The stages of a gum abscess and its healing process


Gum abscess formation process

So you have recently noticed a small swelling in your gums, which makes you think you have a gum abscess.

A gum abscess occurs when an infection in the tooth or surrounding tissue becomes difficult for the body to handle.

It is important to know that there are no hard and fast rules regarding the stages an abscess can go through. This is because our bodies and immune systems are different, and what happens to others may not apply to you.

In this article, we will look at the two most common types of gum abscesses, the different stages they can go through, and their potential complications.

How does a gum abscess occur?

periapical s periodontal abscess
Gum abscesses result from the accumulation of pus in a particular area. Two common dental conditions are known to cause severe infection with pus collection: periapical abscess and periodontal abscess.

Both conditions involve almost the same process. The only difference is where the infection comes from.

A periapical abscess is an infection that comes from inside the tooth. The term "periapical" refers to the periapex, the area around the root tip.

periapical periodontitis due to a cavity

When bacteria get into the pulp (the soft tissue that carries blood vessels and nerves) through a fracture or tooth decay, they cause a condition called pulpitis (inflammation of the pulp).

As long as the tooth is alive, it will contain the infection. But when the pulp dies, the infection can spread to the periapical area, resulting in a condition called periapical periodontitis. Over time, pus accumulates in this area, leading to a periapical abscess.

On the other hand, periodontal abscesses do not involve the tooth's nerves or pulp, but the tissues surrounding the tooth.

The term "periodontal" refers to the periodontium, the tissues that holds the tooth in place. These includes the bone, ligaments, gums, and cementum. In gum disease, when virulent bacteria penetrate deep into these tissues, they trigger intense inflammation. This can result in a build-up of pus and an apparent swelling in the gum called a periodontal abscess.

As pus accumulates, both periapical and periodontal abscesses can lead to a noticeable swelling, often referred to as a gum boil.

Now that we have seen the many ways a gum abscess can occur, we will learn the different stages it can go through.

Periapical abscess: the different stages

periapical abscess stages
Periapical or tooth abscess occurs when an injury connects the pulp to the outside bacterial-rich environment. This can be tooth decay or a fracture. Typically, the stages of periapical abscess are:

1. Tooth decay:


Tooth decay is caused by bacteria that turn sugar into acid, which dissolves the minerals in our teeth. This breaks down the outer layers of the tooth (enamel and dentin) and can lead to decay reaching the pulp. The stages of tooth decay are:

1. Enamel decay:

Enamel is the outermost layer of the tooth and is the hardest tissue in the human body. At the initial stage of decay, bacteria in the mouth produce acid that attacks the enamel, leading to demineralization lesions. These initially appear as white or brown spots on the tooth surface, which can still be reversed with the help of mineral-based products.

However, if left untreated, the decay can progress further to the underlying dentin layer, forming a hole or cavity.

2. Dentin decay:

Dentin is the layer beneath the enamel and is much softer. When the dentin layer is affected, the decay spreads more quickly due to the porous nature of dentin.
Dentin decay appears as larger brown or black holes in the tooth, which becomes extremely sensitive to cold, heat and pressure. Once dentin decay occurs, the damage is irreversible, requiring professional treatment.

3. Pulp decay:

The pulp is the innermost part of the tooth, consisting of connective tissues, nerves, and blood vessels.
When decay progresses through the dentin layer and reaches the pulp, intense, throbbing pain can result, as the nerve becomes inflamed and infected. At this stage, the damage is also irreversible, and the only way to treat the nerve is with a root canal.
If left untreated, the infection can spread and form a dental abscess.

2. Pulp death and early periapical periodontitis:


When bacteria infect the pulp, your body tries to fight them off by triggering an immune response. But there will come a point where the blood flow to the tooth will stop due to the increased pressure. This will result in the death of the pulp, also known as necrosis.

This means the infection can now spread to the tip of the root (periapical area), where it causes inflammation and pain. This is periapical periodontitis.

Some people may not feel much pain at this stage, while others may have a lot of pain and swelling. It depends on how fast the infection progresses and how your body reacts to it.

3. Periapical abscess and gum boil:


If periapical periodontitis is not treated, the infection can form a pocket of pus (periapical abscess) at the root tip. This can damage the bone around the tooth, as well as the nearby gums. When this happens, you may see a bump or a pimple on your gum (gum boil).

