What to do, and what not to
Call, whatever the hour
Not in the morning. Not after the weekend. An abscess is a bacterial infection sitting next to the airway, the sinus and the bloodstream, and it does not respect office hours.
Do not apply heat
A hot compress, a hot water bottle or a hot drink held against it will open the tissue up and encourage the infection to spread further and faster. Cold on the outside of the cheek is fine.
Do not try to burst it
Not with a pin, not with a fingernail, not by pressing on it. Squeezing an abscess drives bacteria into the surrounding tissue, which is precisely the thing you are trying to avoid.
Salt water rinses, gently
Warm, not hot. A teaspoon of salt in a glass of water, held and released rather than swished hard. It helps a gum abscess drain naturally and it does no harm.
Painkillers as normal, and keep drinking
Your usual over-the-counter painkiller at the dose on the packet. Keep taking fluids, since fever and infection dehydrate you quickly.
How to tell an abscess from ordinary toothache
A swelling you can see or feel
In the gum, in the cheek, under the jaw, or under the eye. Toothache alone does not change the shape of your face. Swelling means the infection is no longer contained inside the tooth.
A constant deep throb rather than a sharp shock
Abscess pain is usually continuous and pressure-like, and it does not come and go with hot and cold the way a sensitive tooth does.
A bad taste, or salty fluid
That is pus draining. It often brings a sudden drop in pain, which feels like recovery and is not: the pressure has been relieved, the infection has not gone anywhere.
Fever, or feeling generally unwell
Shivering, tiredness, a raised temperature. This means your body is fighting something systemic and it moves the whole thing up a level of urgency.
The drop in pain when an abscess bursts is the most common reason people cancel the appointment they had booked. The infection is still there, and it comes back larger.
Why antibiotics alone are not the answer
Antibiotics reduce the infection in the surrounding tissue, and there are cases where they are genuinely needed. But the source of a dental abscess is inside the tooth or at the root tip, where the blood supply that carries the antibiotic no longer reaches. That is the whole reason the infection took hold there.
So a course of antibiotics from a pharmacy will usually calm it for a week and then it returns, often worse, and repeated courses build resistance for nothing. The infection stops when the source is drained and treated, which means a root canal or an extraction. Antibiotics are support for that, not a substitute for it.
What is done the same night
An X-ray finds the source, which is not always the tooth you think it is. The abscess is drained, which is usually the moment the pain stops. Antibiotics are prescribed where they are actually indicated. Then the tooth is either opened and started on root canal treatment, or extracted, depending on whether it is worth saving, and you are told which and why before anything begins.
You leave with the pressure gone and a plan for the rest. Prices are published in advance and quoted after the X-ray.