The Stages of a Tooth Abscess

By Jennifer Nadel, MD
Medically reviewed checkmarkMedically reviewed
July 27, 2022

A tooth abscess—also known as a dental abscess or oral abscess—is a painful infection that can occur in a tooth, the jawbone, or the gums surrounding a tooth.

Regardless of where this pocket of pus has formed, it’s not an infection you want to ignore.

Tooth abscesses do not heal on their own, and can lead to serious health complications if left untreated.

Tooth abscesses don’t form overnight.

Instead, there are multiple stages that lead up to the abscess formation.

In this article, I’ll break down the stages of a tooth abscess, and outline some causes, symptoms, potential complications, and treatment methods of these painful infections.

What is a Tooth Abscess?

An abscess is a painful collection of pus that builds up in tissues, organs, or spaces inside the body.

This is the body’s way of trying to heal from an infection.

Depending on the size, severity, and where it forms, an abscess may need to be professionally drained or removed by a doctor.

An abscess can form just about anywhere on the body—and that includes your teeth.

A tooth abscess is a collection of pus that forms inside of a tooth or in surrounding regions, like the gums. 

There are a few different types of tooth abscesses:

  • Periapical: When bacteria infects the pulp inside a tooth
  • Periodontal: When bacteria infects the gums
  • Gingival: When something gets stuck in the gums, like a food particle

While some skin abscesses can heal on their own, a tooth abscess always needs medical or dental attention.

Tooth abscesses do not heal naturally over time, and can spread to other areas of the body if left untreated.

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Symptoms of a tooth abscess

The main symptom of an abscessed tooth is pain.

Most people describe the pain as intense and throbbing—sometimes radiating to the ear, jawbone, and neck.

Other common symptoms of a dental abscess include:

  • Sensitivity to cold or hot foods and liquids
  • A foul taste in the mouth
  • Difficulty swallowing or opening the mouth
  • Insomnia or trouble staying asleep

If you experience any of the following symptoms, this could mean that the tooth infection is spreading, and requires immediate medical attention:

Causes of Tooth Abscesses

A tooth abscess forms because of an infection.

There are a few ways that an oral infection can occur.

Injuries and damage

In the case of gingival abscess, a foreign object—like a particle of food or toothpick splinter—may lodge into the gums and cause an infection.

Unlike periodontal or periapical abscesses, this type of tooth abscess can form fairly quickly.

The infected gum abscess will look red, swollen, and resemble a small pimple. 

Periodontal and periapical abscesses can also be caused by injury or damage.

A fall, accidental bite, contact with scalding liquids, or trauma from an occurrence like a sports injury, can injure the tooth and make it susceptible to infection.

Sometimes, the injury can affect the inner pulp and won’t have a visible fracture or crack.

Underlying medical conditions

If a person has periodontitis, also known as gum disease, the inflammation can eventually develop into a tooth abscess.

Severe cases of gum disease can cause the gums to pull away from the teeth, creating pockets for food and bacteria to collect and grow. 

If a person has a weakened immune system due to an underlying medical condition, they may be at a greater risk of developing a tooth abscess.

Autoimmune conditions like diabetes can increase the risk of a tooth infection. 

People undergoing treatment or medical procedures that affect the immune system, like chemotherapy, may temporarily have a greater risk of developing a tooth infection. 

Sugary foods

People that consume lots of sugary or starchy foods and drinks may be at greater risk of tooth infection.

These types of food and beverages encourage the growth of oral bacteria.

To reduce the risk of dental decay, the WHO recommends that free sugars (this includes added sugars and naturally-occurring sugars) should account for less than 5% of calories consumed each day.

Proper oral hygiene—which includes daily flossing, brushing, and mouthwash rinses—is also important in preventing plaque buildup and decay.

Otherwise, cavities can form. Untreated cavities can eventually result in a tooth abscess. 

Tooth Abscess Stages

Most people don’t realize they have a tooth or gum infection until the later stages—but this doesn’t mean that an infection or abscess happened suddenly overnight. 

Understanding how all the stages of an abscess progress can help you prevent an abscess from developing. 

Enamel decay

Before an abscess develops, an infection needs to be present. 

It’s natural for plaque to live in the mouth and grow.

Plaque is white, tacky buildup that contains bacteria—you can sometimes feel a light film of plaque when you run your tongue over your teeth in the morning. 

Flossing and brushing helps cleanse the mouth and prevents plaque from building up.

When plaque isn’t removed, it can eventually harden into tartar, which can lead to erosion of the teeth’s enamel.

Eventually, this decay can form a cavity.

Dentin decay

If cavities are left untreated, then we move into the next stage of dentin decay.