The pus can work its way through and form a small hole in the gum (fistula), allowing it to drain into the mouth. You may feel less pain as the pressure is released, but this does not mean that the infection has gone away.

In fact, the bacteria involved in dental infections are too strong and too many. As long as the infection source is not treated, the abscess will continue to come back.

Periodontal abscess: the different stages

periodontal abscess stages
A periodontal abscess does not originate from the tooth itself, but from the surrounding tissue. It can occur on a healthy, non-decayed tooth and appear as an isolated swelling in the gum.
According to studies, periodontal abscess is the third most common dental emergency requiring immediate intervention and the third most common acute orofacial infection (6-7%). The stages of a periodontal abscess include:

1. Gum inflammation (gingivitis):

After a few days of plaque build-up, bacteria invade the gum tissue and cause inflammation. This condition refers to gingivitis. The gums become irritated, red, and swollen and tend to bleed when you brush your teeth or eat.
As long as the inflammation is limited to the gum tissue, the damage is reversible. Treatment consists of improving oral hygiene at home and removing plaque and tartar.

2. Periodontitis:

If left untreated, gingivitis can progress to the deeper tissues, including the bone. This stage is known as periodontitis.

Many factors can cause gingivitis to develop into periodontitis, including genetics, poor oral hygiene, smoking, and some medical conditions.

The bacteria involved in periodontitis are more virulent and aggressive. They invade the space between the teeth and the gum and enlarge it, leading to what are called periodontal pockets.

Unlike gingivitis, periodontitis is not reversible. The bone loss is permanent and cannot be restored. As a result, your teeth may become loose and fall out.

The treatment of periodontitis involves a deep dental cleaning. This procedure, also known as scaling and root planing, removes plaque and tartar from teeth and all the way to the roots.

You may also need an antiseptic mouthwash or antibiotics to kill any remaining bacteria and prevent infection.

3. Periodontal abscess:

Not all periodontitis progresses to abscesses. In fact, most of them evolve slowly and go unnoticed when the balance between bacteria and the immune system is maintained. However, when this balance is disrupted, bacteria will overgrow and increase their activities in the pockets. This can lead to rapid tissue destruction and severe pain.
When pus builds up in the pockets, a localized swelling on the gum occurs, known as a periodontal abscess.

Factors that can upset the balance and increase the risk of abscess formation include:

  • Weakening of the immune system.
  • Improper use of antibiotics.
  • Tartar build-up.
  • Trauma.
  • Medical conditions such as diabetes

Gum abscess treatment

To treat a gum abscess, the primary focus is on eliminating the infection's cause and draining the accumulated pus. The dentist will first determine the root cause and then proceed with draining the abscess using one of the following methods:

1. Root canal:

Your dentist will make a large cavity in the tooth to drain the abscess. Once the accumulated pus is out, you will feel immediate relief. After a few days, your dentist will fill the root canals and restore the tooth with a crown.

2. Surgical drainage:

If the abscess has not drained with the root canal, your dentist will use a sharp instrument to open the gum to drain the pus.

3. Deep dental cleaning:

If you have a periodontal abscess, your dentist will drain it through the pockets. After draining, he will deep clean and rinse the area with an antiseptic irrigant to remove dead tissue and reduce the bacterial load.

4. Tooth extraction:

Sometimes the damage is too extensive and the tooth cannot be saved. In this case, the tooth may need to be extracted to get rid of the infection for good.

Antibiotic use for dental infections


  • Antibiotics may not always be necessary to treat a gum abscess if drainage is sufficient.

  • Antibiotics may be prescribed in certain situations, such as when the infection has spread to surrounding tissue.

  • People with weakened immune systems may also require antibiotics to treat a gum abscess.

  • Antibiotics may also be needed if the infection is causing general symptoms like fever, malaise, and tiredness.

  • Antibiotics alone are not enough to treat a dental infection. They may alleviate symptoms, but only temporarily.

The healing stages and recovery

After your dentist has drained your gum abscess, you will feel immediate relief as the pressure from the pus build-up is released.

The healing time depends on several factors, including your health and whether you follow your dentist's instructions. It usually takes about ten days for your gum to return to its normal appearance. However, bone healing takes longer, from months to years.

