Tooth decay is bad enough, but when bacteria enters the picture, things really can get ugly. Bacteria infecting the pulp inside a tooth’s root can find its way there through deep cavities, cracks or untreated gum disease, and the resulting infection forms a pocket of pus known as an abscess.

“The earliest symptom of an abscess is a small pimple on the gum tissue, next to a tooth,” says Dr. Humaira Rosinski, a dentist with Creve Coeur Dental. “An abscess is cause for concern, and any person who notices shape and/or color change in their tissue should be seen immediately.”

The bump on the gum is known as a fistula and may allow an abscess to go unnoticed because it helps relieve pain. “If there’s nowhere for the infection to go and it stay in the tooth, then we see swelling and pain,” says Katie Kuehn, a dental assistant to Dr. Robert Rothenberg. “But if the tooth is broken and the infection drains into the gum, it’s not as painful.”

Other common symptoms related to an abscess include a persistent toothache, sensitivity to temperature or pressure, swelling, and swollen lymph nodes near the infection site. Prompt treatment is important to prevent the infection from spreading to the jaw and surrounding tissue or becoming a body-wide systemic bacterial infection.

There are two ways to treat an abscess, Kuehn says: root canal treatment or extraction. A root canal can save the tooth. “Size and location are the greatest determining factors for how an abscess is treated,” Rosinski adds. Prior to a root canal or extraction, the abscess is drained. “Two quick examples: a larger facial swelling, anything bigger than a pimple, is treated by incision, drainage and a course of antibiotics. Yes, incision and drainage is as painful as it sounds. Once the swelling subsides, further treatment of the tooth is possible. A smaller abscess is treated in the same manner: incise, drain, antibiotics and determination of treatment.”

While root canals have a fearsome reputation, the patient’s mouth is numbed, as if having a cavity filled, and the procedure offers immediate pain relief. By drilling deep into the tooth’s root, infected tissue can be removed. The resulting root canal is sealed and the tooth is filled.

An abscess is no fun, and prevention is the goal. “Take your dental health seriously. An ounce of prevention is worth pounds of cure,” Rosinski says. “Take care of your teeth, take care of your health, keep your regular appointments, and when you notice a change in your oral health, even if it doesn’t hurt, be seen as soon as possible.”

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