Tooth Abscess Still Swollen After Taking Antibiotics

Written & Reviewed by Dr David Chen

The tooth that has been bothering you has finally become abscessed and your face has started to swell up. After much contemplation and procrastination, you’ve mustered up the courage to see your dentist.

amoxicillin RX

As in line with your expectations, you left the appointment with a prescription for antibiotics which was what you thought would happen. You take the first dose and nothing happens. It’s still swollen and it was just as painful as before!

Surely, taking the antibiotics should get rid of the swelling and the abscessed tooth right? But why is it not doing anything? Is this normal or did something go awfully wrong?

Our purpose here today is to guide you through what you should do if the abscess is still swollen after taking antibiotics. It is important to distinguish what is normal and when you need to seek medical help.

If the above scenario sounds like your situation, you shouldn’t panic just yet. As miraculous as antibiotics are in treating infections, they don’t work instantaneously.

When do the antibiotics start working?

Depending on which antibiotic you’ve taken, it may take 1-2 hours before it starts working. It takes that long because two things need to happen.

  • After ingesting the pill, it needs to work its way through your digestive system and get absorbed.
  • Then it needs to be transported to the site of the abscess and that takes time.
AntibioticTmax (Time to reach peak concentration)
Amoxicillin1.31 hours
Augmentin1.03-1.50 hours
Clindamycin0.75 hours
Azithromycin2.2 hours
Chart of antibiotics and their respective Tmax

Ultimately, it takes time before the medications start working. Also just because it has started working, it doesn’t mean you’ll feel the effects immediately. What you will feel are incremental improvements that happen slowly over time. In other words it will not go away immediately but it should trend towards the positive direction.

The four most commonly prescribed antibiotics for dental abscesses:

  • Amoxicillin. The most commonly prescribed antibiotic for dental infections is amoxicillin. It is the first choice unless there is an allergy or the infection is too severe.
  • Amoxicillin and Clavulanate (Augmentin). This is stronger than amoxicillin due to the addition of clavulanate. It can be used to treat sinus involvements and also dog bites.
  • Clindamycin. Was previously the first choice if the patient had a penicillin allergy.
  • Azithromycin. Recently azithromycin has become the first choice for those who are allergic to penicillin. It appears to be safer and has less side effects.

How long after starting antibiotics will tooth pain go away?

It will take about 1-2 hours after you’ve taken the antibiotics before you feel an improvement in tooth pain. It will not go away all at once but you should gradually feel better with each passing day. Your condition should trend towards the positive direction.

How long does it take for antibiotics to reduce swelling from a tooth infection?

The antibiotics will start working 1-2 hours after ingestion but you most likely won’t notice a reduction in swelling until 24-48 hours later. However you should start feeling better on the day of starting the prescription.

The facial swelling should improve with each day. Although it won’t go away completely until after you finish the entire course of the antibiotic. Even if you’ve noticed that the swelling has mostly gone away by the 5th day, you should still finish the course of the medication.

There could be traces of the abscess that is left which you can’t see! You don’t want it to swell back up again because you didn’t finish taking it as directed.

Signs that antibiotics are NOT working

Hopefully you don’t get to this point but antibiotics are not a panacea. If the infections are too severe the swelling from the tooth abscess will not go away with antibiotics alone. Here are some signs to look out for so you know when to seek medical help.

Tooth abscess still swollen after 3 days of antibiotics

If you’re still swollen with no improvement after 3 days of antibiotics, it means that you have a complication. It is quite normal and not unusual for you to still be swollen after the first day because everyone’s immune system works at a different pace.

However to still have no signs of recovery after the third day, something is definitely wrong. The normal course of recovery should be gradual improvements with each passing day. The three day mark is the limit as to how long you should ever wait. You need to contact your dentist now.

Other signs that antibiotics are not working:

  • Tooth abscess still swollen after 5 days of antibiotics.
  • Tooth abscess still swollen after 7 days of antibiotics.
  • Essentially any residual swelling after the 3rd day is a bad sign.

Tooth abscess getting bigger with antibiotics

If your tooth abscess is getting bigger despite taking the antibiotics, it means the antibiotic is not working. The medication should be decreasing the swelling and NOT increasing it.

This is indicative that you’re trending towards a negative outcome. The most important sign to look for while recovering from an abscess is a trend in the positive direction.

Therefore, if you notice the abscess getting bigger after 24 hours, we would immediately seek medical help. Our recommendation is to not even wait for the 3rd day in this situation. Call your dentist right away if it is getting bigger.

Worsening tooth pain

The tooth pain won’t dissipate immediately after taking the antibiotic but it should improve gradually. It should feel a little bit better after each day. However if you notice the pain getting worse, it is an indication that a complication has occurred.

Reasons the antibiotics are not working

Took the antibiotics too late

Antibiotics are effective for reducing swelling from dental abscesses if they were taken within 48 hours of it starting. If you take it after 48 hours, it may be too late and it won’t be effective enough to treat the swelling.

Essentially, oral antibiotics are effective but only for the early stages of the infecIt will not go awaytion. You have a time window for catching it and acting quickly. If you miss this window of opportunity you will need to move onto the next step.

Incision and drainage of a dental abscess

If the dental abscess is still swollen after 3 days of antibiotics, it means it is not working and it needs to be drained instead. This emergency surgical dental procedure is called an incision and drainage. It will definitively reduced the facial swelling.

  1. Administer local anesthesia. You need to be numb for this procedure.
  2. Make an incision. A cut is made into the swelling.
  3. Drain the abscess. The abscess will need to be popped and drained.
  4. Irrigate the wound. Flush out all of the pus and infection.
  5. Place a drain as necessary. A rubber drain may be kept inside the wound to prevent it from closing and to encourage continual drainage.

The swelling should have come down a lot after this treatment but you still need to finish the rest of the antibiotics.

Wrong type of antibiotic

Each antibiotic is effective against a certain spectrum of bacteria. If you happen to have a strain that is not covered by the commonly prescribed amoxicillin, the swelling may not go down.

That is an impossible situation to predict because it is not common place for dentists to do bacterial cultures. Maybe if you were at a hospital they might do a culture but usually the amoxicillin does the trick most of the time. Typically when it doesn’t, it means something very interesting is going on but that isn’t something you want to experience!

The solution for this situation would be to try a different antibiotic. If the abscess decreases in size from the change in medication then it means it is the right one.

Antibiotic-resistant Superbugs

In rare situations, you can have an antibiotic resistant strain of bacteria which are referred to as superbugs. These bacteria have developed resistance or even immunity to our commonly prescribed antibiotics due to overuse of them. If you’ve taken too many antibiotics over the years, there is a chance it may not be working today when you need it to.

One example of a superbug would be MRSA (methicillin-resistant Staphylococcus aureus). If you happen to have this, you may need to go to a hospital to get treated. Dental offices are not equipped for this level of infection.

This is why it is important to practice jurisprudence in prescribing antibiotics only when it is absolutely needed.


The antibiotics take time for it to start working because it needs to get absorbed into the system and transported to the site of infection. It may take 1-2 hours before it even starts working but you probably won’t notice any relief until the next day.

You can expect the tooth pain and swelling to slowly decrease and improve with each passing day. However if you notice it getting worse or if the swelling is still persistent after 3 days, you need to seek help. Don’t wait and contact your dentist immediately.

What you want to look for is a trend of increasing improvements. If you’re headed in the opposite direction of it worsening then a complication has occurred.


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