The healing stages can vary depending on the severity of the infection and the treatment approach used. However, here is what you can expect during the healing process:

1. Drainage and removing the source of the infection

Once your dentist has drained the abscess and removed the source of the infection, the swelling will go down, and you will feel immediate relief. By removing the bacteria and accumulated pus, your tissues will find the right conditions to begin the healing process.

2. Mild discomfort and swelling

Immediately after treatment, you may feel some mild to moderate discomfort. This is normal as your body needs to set up an inflammatory response in the affected area to bring in the cells and nutrients needed for healing. The pain should gradually subside over the next week. However, if the pain worsens or suddenly reappears, you should see your dentist immediately, as it may be a post-operative complication.

3. Tissue healing

3 X-Rays showing the healing stages of a periapical abscess before treatment, 6-month follow-up and 12-month follow-up

After about a week, the inflammation will subside, and cells will start growing to rebuild the damaged tissue. On the x-rays above, the dark areas you can see around the root tips (red circles) represent bone loss due to the abscess process.

After treatment, these dark circles gradually fade as the bone regenerates. 12 months later, you can see that this area appears denser and white. At this point, all the bone has been rebuilt, and healing is complete.

Bone healing is usually slow and can take several months to years. Your dentist will schedule follow-up appointments throughout this period to monitor the healing process and ensure the infection has cleared up.

Other types of gum abscesses

Gingival abscess:


Gingival abscesses usually occur in the back teeth (molars). The pus accumulates in the gum part closer to the gum line, causing local swelling. The most common cause is a piece of tartar or food stuck between the tooth and gum, causing irritation and inflammation. Symptoms of a gingival abscess include pain, heat, bleeding, and discomfort when eating.

Pericoronary abscess:


Pericoronal abscesses occur mainly on emerging wisdom teeth. When the wisdom tooth is not properly positioned in the gum, it can cause food and bacteria to accumulate in the area, resulting in infection. Gradually, pus accumulates in the surrounding tissue, resulting in a painful condition called pericoronitis.

The potential complications of a gum abscess

If left untreated, an abscessed tooth can lead to serious complications.

The first complication is tooth loss. As the pus eats away at the bone, the tooth becomes loose and may eventually fall out.

The infection can spread to soft tissues such as the cheek, lips, and skin. This is called cellulitis. When this happens, you may notice swelling, redness, and pain in the affected area.

In extreme cases, infection on the lower molars can spread beyond the lower jaw. You may have difficulty swallowing and notice that your tongue is raised and pushed to one side. If left untreated, the infection can spread to the neck. This is a life-threatening condition known as Ludwig's angina, which can stop your breathing. It requires immediate hospital admission for appropriate drainage and intensive antimicrobial therapy.

Other complications may include:

  • Sinusitis: The sinuses are bony cavities above the upper molars. If the infection spreads beyond the roots, it can reach these areas and cause sinusitis.

  • Endocarditis: This happens when the infection travels through the bloodstream to the heart. Endocarditis can lead to fatal heart failure.

  • Brain abscess: The infection can travel through the veins to the brain and cause a brain abscess. Although rare, this should be taken seriously as it can have dramatic consequences, including coma or even death.
the complications of tooth decay

Symptoms to look out for

Gum abscesses can never heal on their own. If you delay treatment, the infection can spread, with potentially fatal consequences. So the best thing to do as soon as you notice a cavity or an early infection is to consult your dentist to prevent the situation from getting worse. In the meantime, there are some things to do and avoid at home to ease your pain. Symptoms to watch out for that may indicate an emergency include:

  • Extreme swelling.
  • Fever.
  • Chills.
  • Feeling unwell and tired.
  • Increased heart and breathing rate.
  • Dehydration and stomach pain.

How to prevent dental infections?

Prevention is the best way to avoid oral infections. There are a few tips you can follow to help prevent them in the first place.

  • Brush your teeth with a fluoride toothpaste at least twice a day or preferably after eating or drinking acidic, sweet, or sticky foods.

  • Be sure to clean between your teeth every day with dental floss or an interdental brush.

  • Add a daily mouthwash to your oral hygiene routine, especially if you are at risk of tooth decay or gum disease.

  • Visit your dentist regularly.

  • Drink plenty of water throughout the day.

  • Eat a balanced diet.

  • Avoid snacking and nibbling between meals.

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