I am 90% sure I have a dental abscess. What can I do until I can see a dentist in a few days?

Patient Question

Marcus Johnson 🇺🇸: Dr. Samuel, I’m pretty sure I have a dental abscess. I have significant pain, swelling, and a bad taste in my mouth. My regular dentist can’t see me for 4 days, and I don’t have insurance for an emergency dental visit. What can I do at home to manage this until I can get professional treatment? Are there any warning signs that would mean I should go to the ER instead of waiting? I’ve heard about antibiotics being necessary - should I try to get some prescribed before my appointment?

Dr. Rockson Samuel’s Response

Dr. Rockson Samuel: Thank you for your question, Marcus. A dental abscess is indeed a serious condition that requires professional treatment, but there are several evidence-based self-care measures you can take while awaiting your dental appointment. I’ll also outline the warning signs that would indicate you should seek emergency care rather than waiting.

Understanding Your Dental Abscess

First, let me briefly explain what’s happening in your mouth. A dental abscess is a pocket of pus caused by a bacterial infection. This typically occurs due to:

• Untreated tooth decay that has reached the dental pulp
• A cracked tooth that allows bacteria to enter
• Advanced gum disease (periodontitis)
• A failed root canal treatment

The symptoms you’re describing—pain, swelling, and bad taste—are classic signs of an abscess. The bad taste and possible bad breath come from drainage of the infection.

Immediate Self-Care Measures

Here are evidence-based steps you can take to manage your symptoms until your dental appointment:

1. Pain Management

• Over-the-counter pain relievers:

  • Ibuprofen (Advil, Motrin) is particularly effective for dental pain due to its anti-inflammatory properties
  • Take 400-600mg every 6 hours (not exceeding 3,200mg in 24 hours)
  • You can alternate with acetaminophen (Tylenol) for enhanced pain control
  • Avoid aspirin as it can increase bleeding risk during dental procedures

• Topical remedies:

  • Avoid placing aspirin directly on the gum or tooth (this causes chemical burns)
  • Over-the-counter benzocaine gels (Orajel) can provide temporary relief
  • Apply according to package directions, usually no more than 4 times daily

2. Infection Control

• Warm salt water rinses:

  • Mix 1/2 teaspoon of salt in 8 ounces of warm (not hot) water
  • Gently rinse for 30 seconds, 4-6 times daily
  • This helps draw out infection, reduce inflammation, and cleanse the area

• Hydrogen peroxide rinse (optional):

  • Mix equal parts 3% hydrogen peroxide and water
  • Rinse for 30 seconds, then spit (do not swallow)
  • Limit to 2-3 times daily as excessive use can irritate gum tissue
  • Do not use if you have open wounds in your mouth

3. Reducing Swelling

• Cold compress:
  • Apply to the outside of your face where swelling is present
  • Use for 15-20 minutes on, followed by 15-20 minutes off
  • Repeat as needed throughout the day
  • Never apply heat to facial swelling from a dental infection, as heat can spread the infection

4. Diet and Hydration

• Food choices:

  • Soft, bland foods that require minimal chewing
  • Avoid extremes of temperature (very hot or cold foods/beverages)
  • Avoid spicy, acidic, or crunchy foods that may irritate the area
  • Chew on the unaffected side of your mouth

• Hydration:

  • Stay well-hydrated with room temperature water
  • Avoid alcohol and carbonated beverages as these can irritate the area
  • Avoid very hot drinks which can increase pain

5. Oral Hygiene

• Gentle cleaning:

  • Continue to brush and floss, but be gentle around the affected area
  • Use a soft-bristled toothbrush
  • Consider an antimicrobial mouth rinse like alcohol-free chlorhexidine if available

• Avoid irritants:

  • No smoking or tobacco products (these impair healing)
  • Avoid alcohol (both drinking and in mouthwash)

Warning Signs: When to Seek Immediate Care

While waiting for your dental appointment, be vigilant for these warning signs that would indicate the need for immediate emergency care:

1. Fever over 101°F (38.3°C): Indicates the infection may be spreading systemically

2. Severe swelling: Especially if it affects your ability to breathe, swallow, or fully open your eyes

3. Spreading redness: Facial cellulitis (spreading skin infection) requires immediate medical attention

4. Difficulty swallowing or breathing: This is a medical emergency requiring immediate care

5. Severe, uncontrolled pain: Pain that doesn’t respond to over-the-counter medication

6. Significant fatigue or lethargy: Could indicate the infection is affecting you systemically

7. Rapid onset or progression of symptoms: Fast-developing infections can be more dangerous

If you experience any of these symptoms, please go to an emergency room immediately. Dental infections can spread to other areas of the head and neck, potentially becoming life-threatening in rare cases.

Regarding Antibiotics

You asked about antibiotics, which is an important consideration:

• Antibiotics are often necessary for dental abscesses, but they should not be seen as a substitute for proper dental treatment
• Ideally, you would have a healthcare provider evaluate you to determine if antibiotics are appropriate
• Options to consider:
  • Call your dentist’s office and explain your symptoms—they might prescribe antibiotics to start before your appointment
  • Visit an urgent care center for evaluation and possible antibiotic prescription
  • Some pharmacies offer telehealth services where a provider could evaluate your need for antibiotics

If you do obtain antibiotics:

• Take exactly as prescribed, completing the full course
• Do not save or share antibiotics
• Inform your dentist of any antibiotics you’ve taken when you arrive for your appointment

Alternative Care Options to Consider

If your pain becomes severe or symptoms worsen before your scheduled appointment, consider these options:

1. Dental schools: Often offer reduced-cost emergency services

2. Federally Qualified Health Centers (FQHCs): Provide dental services on a sliding fee scale

3. Dental clinics with payment plans: Many emergency dental clinics offer financing options

4. Hospital emergency departments: For severe infections, though they typically provide antibiotics and pain relief rather than definitive dental treatment

What to Expect at Your Dental Visit

When you do see the dentist, the treatment will likely involve:

1. Drainage of the abscess: To remove the accumulated pus

2. Addressing the cause: Either through:

   • Root canal treatment to save the tooth
   • Extraction if the tooth cannot be saved
   • Periodontal treatment if the abscess is gum-related

3. Antibiotics: If not already started, or a change in antibiotics based on the severity and presentation

4. Follow-up care: To ensure the infection has resolved

Long-term Considerations

Once this immediate issue is resolved, consider:

1. Identifying contributing factors: What led to this abscess, and how can future ones be prevented?

2. Regular dental care: Establishing a prevention-oriented relationship with a dental provider

3. Dental insurance or discount plans: Exploring options for more affordable future care

I hope these suggestions help you manage until your dental appointment. Remember that while these measures can provide temporary relief, they are not substitutes for professional treatment. The underlying infection requires proper dental intervention to be fully resolved.

Would you like more specific information about any of these self-care measures or alternative care options?

Further Reading and Resources

For more information on related topics, you might find these resources helpful:

• Dental Abscess: Understanding Infection Spread
• Emergency Dental Care: When to Seek Help
• Antibiotic Use in Dentistry: What Patients Should Know
• Affordable Dental Care Options