Understanding a Tooth Infection and What To Do
What is a tooth infection and how does it develop?
Essentially, a tooth infection occurs when bacteria get inside a tooth, normally a space where the pulp and the nerve reside. These send signals from your teeth and help keep a tooth healthy. If something happens to that pulp, the nerve inside the tooth, bacteria can grow there. As we know, bacteria can create pus as it grows, killing the surrounding areas and causing a more serious infection to develop. An infected tooth is that process where the nerve has died. The inside of the tooth becomes colonized with bacteria, which then grows, creating pus, pressure, and damage to the areas surrounding it.
What are the most common symptoms or signs of a tooth infection?
One of the biggest signs is pain, swelling, and pus. The area might be red and swollen, and it might look like you have a lump underneath the skin or even larger. The outside could look red or feel warm to the touch.
These are classic signs of infection. In the earlier stages, it may feel more like a toothache with pressure behind it, and that toothache will have a throbbing feeling. But that throbbing can also spread to the skin, bone, and other teeth surrounding it, or if it's in the upper jaw, sometimes even the sinus up top.
How can a dentist tell the difference between a cavity and an infection?
That's a really important question. We get that one all the time. People think automatically, "Well, if my tooth is painful, then I must have a cavity." That's not necessarily true. Many people we meet every day have cavities with no symptoms whatsoever. Sometimes, the same is true with infections.
The classic infection has pain, swelling, pus, and a lot of discomfort. There's a big enlargement of that area, and sometimes you can even see the pus coming from it. Those are unmistakable.
However, we have also seen chronic infections that find some pathway to drain on their own. We've met many people who have infected tissue, dead or dying nerve, and that tooth is ailing. It's not doing well even though there's a silent infection down at its root tip that's draining. So, it's possible to have an infection that causes no pain or a cavity that causes no pain, or it's possible to have a cavity that causes a lot of pain as well as an infection that causes a lot of pain.
One of the best ways to find out for sure is to take an X-ray of that tooth and look at its root tip and compare it to the top of the tooth. In that way, we can determine if it's at the root or at the top of the tooth, helping us differentiate whether we're talking about a cavity or an infection.
What are the risks if a tooth is left untreated?
Sometimes it's tempting to postpone things or just see if they'll go away. That’s never a good choice with a tooth infection. One of the big reasons is tooth infections generally spread and increase until something bad happens. The pressure of the infection below the surface is enlarging and looking for a way to exit. It can exit through the opening of the tooth itself or through the side.
One of the more dangerous situations is when a lower tooth, particularly far back, becomes infected and the pressure drains not into the mouth where it can be swept away or cleaned, but down into some dangerous spaces deep in the middle of our throat and into the upper regions of our chest. That's an infection we would consider life-threatening. Those infections can travel and increase in a way that can truly impact your life.
What are the signs that a tooth infection is spreading to other parts of your body?
One of the simplest signs is if your swelling is spreading to more regions and if that redness is taking up a larger space than it used to.
Another sign is if teeth, in addition to the infected tooth, are also feeling uncomfortable, which is common. That's a sign that the infection is getting bigger, encompassing more area, and enlarging as time goes by. These kinds of infections need prompt treatment. You should call and get in right away to get those evaluated, whether that's at the emergency room or your local dentist.
Another sign an infection could be spreading is transitioning from local symptoms to overall symptoms. Instead of just redness and swelling, you might develop a fever, feel lethargic, or generally feel unwell. Those are much more significant findings that the infection is impacting your entire body and your entire immune system is fighting just a simple tooth infection. Those signs of spread are not ones we like to see, and you should take them very seriously.
What treatment options are available for an infected tooth?
Back in the olden days before the advent of antibiotics, removing the tooth was the only option. That was an unsavory process. Nowadays, we have the advantage of antibiotics, which is both a blessing and a curse for two reasons.
One is if you take antibiotics, they do an effective job of shrinking down the pain, swelling, pressure, and discomfort. Many people mistakenly think that's it, that they're cured. Antibiotics have solved the tooth infection, but it couldn't be further from the truth. In reality, all it's done is masked the symptoms. You no longer have the pain, swelling, pus, and pressure causing you pain. But as long as that tooth is still there, if the origin of the bacteria is inside that tooth, it will come back. That sets the stage for an even more damaging infection once those antibiotics run out or possibly generating a chronic infection situation where the bacteria is still present, eroding the bone, spreading to other teeth, and causing great harm, but silently if you don't have the continuation of your symptoms.
You might actually do yourself a disservice if you just got antibiotics and didn't get the tooth checked out. You could be setting the stage for a more significant infection in the future and more tangible, measurable bone damage and neighboring tooth damage if the true cause didn't get treated.
