A tooth abscess is a collection of infected material (pus) resulting from a bacterial infection in the center of a tooth.

Periapical abscess; Dental abscess; Tooth infection; Abscess - tooth

A tooth abscess is a complication of tooth decay. It may also result from trauma to the tooth, such as when a tooth is broken or chipped. Openings in the tooth enamel allow bacteria to infect the center of the tooth (the pulp). Infection may spread out from the root of the tooth and to the bones supporting the tooth.

Infection results in a collection of pus (dead tissue, live and dead bacteria, white blood cells) and swelling of the tissues within the tooth. This causes a painful toothache. If the pulp of the tooth dies, the toothache may stop, unless an abscess develops. This is especially true if the infection remains active and continues to spread and destroy tissue.

The main symptom is a severe toothache. The pain is continuous and may be described as gnawing, sharp, shooting, or throbbing.

Other symptoms may include:

• Bitter taste in the mouth
• Breath odor
• General discomfort, uneasiness, or ill feeling
• Fever
• Pain when chewing
• Sensitivity of the teeth to hot or cold
• Swollen glandsof the neck
• Swollen area of the upper or lower jaw -- a very serious symptom

The patient will feel pain when the dentist taps the tooth. Biting or closing the mouth tightly also increases the pain. The gums may be swollen and red and may drain thick material.

The goals of treatment are to cure the infection, save the tooth, and prevent complications.

Antibiotics may be given to fight the infection. Warm salt-water rinses may be soothing. Over-the-counter pain relievers may relieve the toothache and fever.

Do NOT place aspirin directly over the tooth or gums, because this increases irritation of the tissues and can result in mouth ulcers.

A root canal may be recommended in an attempt to save the tooth.

If there is a severe infection, the tooth may be removed or surgery may be needed to drain the abscess. Some people may need to be admitted to the hospital.

Untreated abscesses may get worse and can lead to life-threatening complications.

Prompt treatment usually cures the infection. The tooth can usually be saved in many cases.

• Loss of the tooth
• Mediastinitis
• Sepsis
• Spread of infection to soft tissue (facial cellulitis, Ludwig's angina)
• Spread of infection to the jaw bone (osteomyelitis of the jaw)
• Spread of infection to other areas of the body resulting in brain abscess, endocarditis, pneumonia, or other complications

Call your dentist if you have a persistent, throbbing toothache.

Prompt treatment of dental caries reduces the risk of tooth abscess. Traumatized teeth should be examined promptly by the dentist.

An abnormally shaped tooth is any tooth that has an irregular shape.

Hutchinson incisors; Abnormal tooth shape; Peg teeth; Mulberry teeth; Conical teeth

The appearance of normal teeth varies, especially the molars. Abnormally shaped teeth can result from many different conditions. Specific diseases can have a profound effect on tooth shape, tooth color, time of appearance, or absence of teeth.

• Congenital syphilis
• Cerebral palsy
• Ectodermal dysplasia, anhidrotic
• Incontinentia pigmenti achromians
• Cleidocranial dysostosis
• Ehlers-Danlos syndrome
• Ellis-van Creveld syndrome

If the shape of your child's teeth appears to be abnormal, consult a dentist or other health care provider.

The dentist will examine the mouth and teeth. You will be asked questions about your child's medical history and symptoms, such as:

• Does the child have any medical conditions that may cause abnormal tooth shape?
• At what age did the teeth appear?
• In what order did the teeth appear?
• Are there other tooth problems (color, spacing)?
• What other symptoms are also present?

Diagnostic tests that may be performed may include dental x-rays.

Delayed or absent tooth formation; Teeth - delayed or absent formation

The timing of the first appearance of teeth varies. Most infants get their first tooth between 6 and 9 months, although earlier or later eruption may be normal.

In some cases, children or adults are missing teeth they never developed. In such cases cosmetic or orthodontic dentistry can correct the absence of those teeth.

Specific diseases can have a profound effect on tooth shape, tooth color, time of appearance, or tooth absence. Delayed or absent tooth formation can result from many different conditions, including:

• Apert syndrome
• Cleidocranial dysostosis
• Down syndrome
• Ectodermal dysplasia
• Ellis-van Creveld syndrome
• Hypothyroidism
• Hypoparathyroidism
• Incontinentia pigmenti achromians
• Progeria

If your child has not developed any teeth by the time the child is 9 months old, consult your health care provider.

The health care provider will perform a physical examination, including a detailed examination of the mouth and gums, and ask questions such as:

• In what order did the teeth emerge?
• At what age did other family members develop teeth?
• Are there any other family members that have teeth that never "came in"?
• What other symptoms are also present?

An infant with delayed or absent tooth formation may have other symptoms and signs that, when taken together, define a specific syndrome or condition.

Diagnostic tests are usually not necessary unless a disorder is suspected as the cause. Most often, delayed tooth formation is a normal finding. Occasionally, dental x-rays will be needed.

