Generally, a primary (baby) tooth abscess is not an emergency. Cavities are part of the chronic disease process of tooth decay, which means it takes many weeks to months before the infection impacts the tooth’s nerve. When the bacteria reach the nerve, the tooth may or may not become painful, the nerve may ultimately die if exposed to bacteria for an extended period of time, and the tooth may form an abscess if the infection exits the tooth and the body attempts to drain it. In the case of primary teeth, the infection remains localized to the tooth the majority of the time and drains periodically from the bubble (see Photo 1). The treatment of choice for an abscessed tooth is to remove the dead tooth.
If you notice an abscess in your child’s mouth after normal business hours and the child is not experiencing any pain, has no fever, and no swelling of his face or throat, then wait to call your dentist until regular business hours. The dentist’s office can then schedule a time to examine your child and then plan an appointment to extract the dead tooth. Sometimes, the abscessed tooth will be extracted on the same day as the examination, and other times it will be scheduled for a different day. It will depend on the scheduling preferences and availability at your child’s dental office, and either method is acceptable.
A painless, uncomplicated (no associated swelling, fever) abscess, whether bubble-like and filled with pus or flat with a draining fistula (hole), does not require an antibiotic prescription. An antibiotic wouldn’t treat an uncomplicated abscess because the infection is localized to the tooth and the bubble of pus, neither of which are easily penetrated by antibiotics in the bloodstream. When the infection is not spreading systemically (systemic spread would be indicated by fever or face/throat swelling), an antibiotic will do little to improve the infection. The antibiotic also cannot reach the source of the infection (the bacteria inside the tooth) through the pulp (the blood supply of the tooth) because the tooth is no longer alive and blood is no longer flowing in it. Taking an antibiotic in this situation could contribute to the development of antibiotic-resistant bacteria and diminish healthy gut flora, which may lead to diarrhea.
Signs of systemic infection associated with an infected (and not necessarily abscessed) tooth, such as fever, facial swelling, or swelling inside the mouth or throat, indicate that a dental abscess is an emergency and you should contact your child’s dentist immediately. These cases often require systemic IV antibiotics and could require extraction of the tooth on an emergency basis, which for young children may necessitate seeing an oral surgery specialist or a stay in the hospital and the use of sedation. If you suspect your child has a dental abscess that fits the emergent description, call your child’s dental provider immediately. He or she will instruct you on the next steps unique to your location and situation.
Permanent teeth are a little different story. The permanent molars begin to erupt around age six, and if they become infected with bacteria and large cavities form (with or without abscesses) those infections are often significantly more painful than when in baby teeth. Based on the location of the permanent molars further back in the jaw, tooth infections there are more at risk for spread, swelling, and systemic involvement. Call your pediatric dentist to schedule an examination if your child is experiencing pain in a permanent molar from decay, and if there is fever or face or throat swelling associated, as with the primary tooth abscess, call your dentist right away regardless of the time of day or night because this is considered an emergency.
Many parents remember the tragic case of Deamonte Driver, a 12-year-old who died from an untreated dental abscess in a permanent molar. Tooth decay left untreated can be deadly, especially when permanent teeth are involved. So please don’t ignore tooth decay or dental abscesses even if they aren’t causing your child pain. The same goes for you as the parent! Take care of yourself and your own teeth as well. And remember, prevention is the best medicine, so make sure the entire family visits the dentist for routine checkups every six months.
