Acute periapical abscess

Pain of dental abscess


An acute periapical abscess (dental abscess) is what most people are referring to when they say: ‘I have a tooth abscess’. Periapical means around the apex of the tooth, which is the end of the root. A dental abscess occurs due to infection of the pulp inside the tooth.  Acute means that the infection is in its ‘acute phase’ which refers to the types of response your immune system is making to the infection. Basically it means it is likely to be painful and also may be swollen.


  • Pain - well localised to a tooth, made worse by any pressure on the tooth
  • Tenderness and/or swelling in the gum around the root of the tooth
  • Swollen tender lymph glands - this is a sign that the infection is increasing
  • Facial swelling - in more severe case there can be significant swelling and an associated fever if left unchecked this infection can become a medical emergency.


Home care advice

A dental abscess in its early stages may be managed until you can get to see a dentist with pain killers and hygiene measures and sometimes the immune system will keep the abscess under control. However if it gets more serious then it is likely to need urgent professional attention. Any uncontrolled swelling especially when heading towards the neck and throat needs to be URGENTLY treated at an A&E department as there is the danger of life threatening conditions such as Ludwig's Angina.

  • Painkillers such as ibuprofen and paracetamol can be taken together to combat the pain

  • Hot salty rinses to clean the area and encourage any drainage of pus that maybe occurring.

  • Gels that anaesthetise (numb) the area. They usually contain either Benzocaine or lidocaine.

  • Applying a cold compress may reduce swelling

  • Keep hydrated and rested to maintain a good immune response

  • Natural remedies may offer some relief such as Clove Oil which contains eugenol - a natural anaesthetic and antiseptic.

  • Oral Antibiotics - Any swelling which increases or does not respond to local measures will require a prescription for an antibiotic such as Amoxycillin (IF NO ALLERGY), Clarithromycin or Metronidazole.

  • IV Antibiotics - in a hospital environment if swelling keeps spreading as mentioned above.

Once lockdown is lifted the tooth will definitely need treatment from a dentist. If there is enough tooth structure left in the tooth a root canal treatment is the only way to save the tooth. Otherwise the tooth will need to be extracted.

Written by Andrew Bain BDS MJDF (RCS Eng)
May 1, 2020