During this stage, bacteria will continue through the tooth’s enamel and make its way into the dentin, a soft layer beneath the enamel.

Pulp decay

Once bacteria has made its way through the dentin layer, it can begin eating away at the tooth’s inner pulp.

Tooth pulp, also referred to as dental pulp, is the center part of a tooth composed of connective tissue, blood vessels, and cells.

It is the soft, jelly-like core of the tooth. 

Since the dental pulp is the innermost layer that contains nerves and blood vessels, infection and inflammation of the pulp can be extremely painful.

The body’s immune system will try to begin fighting off this infection, which sets the stage for an abscess to form.

Abscess formation

During this stage, your immune system is trying to fight off the infection and heal.

Pus will begin to form, and an abscess will develop. 

You will likely feel throbbing pain and discomfort as the abscess develops.

Since a tooth abscess will not naturally heal on its own, getting immediate dental or medical attention is essential. 

Over time, a tooth abscess will continue eroding the tooth and can eventually cause tooth loss.

In some severe cases, the infection spread to other areas of the body.

Complications from Tooth Abscesses

An untreated tooth abscess can spread to your jaw, neck, and head.

This can lead to sepsis or meningitis.

Both of these conditions can be life-threatening. 

The infection from an untreated dental abscess can also lead to osteomyelitis, an infection of the bone.

If a dental abscess develops into a bone infection, you may experience fever and severe jaw pain.

If not treated soon enough, this could cause permanent damage to the jaw bone.

An untreated tooth abscess can also lead to total tooth loss, where the tooth becomes so decayed it breaks or falls out.

Tooth Abscess Treatment

Dental infections like a tooth abscess can easily be treated.

The sooner you see a doctor, dentist, or other medical professional, the easier the treatment process will be. 

The type of treatment your doctor or dentist recommends will depend on the location and severity of your dental abscess. 

Root canal

If you have a severe infection, your dentist may recommend a root canal.

In these cases, the infection has usually worked its way down to the inner dental pulp.

This procedure will involve removing the tooth’s infected inner pulp and filling the gap with material to prevent another infection from happening.

Dentists use anesthesia to numb the tooth and its surrounding areas before the procedure.

After the anesthetic injection there should not be pain during the root canal.

You may feel mild discomfort or pain for a few days after the procedure. 

Tooth extractions

In severe cases where there’s a substantial amount of decay, your dentist may recommend extracting the entire tooth. This is usually a last resort. 

Similar to a root canal, your dentist will administer local anesthesia so you won’t feel pain during the extraction.

Over-the-counter pain medications should provide sufficient pain relief as you heal after the procedure, or your dentist may prescribe prescription medication to help manage the pain for the first few days after the procedure.


Many infections will require a course of antibiotics to get rid of any remaining bacteria.

Antibiotics alone are usually not enough to get rid of an infection.

Instead, they are usually used as a supplementary treatment in tandem with a dental procedure.

Talk to a doctor

K Health can help you get the antibiotics you need.

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How K Health Can Help

Did you know that you can get online dental prescriptions for tooth infections? 

Download the K Health app to check your symptoms using our symptom checker and text with a doctor in minutes. 

K Health’s board-certified, U.S.-based doctors can provide a treatment plan and, if required, a prescription to resolve your symptoms as soon as possible. Clinicians are available 24/7.

Frequently Asked Questions

How do I know if my tooth abscess is spreading?
Although rare, it's possible for a tooth abscess to spread to other areas of the body. If you are experiencing fever, persistent swelling, increased heart rate, dehydration, or stomach pain, these are all warning signs that the infection is spreading. Seek immediate medical attention.
How long can you go with an abscessed tooth?
A tooth abscess will not heal on its own. Left untreated, the infection can spread to other areas of the body and cause serious complications. Seek medical attention as soon as possible to prevent the infection from spreading.
How quickly do tooth abscesses grow?
Tooth abscesses don't form overnight—there are multiple stages to formation, starting with enamel erosion and progressing to dentin decay, pulp decay, and finally abscess formation. This process can take weeks or even months.
When should I worry about a tooth abscess?
If you suspect that you have a tooth abscess, seek dental or medical attention as soon as possible to prevent serious complications from occurring. If you are experiencing fever, chills, nausea, vomiting, or diarrhea, seek emergency care.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Jennifer Nadel, MD

Dr. Jennifer Nadel is a board certified emergency medicine physician and received her medical degree from the George Washington University School of Medicine. She has worked in varied practice environments, including academic urban level-one trauma centers, community hospital emergency departments, skilled nursing facilities, telemedicine, EMS medical control, and flight medicine.

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