The visible portion of the tooth is the crown. The outer surface of the crown is made of enamel. Just beneath the enamel is dentin, a substance harder than bone. The gum surrounds the base of the tooth.

The root of the tooth extends down into the jaw bone and provides circulation and sensation to the tooth. The root contains blood vessels and nerves, which supply circulation and sensation to the entire tooth. The area is known as the "pulp" of the tooth.

The jaw bone contains all the teeth and provides stability and mobility for the mouth and teeth for chewing. The lower jaw bone is called the mandible and the upper jaw bone is called the maxilla.

Lingen MW. Head and neck. In: Kumar V, Abbas AK, Fausto N, eds. Robbins and Cotran Pathologic Basis of Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 16.

Abnormal tooth color is any color other than the white to yellowish-white of normal teeth.

Discolored teeth; Tooth discoloration; Tooth pigmentation

Many different things can cause tooth discoloration. The change in color may affect the entire tooth, or just appear as spots or lines in the tooth enamel.

Your genes influence your tooth color. Other things that can affect tooth color include:

• Congenital diseases
• Environmental factors
• Infections

Inherited diseases may affect the thickness of enamel or the calcium or protein content of the enamel, which can cause color changes. Metabolic diseases may cause changes in tooth color and shape.

Drugs and medications either taken by the mother while pregnant or by the child during the time of tooth development can cause changes in both the color and hardness of the enamel.

• Antibiotic tetracycline use before age 8
• Eating or drinking items that temporarily stain the teeth, such as tea or coffee
• Genetic defects that affect the tooth enamel, such as dentinogenesis and amelogenesis
• High fever at an age when teeth are forming
• Poor oral hygiene
• Porphyria
• Severe neonatal jaundice
• Too much fluoride from environmental sources (natural high water fluoride levels) or overuse of fluoride rinses, toothpaste, and fluoride supplements

Good oral hygiene will help if the teeth are stained from a food or fluid, or if the abnormal color is the result of poor hygiene.

It is appropriate to consult your dentist for abnormally colored teeth. However, if the color seems to be related to a medical condition, your regular health care provider should also be consulted.

Call your health care provider if:

• Teeth appear to be an abnormal color without cause
• Abnormal tooth color lasts even after practicing good oral hygiene

The dentist will examine the teeth and ask questions about the symptoms. Questions may include:

• Time pattern
  • Have the teeth been abnormally colored since they grew in, or did they change color over time?
  • When did you notice this problem?
  • Does it improve when good oral hygiene is maintained?
• Diet
  • What foods and drinks do you or your child usually consume?
  • Does the person drink coffee or tea?
  • How much milk and dairy products does the person drink?
• Medication history
  • What medications are currently being used?
  • What medications have been taken in the past (particularly, did the child ever take tetracycline)?
  • What medications did the mother take when pregnant?
• Health history and family history
  • Do other members of the family have teeth that are abnormally colored?
  • How has the general health been?
  • Was the child jaundiced as a baby?
• Fluoride exposure
  • Is the water fluoridated where you live or visit frequently?
  • Do you take fluoride supplements?
• Oral hygiene habits
  • Are there frequent problems with the teeth such as cavities or gum inflammation?
  • What are the dental habits?
  • How often are the teeth brushed and flossed?
  • What kind of toothpaste, mouthwash, or similar substances are used?
• What other symptoms are also present?

Testing may not be necessary in many cases. However, if the health care provider suspects the coloration may be related to a medical condition, testing may be needed to confirm the diagnosis. Dental x-rays may be taken.

Review Date: 02/22/2010

Jack D Rosenberg, DDS, Advanced Dental Care, Palm Beach Gardens, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, M.D., MHA, Medical Director, A.D.A.M., Inc.

Toothache is pain in or around a tooth.

Pain - tooth or teeth

A toothache is generally the result of dental cavities (tooth decay) or sometimes an infection. Tooth decay is often caused by poor dental hygiene, although the tendency to get tooth decay is partly inherited.

Sometimes, pain that's felt in the tooth is actually due to pain in other parts of the body. This is called referred pain or radiating pain. For example, an earache may sometimes cause tooth pain.

• Abscessed tooth
• Earache
• Injury to the jaw or mouth
• Heart attack(can include jaw pain, neck pain, or toothache)
• Sinusitis
• Tooth decay

Over-the-counter pain medications may be used while waiting to see the dentist or primary health care provider.

For toothaches caused by a tooth abscess, the dentist may recommend antibiotic therapy and other treatments, like root canal.

To prevent tooth decay, use good oral hygiene. A low sugar diet is recommended along with regular flossing, brushing with fluoride toothpaste, and regular professional cleaning. Sealants and fluoride applications by the dentist are important for preventing tooth decay.

Seek medical care if:

• You have a severe toothache
• You have a toothache that lasts longer than a day or two
• You have fever, earache, or pain upon opening the mouth wide

Note: The dentist is an appropriate person to see for most causes of toothaches. However, if the problem is referred pain from another location, you may need to see your primary health care provider.