Do I need an antibiotic prescribed by a dentist for a tooth infection?
The answer is usually you could get your antibiotic prescribed by the emergency room or your standard physician. Those are totally fine. But I would caution any listener that if antibiotics are used for a tooth infection, it is always necessary to get that tooth evaluated, take an X-ray, get a diagnosis, and find out what's going on. If that's a tooth that can be fixed, remedied, and saved, then it's important that that be done promptly.
On the other hand, if that's a tooth that needs to be removed because it's not fixable or savable, it's also important that that gets done promptly. The wrong thing to do would be to take antibiotics and then do neither of those two things, which is remove the infection and save the tooth or completely remove the tooth. If you did neither, you're setting up the stage for the return of infection, possibly a more difficult-to-fight infection, as well as continued ongoing bone damage and tissue damage around this tooth, possibly spreading to neighboring teeth.
So, the wrong thing to do would be to take antibiotics and then not get the tooth evaluated. The right thing to do would be to take antibiotics if they're necessary, diminish your symptoms, start to feel good, and then take that final step of whatever needed to happen to the tooth.
Are there home remedies that are useful for taking care of a painful tooth or an infected tooth?
The answer is to some degree yes. There are some superficial treatments to decrease nerve pain from teeth. Clove oil is a common one and is used within dentistry in several products. That's usually for nerve irritation, not so much for an infection. In terms of infection, if it is spreading into soft tissue, sometimes using either a heating pad or moist heat on the outside can help tissue infections gather together in a way that they can be appropriately drained. Sometimes the body can fight those themselves.
But I would caution any listener, those remedies have nothing to do with the bacteria inside of a tooth. There is no home remedy that can get into the center of a tooth in a way that eliminates the bacteria. So, no, we don't have a good effective home remedy for an infection that comes from inside of a tooth if that infection is spreading into the soft tissues, the bone around the tooth, and the ligament. The only answer is you need to be seen. You need a real procedure to either fix that tooth and save it or remove it if it's not fixable.
What are the most common signs of an infected wisdom tooth?
An infected wisdom tooth almost always appears as pain and swelling in the gum tissue. A common symptom is that the gums in the very far back around where the wisdom teeth are coming in feel swollen, puffy, tender to the touch, and you can't bite down all the way or eat food. If you try to squeeze, it feels like it pinches that tissue, causing redness of your cheek, swelling, and radiating pain. These are classic signs.
The reason for this is usually the infection around the skin, the gum tissue around the top of that tooth is infected. This is a common reason why people have their wisdom teeth removed, in addition to impaction where wisdom teeth don't have enough room to come in. They're stuck on the neighboring teeth, underneath the level of the gums, causing problems until they're removed. Wisdom tooth infection is real and mostly involves swelling in that region.
What about treating an infected wisdom tooth? Is the answer always an extraction?
The answer is usually extracting a wisdom tooth is the solution to the infection. In many cases, antibiotics aren't necessarily recommended for infected wisdom teeth. The removal of the wisdom teeth is considered the cure. Many of our clinical guidelines say that for root tip infections and a number of endodontic infections, the recommendation is to do the proper curing procedure and that infection will go away on its own.
In almost all cases, that's true. We have amazing immune systems, but the answer to an infected wisdom tooth is almost always to take it out. Are there cases where just removing the skin, essentially doing gum surgery around the wisdom tooth, could eliminate that infection? The answer is yes, but it carries a good amount of risk and it's not our recommended way to deal with an infected wisdom tooth. It's a lot of extra work with little payoff.
What should patients do if they notice a swelling around a tooth or a swelling in their face?
The answer is to prioritize your trip to the dentist. Get in and get that tooth evaluated as promptly as possible. The wrong thing to do would be to procrastinate and postpone because that's almost always when Murphy's law strikes—it will be late at night at an inconvenient time when the infection spikes and crescendos, leaving you with worse options for getting that tooth looked at.
A second option would be to go to the emergency room or urgent care, but they often don't have the ability to look at the tooth itself, take an X-ray, or truly diagnose the origin of it. They can just say, "Yep, it's coming from your tooth," and will tell you to see a dentist. So, if you have an infection or suspect one, even if it's just a swelling around a tooth and you suspect something's wrong, make it a priority to get in and have that tooth evaluated. Go for an emergency exam, limited exam, and find out, "Hey, this tooth is acting up. I need to know what's going on." There's nothing smarter than making that your first call—call your dentist, make that appointment, and get that tooth looked at.
If you’re ready to schedule an exam or would like to learn more about our services, we’d love to hear from you. Call us at 503-786-3000 or email [email protected]. We look forward to caring for your smile.