Opening and drainage of category I abscesses

Swollen gums, a throbbing tooth and a bad taste in the mouth? This is often how a gum boil shows itself. Doctors call it an abscess. Pus does not go away on its own: it needs drainage. At UKRMED Maxillofacial Surgery, surgeon Anna Kravchenko assesses the spread of inflammation, opens the abscess and plans treatment of the cause.

What a dental abscess is

An abscess is a contained collection of pus caused by bacterial infection. The most common sources are:

• Periapical abscess — at the root tip of a tooth with a dead nerve, after deep decay or injury.
• Periodontal (gum) abscess — in a deep gum pocket in periodontitis.
• Pericoronitis — inflammation of the gum over a partly erupted wisdom tooth.

Symptoms

• throbbing pain that worsens when the tooth is touched;
• a swelling on the gum, sometimes with a white head;
• swelling of the gum or cheek;
• a bad taste or breath;
• fever and enlarged lymph nodes under the jaw.

Seek urgent help if the swelling spreads quickly to the neck or eye, or if swallowing, breathing or opening the mouth becomes difficult, or you have a high fever. These are signs of spreading infection.

What category I means

The category reflects the extent of surgery. Category I is an abscess in the gum or under the periosteum that can be drained through a small incision inside the mouth. Deeper infections in the fascial spaces of the face and neck are category II.

Why an antibiotic alone is not enough

An antibiotic does not penetrate a pus-filled cavity and does not remove the source — the infected tooth. A 2024 Cochrane review and the American Dental Association (ADA) guideline stress that the main treatment is draining the pus and removing the cause; antibiotics are added only for spreading infection or systemic symptoms such as fever and malaise.

The procedure

1. Examination and an X-ray, plus CT if needed, to find the causative tooth and the extent of infection.
2. Anaesthesia. Numbing works less well in inflamed tissue, so the surgeon chooses the technique carefully.
3. Incision at the most prominent point to release the pus.
4. Irrigation of the cavity with antiseptic.
5. Drainage — a thin rubber drain keeps the wound open until the pus has cleared.

Relief usually comes within a few hours.

Treating the cause

Drainage is only the first step. Without treating the cause, the pus comes back:

• a tooth that can be saved is treated with root canal therapy under a microscope;
• a badly damaged tooth is extracted;
• a gum abscess in periodontitis needs periodontal treatment.

Abscess after tooth extraction

After an extraction, the socket hurts for two to three days and then settles. Swelling, pus and fever a few days later may mean an abscess. Severe pain with an empty socket and no pus more often means dry socket. Both need a surgeon's review.

Aftercare

• A check-up after one to two days; the drain is removed once drainage stops.
• Warm mouth rinses if prescribed; do not apply heat to the cheek.
• Soft, lukewarm food, no smoking or alcohol.
• Medicines exactly as prescribed.

Prices at UKRMED

Sources

1. Cope A. L., Francis N., Wood F. et al. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev, 2024. https://doi.org/10.1002/14651858.CD010136.pub4
2. Lockhart P. B., Tampi M. P., Abt E. et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. J Am Dent Assoc, 2019. https://doi.org/10.1016/j.adaj.2019.08.020