Tooth Abscess Stages And Their Treatment

Written & Reviewed by Dr David Chen

A tooth abscess will progress through all of its stages sequentially with each one increasing in severity. It actually begins with tooth decay but it ends with a severe abscess that is accompanied by major swelling.

Tooth Abscess Stages
Tooth Abscess Stages

Are you reading this because you wish to know which stage of the abscessed tooth that you’re at and what you should do about it? Well, we shouldn’t keep you waiting much longer so let’s get right to it!

Stage 1 – Tooth Decay

The first stage of an abscess is tooth decay and it coincides with the stages of tooth decay. This stage can be further divided into three sub-stages beginning with enamel demineralization.

  1. Demineralization. Oral bacteria process sugar and produce acidic byproducts that demineralize the enamel. The tooth is literally losing minerals and weakening.
  2. Enamel decay. Once the enamel loses enough minerals and weakens enough, it will collapse and form a hole. The cavitation that develops is what we call enamel decay.
  3. Dentin decay. An untreated cavity in the enamel will grow and eventually progress into the dentin. The same demineralization process ensues in the dentin until it weakens enough to form a cavitation. Since the cavity is now into the dentin, we call it dentin decay.

The series of x-rays above show what cavities look like. Decay looks like a dark spot (radiolucent area) on the x-ray. The bigger the radiolucency is, the more severe the cavity.


The longer you delay treatment, the more involved, complex, and expensive it will be. However if you act quickly you may even be able to treat this stage with just at home oral care products.

Stage 1 - Tooth Decay Progression & Treatment
Stage 1 – Tooth Decay Progression & Treatment

Demineralization treatment

Demineralized enamel can be reversed if you use a remineralizing toothpaste that contains fluoride or nano-hydroxyapatite. Essentially you can self-treat this stage from the comfort of your home simply by practicing good oral hygiene habits.

Enamel decay treatment

Once you’ve a cavitation in the enamel, it can no longer be treated at home. You will need to seek out a dentist to get the tooth filled. The most popular filling choice would be a tooth colored composite resin.

Dentin decay treatment

Depending on the size of the carious lesion, a dental filling may suffice if it is small. However if the cavity is fairly big, you may benefit from a crown instead since it offers better protection.

Stage 2 – Pulp Infection

The second stage of an abscessed tooth is a pulp infection, which occurs when bacteria penetrate into the tooth nerve. This is a continuation of the dentin stage of tooth decay when the lesion is left untreated.

Pulp decay on x-ray
Pulp decay on x-ray

What it looks like on an x-ray is a large black area that is into the tooth pulp. At this point in time, the infection is still contained within the tooth but that changes shortly in the next stage.

Stage 3 – Periapical Abscess

The third stage is a periapical abscess which is when the infection travels from the pulp down to the tip of the tooth root. The abscess is no longer contained within the tooth but has now spread to the bone and periodontium outside of the tooth. Essentially the infection is now making a hole through your jaw bone.

front-tooth-periapical-pathology - marked
Periapical abscess outlined on x-ray

You can see the bone loss on the x-rays above. There is a large radiolucent area surrounding the root tip. Objects that are radiopaque are solid while radiolucent ones denote less solidness.

Gum boil

Periapical abscesses can sometimes present with a gum boil, which is a pimple on the gums. The pimple forms because the infection ate its way through the jaw bone and reached the surface of the gums. You may notice pus (white fluid) ooze out of the gum boil.

Stage 4 – Facial Swelling

Untreated periapical abscesses may lead to facial swelling, which is the fourth stage of an abscess. Basically the infection has grown so large that it has now overwhelmed your immune system. It has now spread from the periodontium to the soft tissues of your mouth and face.

The previous stage was considered urgent but a swollen face is a legitimate dental/medical emergency. The swelling can be disfiguring and extremely painful. This stage requires treatment immediately.

Stage 5 – Throat swelling

Untreated facial swelling can spread to your throat, which is the fifth and last stage of a tooth abscess. This can be life threatening because swelling in the throat can compromise the airway space which affects your breathing. If it closes off your airway, you won’t be able to breathe.

The time it takes for it progress from stage 4 to 5 could be days or if you’re unlucky it can be less than 24 hours. We do not recommend waiting to see if it will go away because it won’t. This condition needs to be treated right now with an incision and drainage (I and D) along with antibiotics.

What are you waiting for? Stop reading and get going now! The emergency department should be well equipped to treat you.

Treatment – Stages 2-5

All of treatments for stages 2-5 will require a visit to the dentist because there isn’t a single home remedy that will work.

  • Incision and drainage. Commonly known as draining an abscess but people tend to forget that it requires an incision before it can be drained. This is required to treat moderate-severe swelling.
  • Root canal. The abscess essentially originates from within the tooth nerve and the procedure which removes it is called a root canal.
  • Tooth extraction. If the infection is too big to treat with a root canal, tooth removal may be your only option. This is preferred if the tooth prognosis is questionable to poor.
  • Antibiotics. Any moderate to severe abscess will require a full course of antibiotics.
Abscessed tooth treatment - decision tree
Abscessed tooth treatment – decision tree

We’ve put together a diagram to show you the type of treatments that are needed based on the severity of your abscessed tooth. Essentially the longer you wait and the later the stage that you’re in, the more complex, involved, and expensive the treatment will be.

Don’t wait. Seek treatment immediately regardless of which stage of the infection that you think you’re in.


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