Hesperian Health Guides

Tooth Abscess

In this chapter:

A cavity that is not treated grows bigger and deeper until it touches a nearby nerve. Germs travel inside the tooth’s root and start an infection called an abscess. Pus forms at the end of the root, inside the bone. As the pus increases, it causes great pressure. This is why an abscess causes severe pain.

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  • Pain all the time, even when trying to sleep.
  • Tooth often feels longer, and even a bit loose.
  • Tooth hurts when it is tapped.
  • A sore on the gums near where the root ends (gum bubble).
  • Swelling of the gums around the tooth, or swelling of the face on the same side as the bad tooth.

If possible, first drain the abscess. To do this, open the abscess with a sharp sterile knife to release the pus. Or you can remove the pus with a sterile syringe and needle. Then cover the wound with a sterile dressing to keep it clean. If you are not able to drain the abscess, reduce the swelling with heat and show the person how to continue doing this at home. Until the swelling goes away, they should regularly (many times a day):

  • soak a cloth in warm water and hold it against their face.
  • hold warm water inside their mouth near the swelling. It is not necessary to use salt water.

After draining the abscess or reducing the swelling, treat with antibiotics. See below for the correct doses.

(for those allergic to penicillin)
Amoxicillin Erythromycin
Give enough medicine for 7 to 10 days Give enough medicine for 7 to 10 days
Take this dose for 5 days Take this dose for 7 to 10 days
Adults and children 8 years or older 1 g (1000 mg), 2 times a day Adults 500 mg, and children 13 years or older 500 mg, 4 times a day
Children 2 to 8 years 500 mg, 2 times a day Children 11 to 13 years 500 mg, 3 times a day
Children 3 months to 2 years 250 mg, 2 times a day Children 8 to 11 years 500 mg, 2 times a day
Children 3 to 8 years 250 mg, 3 times a day
Children 1 to 3 years 250 mg, 2 times a day
Children 2 to 12 months 125 mg, 2 times a day
IMPORTANT:: if amoxicillin upsets your stomach, take it with meals. IMPORTANT: to avoid upset stomach, take erythromycin with meals.

Note: If you do not have amoxicillin, you may be able to use ampicillin. To use ampicillin, see Where There Is No Doctor. People allergic to penicillin will also be allergic to amoxicillin and ampicillin.

Make sure the person knows they must take all of the antibiotic as directed, even if the abscess is drained, the tooth is removed, or their signs improve. If they do not take the full dose, the infection may come back stronger than before.

Also give the person medicine for pain. A 2-day supply should be enough, because draining the abscess or removing the tooth and giving antibiotics should reduce the pressure and that will reduce the pain. The best medicines for pain are aspirin, which usually comes in 300 mg tablets, paracetamol (acetaminophen), which usually comes in 500 mg tablets, and ibuprofen, which usually comes in 200 mg tablets. Aspirin is usually cheapest, but paracetamol (acetaminophen) does not cause stomach pain and is safer than aspirin for children. (To avoid stomach pain, take aspirin with food, milk, or water.)

(4 times a day):
aspirin or paracetamol (acetominophen) or ibuprofen
adults 600 mg 500 to 1000 mg 200 to 400 mg
children 8 to 12 years do not use 375 mg (¾ of 500 mg tablet) 250 mg (1one 200 mg tablet + ¼ of 200 mg tablet)
3 to 7 years do not use 250 mg (½ of 500 mg tablet) 150 mg (¾ of 200 mg tablet)
1 to 2 years do not use 125 mg (¼ of 500 mg tablet) 75 mg (¼ of 200 mg tablet + ⅛ of 200 mg tablet)

This page was updated:17 May 2024