The dentist will examine you. The physical examination may include an examination of the mouth, teeth, gums, tongue, throat, ears, nose, and neck. You may need dental x-rays. The dentist may recommend other tests, depending on the suspected cause.

The dentist will ask questions about your medical history and symptoms, including:

• When did the pain start?
• How severe is the pain?
• Where is the pain located?
  • Does it involve the jaw or ears?
  • Does it radiate to other parts of the body, such as the neck, shoulder, or arm?
• What makes it worse?
  • Is it worse after cold foods or liquids?
  • Is it worse after sweet foods or liquids?
  • Is it worse after chewing?
  • Is it worse after drinking?
  • Is it worse when you touch the area?
  • Is it worse after physical exertion?
• Does the pain wake you up at night?
• What makes it better?
  • Is it better after you use medications? (Which ones?)
  • Is it better after you use a heating pad?
  • Is it better after you rest?
• What other symptoms do you have?
  • Fever ?
  • Nausea?
  • Sweating?
  • Indigestion?
  • Chest pain?
  • Bleeding?
• What medications do you take?
• Have you been injured?
• When was the last dental checkup?
• Have you had previous dental problems?

Treatment may involve fillings, tooth removal, or a root canal, if the problem is severe. If there is a fever or swelling of the jaw, an antibiotic will usually be prescribed.

Tooth decay in early childhood occurs most often in the upper and lower front teeth (incisors) and can be a serious problem.

Bottle mouth; Bottle carries; Baby bottle tooth decay; Early childhood caries (ECC)

Your child needs strong, healthy baby teeth. These teeth help your child chew food, speak, and have enough space in his or her jaw for the adult teeth to grow in straight.

Tooth decay can happen when your child's teeth come in contact with too much sugar. This sugar helps bacteria grow. Acids that the bacteria make cause the teeth to decay.

Many of the liquids that your child drinks contain sugar, including milk, formula, and fruit juices. Eating snacks with sugar also places more sugar on your child's teeth.

How often your child drinks liquids containing sugar, and how long the sugar stays in the mouth are also important. When children sleep or walk around with a bottle or sippy cup in their mouth, sugar coats their teeth for longer periods of time, causing teeth to decay more quickly.

Breast milk by itself is the healthiest food for babies' teeth. It tends to slow bacterial growth and acid production. However, when breast milk is alternated with sugary foods or drinks, the rate of tooth decay can be faster than with sugar alone.

Prevention

Feeding tips to prevent tooth decay:

• DO NOT fill your child's bottle with fluids that are high in sugar, such as punch, gelatin, or soft drinks.
• Put your child to bed with a bottle of water only -- not juice, milk, or other drinks.
• Give children ages 6 - 12 months only formula to drink in bottles.
• Remove the bottle or stop nursing when your child has fallen asleep.
• Avoid letting your child walk around using a bottle of juice or milk as a pacifier. Avoid prolonged use of pacifiers and DO NOT dip the pacifier in honey, sugar, or syrup.
• Begin teaching your child to drink from a cup at around 6 months of age. Try to stop using a bottle by age 12 - 14 months.
• Limit juice to fewer than 6 ounces per day during meals.

Tips for caring for your child's teeth:

• After each feeding, gently wipe your child's teeth and gums with a clean washcloth or gauze to remove plaque.
• Begin toothbrushing as soon as your child has teeth. Brush your teeth together, at least at bedtime. If you have an infant or toddler, place a small amount of non-fluoridated toothpaste on a washcloth and rub gently on their teeth. You can switch to fluoridated toothpaste when you are sure that your child spits out all of the toothpaste after brushing. Older children can use a toothbrush with soft, nylon bristles. Use a very small amount of toothpaste (no more than the size of a pea).
• Begin flossing children's teeth when all of the primary (baby) teeth have erupted (usually around age 2 1/2).
• If your baby is 6 months or older, use fluoridated water or a fluoride supplement if you have well water without fluoride. If you use bottled water, make sure it contains fluoride.
• Inspect your child's teeth regularly and begin dental visits when all of the baby teeth have erupted or at age 2 or 3, whichever comes first.

Douglass JM, Douglass AB, Silk HJ. A practical guide to infant oral health. Am Fam Physician. 2004 Dec 1;70(11):2113-20.

Dental caries. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 304.

Ribeiro NM, Ribeiro MA. Breastfeeding and early childhood caries: a critical review. J Pediatr (Rio J). 2004 Nov;80(5 Suppl):S199-210.

Sexton S, Natale R. Risks and benefits of pacifiers. Am Fam Physician. 2009;79:681-685.

Touger-Decker RJ. Position of the American Dietetic Association: oral health and nutrition. J Am Diet Assoc. 2007 Aug;107(8):1418-28.

Review Date: 08/02/2011

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.