What are the different stages of gum abscess?

gum abscess
A gum abscess occurs when a tooth or the gum becomes infected, often due to bacteria. Our immune system will trigger an acute inflammation to prevent the infection from spreading to the rest of the body. The products of this inflammation will form pus that will accumulate and result in a gum abscess.

How abscess appears in the gum

There are different types of gum abscesses. The common point is that they develop in the same way.

The primary cause of a gum abscess is a bacterial infection.

In periodontal disease (infection of the tissues surrounding the tooth), the pus will accumulate directly on the gum resulting in localized swelling.

But how does the gum abscess form if the infection comes from the tooth?

pulp infection

In normal conditions, there is a bone that separates our teeth from the gum.
When aggressive bacteria get access to the dental pulp, which is the tissue containing the nerves and blood vessels of the tooth, through a cavity or fracture, our immune system kicks in.

Our body will trigger an inflammation to keep the infection inside the tooth and prevent it from spreading to other tissues.

But once the pulp is affected, sooner or later our immune system will be overwhelmed, because the dental infection is resistant and includes millions of bacteria of different species.

In most cases, the inflammatory reaction intensifies and leads to necrosis (death of the pulp). Subsequently, the area near the root tip will be affected, leading to what is called a periapical abscess.

The products of inflammation, including dead cells, bacteria, and toxins, accumulate and form pus that will lead to bone loss around the root tip.

As the pus accumulates, the destruction of the bone progresses toward the gum. The pus will fill the void created and eventually reach the gum, where it will appear as a gum abscess.

What are the gum abscess stages?

A gum abscess does not appear overnight. The dental infection goes through different stages:

The first stage: infection

Bacteria must first find an entry point to the internal tissues, which can be the pulp or the periodontium. Caries and gum disease are the most involved in dental infections.

Tooth decay goes through three stages before reaching the pulp. Once the pulp is affected, our immune response begins.
It is the same process for gum disease. The only difference is the type of tissue affected. Bacteria get deep into the gum line, causing periodontal infection.

After infection, our body will initiate an inflammatory response. This response differs from person to person. Some will develop chronic inflammation, which involves a slow progression of the disease, while others will develop severe inflammation resulting in rapid progression of lesions and formation of abscesses.

Inflammation is not a bad thing. It is a vital defense mechanism that detects, destroys, and eliminates all substances not recognized by our body. It is, therefore, meant to protect us.

However, inflammation can become harmful if it lasts a long time or occurs in areas where it is unwanted.

During the inflammation process, blood vessels dilate to supply the infected area with immune cells, nutrients, and inflammatory mediators.
Symptoms of the dental infection include:
  • Swelling, redness, and bleeding of the gums.
  • Pulsating and radiating pain towards the jaws.
  • Localized edema of the face.
  • Unpleasant taste in the mouth.
  • Long tooth sensation.
  • Heat sensation.
  • Compromised general health with fever, fatigue, and swollen lymph nodes.

At this stage, you need to act quickly to avoid serious complications. If the infection is left untreated, it will continue to progress and cause more damage, including bone destruction, teeth loss, or septicemia (spread of the infection throughout the body).

The second stage: Pus collection

The product of the inflammation will build up to form pus, which will lead to an abscess.

A gum abscess means that the infection has reached an advanced stage and the immune system has not been able to handle the situation due to very aggressive bacteria or a weakened immune system.

So, it is important to act quickly at the first signs when the infection is easily treatable.

Third stage: The spread of infection

Left untreated, an abscessed tooth can lead to serious complications.
At a very advanced stage, the lymph nodes in the jaw will swell, which can be noticed from the outside.

The infection then can spread to soft tissues such as the cheek, skin, muscles. This condition is called infectious cellulitis.

The collected pus sometimes creates a new pathway when the dental abscess applies pressure and has no other place to drain. This new drainage canal is called a dental fistula and can end up on the gum or sometimes on the face (cheek or chin).

The different types of gum abscesses

Gingival abscess

gingival abscess

A gingival abscess occurs mainly in the back teeth (molars). The pus accumulates in the gum part closest to the tooth (marginal gum), leading to gum swelling.
The cause of gum abscess can be a piece of tartar or food debris stuck between the tooth and the gum, which irritates the gums and causes inflammation.
Symptoms of a gingival abscess include pain, heat sensation, bleeding, and discomfort during meals.

Periodontal abscess

periodontal abscess

It is a severe form of periodontal disease. Inflammation has reached the deep tissues surrounding the tooth. Subsequently, the space between the tooth and the gum widens, leading to the formation of periodontal pockets.

These periodontal pockets are a reservoir of bacteria and toxins, leading to the accumulation of pus and the formation of periodontal abscesses.

Factors that may promote virulent bacteria include poor oral hygiene, smoking, systemic diseases such as diabetes and blood disorders.

Symptoms can range from mild discomfort to severe pain. The most common signs are swollen and bleeding gums, tooth mobility, bad breath, and pus discharge around the gum line.

Periapical abscess

periapical abscess

Once the dental pulp is affected, our immune system will fight the infection until pulp necrosis occurs, which involves the death of the pulp and the contamination of the space under the root tip, also called an apical periodontitis.

The pus will accumulate in this area and cross the bone to reach the gum where the periapical abscess will appear.

Pericoronary abscess

Pericoronary abscess occurs primarily on wisdom teeth. The connection between the gum and the tooth of a partially erupted wisdom tooth is not done properly. This can cause food and bacteria to accumulate in the area, leading to infection, resulting in an abscess that may hide the entire tooth.

What else can cause a gum abscess?

