What are the different stages of gum abscess

gum abscess

What is a gum abscess?

Gum abscess is a dental emergency, it is the consequence of a persistent and untreated infection. Its location on the gum is different, but the process is the same: some virulent bacteria will trigger reactions in the tooth or the surrounding tissues. The products of these reactions (dead cells, inflammatory mediators, bacterial products) will form what is called pus. This pus will be collected in an area leading to an abscess.

Different types of abscesses can occur:

gingival abscess

Gingival abscess: The gingival abscess mainly affects the posterior teeth. It is the accumulation of pus in the gum part closest to the tooth (marginal gum). The most common cause is the penetration of a foreign body into the gum which is considered as a bacteria, the gum will trigger an inflammation to defend itself. Among the symptoms: a feeling of pain, heat, bleeding, and discomfort during meals.

periodontal abscess

Periodontal abscess: This type of abscess occurs during periodontal disease. Factors such as poor oral hygiene, smoking, or certain diseases such as diabetes, can unbalance the oral flora in favor of aggressive bacteria. These bacteria will attack our gums and create pockets (widening of the space between the tooth and the gum). Inflammation persistence in these pockets due to the lack of treatment will lead to the accumulation of pus and the formation of an abscess known as a periodontal abscess.

periapical abscess

Periapical abscess: Tooth infection will trigger reactions throughout the pulp, including the end of the root (the periapical part). Caries is the main cause of this condition, but other factors can also interpose: fracture, shock, unbalanced occlusion, complications of a root canal treatment. The infection will result in the destruction of bone and the accumulation of pus in the periapical region. Lack of treatment will worsen the infection, leading to an abscess. It will continue to progress until it reaches the gum.


Pericoronary abscess: Pericoronary abscess is a common condition for wisdom teeth. It is mainly due to the partial eruption of these teeth. Normally, when the teeth erupt, a connection is formed between the tooth and the gum, but in partial eruption, the tooth has only a visible part, the rest is often covered by an inflamed gum: the connection between the gum and the tooth has not been properly established, which leads to the accumulation of debris and bacteria in this area resulting in infection. Like other types of abscesses, pus will be accumulated in this area leading to an abscess.

Gum abscess stages: The long process of infection

The gum abscess does not appear overnight, the infection must go through different stages. The principle is the same for all types of abscesses, but the location and factors are different.

The first stage: Inflammation

What is an inflammation

Inflammation is our body's response to injuries and infections. It is a vital defense mechanism that allows detecting, destroying, and eliminating all substances not recognized by our body. However, if the inflammatory process goes on for too long or if it occurs aimlessly, it can become harmful: The damage is then more than the benefits.

This stage represents the response of our tissues to aggression. To defend themselves, our tissues will trigger reactions which will be manifested by:

  • Redness
  • Swelling
  • Pain
  • Heat

This is the stage where you need to react in order to avoid complications. Visit your dentist quickly if you notice any of these signs.

The second stage: Abscess

If the infection is not treated in time, it will continue to evolve and will do more damage including destruction of the bone, loss of teeth, or the spread of the infection in the body (septicemia).
The product of inflammation will be collected and accumulated as pus, resulting in an abscess.

The abscess is an advanced stage of the infection and means that the organism could not manage the situation because of very virulent bacteria or a weakened immune system. This is why you should act quickly at the first sign, where the infection is easily treatable.

The third stage: The spread of infection

Left untreated, an abscessed tooth can lead to serious complications. At a very advanced stage, the swelling will be seen externally, the ganglia of the jaw will be activated: the infection then spreads to the soft tissues such as the cheek, the skin, the muscles, this condition is called infectious cellulitis.
The pus makes its way through the tissues and pierces an outlet (the fistula), which will end up on the gum or sometimes outside, on the skin of the face (cheek, chin).

What causes gum abscess?

In most situations, the abscess is triggered by an infection. The pulp is one of the main entry points for bacteria. Virulent bacteria will penetrate the pulp through a cavity or fracture and will subsequently cause the formation of an abscess. Like the pulp, periodontal tissue can also be attacked and cause an abscess. The abnormal evolution of certain teeth, especially wisdom teeth, can also lead to a gum abscess. This is the case with pericoronitis.

So anything that involves bacteria including cavities, plaque, tartar can lead to infection and the appearance of an abscess. Besides the infection, other causes can be associated with a gum abscess:

  • Foreign body
  • Excessive occlusal forces
  • After endodontic treatment
  • Deficiency of the immune system
  • Some bad habits harmful to our oral health

Should you be worried?

The short answer is No! As long as you know when and how to act, you have nothing to worry about.
According to the statistics, the number of people hospitalized due to dental abscesses increased by more than 40% between 2000 and 2008, from 5,757 in 2000 to 8,141 in 2008. Some 66 people died after they were hospitalized.
But why are people being hospitalized—and possibly even dying—over such a preventable dental condition?
The answer is that these people neglect their oral health, and instead of acting quickly, they wait for the infection to spread to the point where it becomes difficult to eat, breathe, or speak.

