Gum Abscess: Symptoms and What to Do in an Emergency

A gum abscess is a collection of pus in the gum or the tissues surrounding a tooth as a result of a bacterial infection. It usually shows itself with pain, swelling and tenderness that start suddenly. Even if the abscess drains on its own and you feel relief, a dental assessment is needed because the underlying cause has not gone away.

What is a gum abscess?

A gum abscess is an acute infection in which pus collects in a confined area of the tissues around a tooth. The type most often encountered in the periodontal literature is the periodontal abscess: it develops when bacteria multiply inside the pocket between the tooth and the gum and the opening of the pocket narrows.

In the classification of periodontal diseases published jointly in 2017 by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP), the periodontal abscess is addressed among the acute periodontal lesions. In this classification, abscesses are divided into those that develop in patients with periodontitis and those related to causes other than periodontitis.

A gum abscess needs to be distinguished from an abscess that originates in the nerve of the tooth (the pulp) and develops at the root tip. The two conditions can look similar, but their treatments are different. The distinction is made by examination, tooth vitality tests and X-rays.

What are the symptoms of a gum abscess?

The most common symptoms of a gum abscess are a raised, red and tender swelling on the gum, throbbing pain, and tenderness that increases when the tooth is touched. Other symptoms include:

• A shiny, tense and red bump on the gum,
• Pus coming from the gum pocket when pressed or on its own,
• Pain in the tooth when chewing and a feeling that the tooth is "longer" than usual,
• Increased looseness of the affected tooth,
• A bad taste in the mouth and bad breath,
• In some cases, swelling of the cheek and enlarged, tender lymph nodes under the jaw,
• In more advanced cases, fever and fatigue.

The severity of the pain varies from person to person. Some abscesses may cause only mild pain because the pus drains on its own through a pathway; this does not mean the infection has cleared.

What causes a gum abscess?

The most common cause of a gum abscess is periodontitis that has not been treated or is still being treated. When the opening of a deep gum pocket narrows, the bacteria that build up inside cannot drain out, and the inflammation collects in a confined area. Other possible causes include:

• Trapped foreign objects: Objects such as a fish bone, a popcorn hull, a toothpick or a piece of dental floss becoming lodged in the gum pocket,
• Changes during treatment: Rapid tightening of the gum margin over deep pockets, with tartar left deep inside, can rarely set the stage for an abscess,
• Causes related to root structure: Anatomical grooves on the root surface, root cracks or fractures,
• Systemic factors: Conditions that affect the immune response, such as uncontrolled diabetes,
• Inappropriate use of medication: Taking antibiotics alone, without cleaning the gum pocket, has also been associated with abscess formation in the literature.

If you are curious about how periodontitis progresses, you can read our article Periodontitis Stages and Grades.

What can you do at home in an emergency?

What you can do at home for a gum abscess is aimed only at easing discomfort until you can reach a dentist; it does not remove the source of the infection. In the meantime, the following may help:

• Gently rinsing your mouth with warm salt water (half a teaspoon of salt in a glass of warm water),
• Continuing to clean the area with a soft brush, without pressing,
• Taking a pain reliever that you have used before without problems and that your doctor considers suitable, at the dose on the package insert,
• Drinking plenty of water and not chewing hard foods on the affected side.

What to avoid is just as important:

• Do not try to burst the abscess with a needle, a toothpick or a similar object.
• Do not apply a warm compress to the outside of the face; heat can make it easier for the infection to spread toward the surface.
• Do not place aspirin or any other tablet on the tooth or gum; it can burn the tissue.
• Do not start taking leftover antibiotics at home without consulting your doctor.

How is a gum abscess treated?

The first step in treating a gum abscess is draining the pus (drainage) and cleaning the source of the infection. Antibiotics are not routinely needed for every abscess; they are generally considered as an adjunctive treatment when there are systemic signs such as fever and spreading swelling, or when drainage is not sufficient.

Treatment usually consists of the following stages:

1. Examination and diagnosis: Whether the abscess originates from the gum or from the nerve of the tooth is assessed through clinical examination, pocket measurements, vitality tests and X-rays.
2. Drainage: Under local anesthesia, the pus is drained through the gum pocket or through a small incision; the aim is that you do not feel pain during the procedure.
3. Cleaning the pocket: Bacterial plaque, tartar and any foreign object inside the pocket are removed.
4. Medication if needed: If there are systemic signs, the doctor may prescribe an appropriate antibiotic.
5. Comprehensive periodontal treatment: Once the acute phase has settled, the underlying periodontitis is assessed and gum disease treatment is planned.

For teeth with advanced loss of support, whether the tooth can be preserved is assessed after examination and tests. In treating an abscess, periodontist Dr. Nadin Gemrekoğlu, DDS, PhD, places emphasis not only on resolving the acute condition but also on planning treatment aimed at the cause of the disease.

Can a gum abscess come back?

If the underlying periodontitis is not treated, a gum abscess may recur in the same tooth or a different one. The way to prevent recurrence is treatment of deep pockets, effective plaque control at home and regular periodontal maintenance appointments. It is also important to pay attention to early warning signs such as bleeding gums; our article Why Do Gums Bleed? can be a helpful guide on this.

When should you see a dentist?

When you notice swelling on your gum, pus discharge or throbbing pain, see your dentist at the earliest opportunity. It is especially important not to delay in the following situations:

• If the swelling is growing within a day or two,
• Even if the abscess has drained on its own and you feel relief, because the source of the infection is still there,
• If the tooth has become looser,
• If you have a condition that affects immunity, such as diabetes, or if you are pregnant.

Although the symptoms may suggest an abscess, a diagnosis can only be made through an examination. To make an appointment, you can reach us through our contact page.