In addition to bacterial infection, other causes can also lead to a gum abscess. Among them:
  • A foreign body stuck between the tooth and the gum.
  • Dental fracture.
  • Trauma.
  • Some bad habits such as teeth grinding or bruxism lead to excessive stress on the teeth and can worsen periodontal disease.
  • Some medical conditions that weaken our immune systems such as diabetes, HIV, blood and hormonal disorders.

Should you be worried?

A gum abscess is a preventable dental condition. There is nothing to worry about as long as you know when and how to act.

According to statistics, the number of people hospitalized for abscessed gum increased from 5,757 in 2000 to 8,141 in 2008. 66 of them subsequently died.

But the reason these people passed away of gum abscess is they waited too long to see a health professional until their general condition was affected and it became difficult to eat and speak.

The best way is to visit your dentist regularly, at least twice a year, even if you do not have any symptoms, as dental infection can sometimes be asymptomatic. Also, you have to take preventive measures that will cost you nothing to avoid the worst complications.

How to prevent a gum abscess?

Prevention is the best way to avoid any oral infection.
Here are some tips to prevent a gum abscess:
  • Brush your teeth with fluoride toothpaste at least two times a day or after eating or drinking acidic, sweet, or sticky foods.
  • Floss your teeth daily. It may seem hard in the first days, but you will soon get used to it.
  • Rinse your mouth with an antimicrobial mouthwash free of alcohol to avoid irritating your gums.
  • Visit your dentist regularly.
  • Drink a lot of water.
  • Balance your diet.
  • Avoid frequent snacking and sipping.
  • Eat foods that are healthy for your teeth, including foods rich in minerals and water such as green vegetables, cheese, apples, tea, fish.
  • Learn about antibacterial treatments. If you are particularly vulnerable to tooth decay - for example, because of a health problem - your dentist may recommend special antibacterial mouthwashes or other treatments to help reduce the harmful bacteria in your mouth.

The treatment of a gum abscess

The most important thing is to see your dentist as soon as possible at the slightest symptom.

Before starting the treatment, your dentist will first figure out the cause of the gum abscess.

The treatment goal is to drain the abscess to relieve pain and reduce the bacterial load. Then, antibiotics can be prescribed to clear the infection.

Drainage of the abscess by root canal treatment

Before starting the treatment, your dentist will deem if the tooth is restorable. If so, your dentist will make a large cavity in the tooth to drain the abscess through the emptied pulp.

The root canals will then be shaped, disinfected, and filled with dental material. Finally, the tooth will be restored with a filling or a crown. If the tooth is not restorable due to extensive damage, extraction may be necessary.

Surgical drainage of the abscess

If the abscess does not originate from the pulp or if it has not drained properly with root canal therapy, surgical drainage may be necessary.

Your dentist will make an opening in the abscess to remove the infected tissue and drain the accumulated pus.

He will then rinse the area to remove any lingering bacteria or debris. After the removal of all infected material and pus, he will close the opening with a few sutures.

He will then prescribe antibiotics and pain relievers for optimal healing.

Drainage of the abscess by tooth extraction

Sometimes the tooth is damaged and cannot be saved. Extraction will be done followed by abscess drainage.

What to expect after treatment

After the abscess drainage, you will notice that the pain decreases, which is very relieving.

The healing time depends on whether you follow your dentist's instructions. It usually takes around ten days.

Sometimes, post-operative pain can appear, which is normal. Over-the-counter pain reliever medications may help take the edge off your discomfort.

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

Saltwater mouthwash

Saltwater mouthwash will help you speed up the healing process. Pour about 250 ml of hot water into a glass and add two tablespoons of salt until it is completely dissolved.

Rinse your mouth for several minutes, or as long as you can stand the salty taste, then spit it out.

Repeat the process every few hours for the first 24 hours, and the pain should gradually disappear.

If you want to use mouthwash after wisdom teeth removal, ask your dentist for advice.

Baking soda

Baking soda is another affordable option for treating abscessed gum. Baking soda has antibacterial properties, but you should use it in moderation.
  • Mix 1/2 tablespoon of baking soda with 1/2 cup of water and a pinch of salt.
  • Rinse your mouth for up to two minutes.
  • Spit it out, and repeat until there is no more left.

Apply Ice

Applying an ice pack to the painful area may be relieving. 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.


Cloves are antiseptic, anti-inflammatory, and painkillers. They are a good option to fight toothache.

Crush a clove between your fingers and then apply it for a few minutes to the painful area.

What are the complications?

If left untreated, an abscess can lead to serious complications:

  • Tooth loss: Gum abscess will destroy the bone that supports the tooth, causing first mobility and then tooth loss.
  • Sinusitis (sinus infection): The roots of the upper molars are close to the maxillary sinuses. The accumulated pus will infect the sinuses and cause sinusitis. Signs include pressure around your eyes, cheeks, and forehead. Pain when pressing on the cheekbones. Bad breath and smell feeling. Pus discharge from the affected sinus.
  • Bacterial endocarditis: Bacteria from the damaged tooth can reach the heart through the bloodstream. This complication can be life-threatening.
  • Brain abscess: The infection can spread to the brain through the veins and lead to a brain abscess. Although rare, it should be taken seriously because it can lead to dramatic consequences, including coma or even death.
  • Patients with low immunity are more prone to sepsis, which involves the infection spreading throughout the body.
  • Ludwig's angina: Ludwig's angina is a serious infection that affects parts of the face and lower jaw. If it enlarges to the point of blocking the upper airway, it can cause suffocation with a fatal risk.