The different stages a gum abscess can go through

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 the abscess appear in the gum?

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 the type of tissue affected.

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

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

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

In periodontal abscesses, the infection does not come from the tooth, but from the tissues surrounding it. The term periodontal refers to the periodontium, which is the tissue that holds the tooth in place. This includes the bone, ligaments, gums, and cementum.

In gum disease, when virulent bacteria penetrate deep into the tissue, they trigger intense inflammation. This can result in a build-up of pus and an apparent swelling in the gum called a periodontal abscess.

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.
As a result, bacteria will reach the pulp and grow inside, leading to tooth infection. The periapical abscess stages include:

1. Tooth decay:

Tooth decay is an infectious disease caused by bacteria. Bacteria convert the sugar in the food we eat into acid that dissolves the minerals in our teeth. This breaks down the tooth's outer layers (enamel and dentin) and eventually reaches the pulp. The stages of tooth decay include:

Enamel decay:

Enamel is the outermost tooth layer. At this stage, you may not feel anything, as the enamel does not have nerves. However, the lesions appear as white or brown spots, also known as demineralization lesions.
The good news is that they are reversible by some topical treatments. They consist of applying products rich in minerals (calcium, phosphorus and fluoride) to the tooth to replenish the lost minerals.
So, as soon as you notice rough stains on your teeth, visit your dentist as early as possible to prevent the injury from progressing.

Dentin decay:

Dentin is the layer beneath the enamel. Instead of small surface lesions, dentin decay looks like bigger brown or black holes. Since the dentin lies right over the pulp, you may have sensitivities to cold, heat, and pressure. At this stage, the damage is irreversible and must be treated by a dentist.

Pulp decay:

When bacteria pass through the dentin barrier, they reach the pulp. Intense, throbbing pain can occur. 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 start the abscess process.

2. Periapical periodontitis:

Once the pulp is infected, the body triggers multiple immune responses to overcome the invading bacteria. However, the bacteria involved in dental infections are virulent and resistant, and there are billions of them. Sooner or later they will overwhelm the immune system.

As long as the tooth is alive, it keeps the infection inside. But after a while, the pulp will die. The infection will then spread to the root tip (periapical area), resulting in periapical periodontitis.

At this stage, the symptoms and course of the infection vary from person to person. In some people, the infection progresses slowly over years without causing pain, while others experience acute inflammation and severe pain with rapid abscess formation.

3. The periapical abscess (abscess on the gum):

In periapical periodontitis, the infection has moved from the pulp to the root tip. The inflammatory products and debris accumulate in this area, resulting in a pocket of pus known as periapical abscess.

This usually happens when the immune system has not been able to cope with the situation due to very aggressive bacteria or a weakened immune system.

The pressure and pus gradually eat away at the bone and eventually reach the gum. At this point, the pus that was trapped inside the bone now appears as a pimple, also known as a gum boil.

At this stage, the pain decreases considerably as the pressure is relieved. However, as the gum reacts to the infection, the pain may return after 2 or 3 days.

The pus may continue to work its way through the gum, forming a small hole through which it can drain. This is called fistulation. It reduces the pressure and therefore provides great relief.

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%). It also has many bacteria in common with periapical abscess. The stages of a periodontal abscess include:

1. Gum inflammation (gingivitis):

After a few days of plaque build-up, bacteria will 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 removing plaque and tartar build-up and some oral hygiene measures.

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 trigger intense inflammation that leads to irreversible tissue destruction. This is because once the bone is lost, it cannot recover to its previous state.

The spaces between the teeth and gums, known as periodontal pockets, become larger. These pockets are a breeding ground for bacteria that can release toxins. If left untreated, they will deepen and cause the teeth to loosen.

Treatment consists of a deep dental cleaning (scaling and root planing) to reach and clean these pockets. Depending on the severity of the condition, your dentist may give you an antiseptic mouthwash or antibiotics to eliminate the bacteria for good.

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 treatment with antibiotics.
  • Tartar build-up.
  • Trauma.
  • Certain medical conditions such as diabetes.

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

The best thing to do as soon as you notice tooth decay or an early stage of gum disease is to see your dentist to prevent the situation from getting worse. If you delay treatment, the infection can spread, with potentially fatal consequences. Symptoms to look out for 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.

Gum abscess treatment

Treating a gum abscess mainly involves removing the source of the infection and draining the accumulated pus.
Before starting, your dentist will determine the root cause. Once the infected tooth has been identified, he will drain the abscess using one of the following procedures:

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.

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.

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.

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.


Antibiotics are not always needed to treat a gum abscess. For example, if you are young and in good general health, drainage alone may be enough to clear up the infection. Situations in which an antibiotic may be prescribed include the following:
  • The infection has spread to surrounding tissue.
  • Your immune system is weak, often because of a health problem.
  • The infection is associated with general symptoms such as fever, malaise, and tiredness.

What to expect after treatment?

After the abscess has been drained, you will feel immediate relief. The healing time depends on whether you follow your dentist's instructions. It usually takes about ten days. Sometimes, some post-operative pain may persist, which is normal. Over-the-counter painkillers may help to ease your discomfort.

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

  • Saltwater mouthwash.
  • Applying ice to the painful area.
  • Try cloves as a mouthwash or essential oil. As well as reducing pain, clove oil is antibacterial and anti-inflammatory. Be sure to dilute it before applying it to your gums.