But there is a better way!

Do not wait until your health is threatened to visit your dentist, take preventive measures from the start that will cost you nothing to avoid the worst complications.

How to prevent a gum abscess?

Prevention is the best way to beat any type of oral infection.
Dental abscess prevention tips include:

  • Brush with fluoride toothpaste after eating or drinking acidic, sweet, or sticky foods.

  • Floss your teeth. It may seem difficult at first, but once you get used to it, you can't do without it- -Rinse your mouth with natural mouthwashes.

  • Visit your dentist regularly at least two times a year.

  • Drink a lot of water.

  • Balance your diet.

  • Avoid snacking and sipping frequently.

  • Eat healthy foods for your teeth that are rich in minerals and water like green vegetables, cheese, apples, tea, fish...

  • Learn about antibacterial treatments. If you're especially vulnerable to tooth decay — for example, because of a medical condition — your dentist may recommend special antibacterial mouth rinses or other treatments to help cut down on harmful bacteria in your mouth.

How gum abscess is treated?

The treatment is performed according to the state of the tooth and the type of abscess, the aim is to drain the abscess in order to relieve pain and reduce the bacterial load, then completely eliminate the infection by the prescription of antibiotics and maintaining good oral hygiene.

Endodontic treatment with drainage

Realized if the infection comes from the pulp (caries, fracture) and the tooth can be restored. The bacteria affected the pulp and caused a periapical infection.
The periapical abscess can be drained directly from the tooth. A cavity is made on the tooth, then the pus accumulated under the root will be evacuated. The canal will be prepared, disinfected, and filled.
An antibiotic and mouthwash will be prescribed afterward.

Drainage of the periodontal abscess

Your dentist will make a small incision into the abscess to drain the pus. Your dentist will clean the infected area and will prescribe antibiotics post-op.

Tooth extraction

Sometimes the tooth is very damaged that it is impossible to save it. The extraction will be necessarily followed by drainage of the abscess. During the procedure, local anesthesia is administered and the tooth is removed using small instruments.

What to expect after treatment?

After drainage, you will notice that the pain will decrease, which is very relieving. By following the advice of your dentist, your gum will quickly regain its normal appearance. Sometimes post-op pain can occur, which is normal. Consider contacting your dentist, he will prescribe painkillers.

In the meantime, you might be able to find relief at home. Try using the following:

A mouthwash of saltwater

Think about it if your gum is red, sore and swollen. All you have to do is pour about eight ounces of warm water into a glass and stir in two tablespoons of salt until it’s completely dissolved. Rinse with the water for several minutes, or as long as you can stand the salty taste, and then spit it out. If you want to use mouthwashes after extracting your wisdom teeth, ask your dentist for advice. Repeat the process every few hours, the pain will gradually disappear.

Baking soda

Baking soda is another affordable option for treating an abscessed tooth. Baking soda is excellent for removing plaque in the mouth. It also has antibacterial properties, but you should use it sparingly.
To use this remedy:
  1. Mix 1/2 tablespoon of baking soda with 1/2 cup of water and a pinch of salt.
  2. Swish the mixture in your mouth for up to two minutes.
  3. Spit out, and repeat until you’ve finished the mixture.

Apply Ice

Applying an ice pack may be able to help. Simply use a commercial ice pack or put some ice in a plastic baggie, wrap it in a towel and apply it to the swollen area.


Antiseptic, anti-inflammatory and anti-pain, clove is a good way to fight against toothache. Simply crush a clove between your fingers and then apply it a few minutes on the painful area.

What are the complications?

Serious complications, sometimes fatal...
Untreated, the abscess will reach a stage where the infection is uncontrollable: The bacteria will attack other organs and will cause more severe complications:

  • Tooth loss: This is the case with periodontitis, the main cause of tooth loss. The periodontal abscess will destroy the bone that supports the tooth, first causing mobility and then its loss.

  • Sinusitis (sinus infection): The roots of the upper molars are located near the sinuses. The pus accumulated by these teeth will infect the sinuses and cause their infection, Among the signs of sinusitis: Pain when pressing on the cheekbones or when the head is thrown forward, feeling of a bad smell in the nose and discharge of pus from the affected sinus.

  • Bacterial endocarditis: bacteria from the abscessed tooth reach the heart through the blood vessels. These bacteria arriving at the heart can infect the valves and lead to fatal consequences.

  • Exceptionally a brain abscess: the infection could spread from the teeth to the brain through the veins. A brain infection can lead to coma.

  • Patients with low immunity (unbalanced diabetes for example) are predisposed to septicemia which is the spread of infection throughout the body.

  • Ludwig's angina: this serious infection, sometimes fatal, affects the parts under the tongue and on the side. It can block the airways and cause death by suffocation. A tracheostomy must, therefore, be performed urgently.