonder whether they should go to the dentist or to the doctor when they have a tooth abscess. The simple answer is BOTH. A tooth abscess almost always requires dental work because there is an underlying disease tooth that needs to be removed or repaired. It’s best to first schedule an appointment with your doctor because most dentists aren’t comfortable with prescribing antibiotics and they won’t do any procedure to fix or remove the tooth until the infection has been treated. This is to prevent seeding the bacteria into the bloodstream. After the infection is treated, it’s time to take a trip to the dentist.
How Do You Get Rid of a Tooth Abscess?
In general, tooth abscesses won’t go away on their own and typically can’t be cured through antibiotics alone. They often require surgical drainage and even surgical extraction of the infected tooth (or what remains of it). The following steps can help you get rid of a tooth abscess:
- Step 1: Receive 2 weeks of antibiotics and pain medication from your telemedicine or primary care doctor
- Step 2: Schedule a doctor’s appointment for the day after your last dose of antibiotics
- Step 3: Have the infected tooth removed and the abscess drained in your appointment
- Step 4: Continue with an additional 3-5 days of antibiotics after the abscess is drained
Please note that the above treatment plan is not for everyone. If you are immunocompromised, diabetic, or have a history of antibiotic-resistant infections, speak with your doctor for an individualized treatment plan. Also, not every patient requires 3-5 days of antibiotics after surgical drainage, whereas others require more than 5 days. If your symptoms are completely resolved by your final day of antibiotics, talk to your doctor about continuing the antibiotics.