Periapical Abscess
What Is a Periapical Abscess?
When bacteria from an infected or necrotic pulp escape through the apical foramen (the small “opening” at the tip of the root), they cause an infection in the bone around the root. The body responds by producing pus — and this is the “abscess”. It’s a serious condition that requires immediate dental care. Without treatment it can spread to adjacent areas and — rarely but possibly — become life-threatening.
Symptoms — How to Recognise It
- Early stages:
- Intense, persistent pain in the tooth
- Pain that worsens with chewing or touch
- The sensation that the tooth is “higher” than the adjacent ones
- Pain that becomes throbbing (you feel your heartbeat in the tooth)
- Advanced stages:
- Swelling on the gums around the tooth
- Facial or cheek swelling
- Red, tender gums
- Bad taste in the mouth (when the pus breaks through)
- Sinus tract — small “hole” on the gums from which pus drains
- Fever, malaise
- Swollen lymph nodes in the neck
- Important note: when a sinus tract forms and pus drains, the pain often subsides — but the infection CONTINUES. DO NOT assume that it has “passed”.
Treating the Periapical Abscess
Drainage & pain relief (first appointment):
The tooth is opened and the pus is drained. If there's significant swelling, an incision in the gums may also be made. We prescribe antibiotics only where needed.
Root canal treatment:
Cleaning and disinfection of the root canals. In advanced cases, 2–3 appointments may be needed with intermediate medication inside the tooth
Final sealing & restoration:
Once the infection has subsided, we seal the canals and place a permanent restoration (usually a crown)
Follow-up:
Re-examination at 6 and 12 months with X-rays, to confirm healing of the bone around the root.
When It's an Emergency
- Call immediately or go to A&E if:
- You have a high fever (>38.5°C) with facial swelling
- Swelling spreads toward your eyes or neck
- You have difficulty breathing or swallowing
- You feel unwell, confused or nauseous
- These are signs the infection is spreading and requires immediate intervention.
How It's Diagnosed
- Detailed clinical examination
- Sensitivity testing for chewing and pressure
- Pulp vitality tests (cold/heat/electric testing)
- Digital intraoral (periapical) X-ray — reveals a “shadow” (lesion) around the root
- 3D X-ray (CBCT) in complex cases for precise mapping
How It's Diagnosed
In a few cases (persistent abscess, anatomically complex roots, failed previous treatment), an apicoectomy may be needed — a minor surgical procedure where the tip of the root is removed along with the infected tissue.
Prevention
- Proper oral hygiene — brush twice daily, floss daily
- Preventive check-up every 6 months
- Treat decay promptly — don't wait until pain appears
- Immediate visit if there's a broken or cracked tooth
- Don't ignore the early signs of pulpitis
Everything You Need to Know
Frequently Asked Questions (FAQ)
Can an abscess go away on its own?
No. Even if symptoms temporarily subside (e.g. via a sinus tract), the infection continues silently and worsens the condition. Dental treatment is always required.
Are antibiotics enough?
No. Antibiotics temporarily control the infection but don’t address the cause — which lies inside the root canals. Root canal treatment or extraction is essential.
Will I lose my tooth?
In most cases, no. With prompt root canal treatment, we save the tooth in 85–95% of cases. Only with severely damaged teeth or root fractures is extraction required.
How long does treatment take?
Usually 2–3 appointments over 2–4 weeks (to control the infection before final sealing). The first appointment provides immediate pain relief.
Is an abscess dangerous?
Rarely, but yes. Without treatment, the infection can spread to surrounding tissues (cellulitis), the sinuses, or — rarely but possibly — to the neck or brain. That’s why immediate action is critical.
Why did my pain stop suddenly?
Most likely a sinus tract has formed and pus is draining. It doesn’t mean the problem is resolved — it just means the pressure has reduced. The infection continues and needs treatment.
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