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ProceduresCervicofacial infections · Emergencies

A swollen face
from a dental infection

A dental abscess does not heal on its own and can spread to the face and neck. If the swelling grows, or swallowing or breathing becomes difficult, it is an emergency.

Book your consultation→Step by step↓
If breathing or swallowing is hard
Go to the emergency room now
Treatment
Drain it and remove the cause
Where
In the practice or in hospital, depending on severity
Diagnosis
Examination, and a CT scan if it spreads

Approximate values: every case is different and your plan confirms them at the consultation.

Where does the infection come from?

It almost always starts in a tooth: deep decay, a half-erupted wisdom tooth or an infected gum. Pus collects in an abscess and, if untreated, makes its way into the spaces of the face and neck.

Treatment has three parts: draining the pus, removing the cause—treating or extracting the tooth—and antibiotics when indicated. Antibiotics alone do not cure an abscess that is not drained.

Ludwig's angina is an infection of the floor of the mouth, usually from a lower molar, that progresses within hours and can close the airway. It is a medical emergency.

Go to the emergency room immediately if:
  • 01It is hard to breathe, speak or swallowor you cannot swallow your saliva.
  • 02The swelling reaches the eye or the neckor grows quickly.
  • 03You cannot open your mouthor your tongue is pushed up.
  • 04You have a high fever and feel very unwellalong with the swelling.

In Costa Rica, if breathing is difficult, call 9-1-1.

Treatment

Drain it, and treat the cause.

  • 01Localised abscess

    Drainage in the practice

    Under local anesthesia the abscess is opened so the pus can drain; relief is usually quick.

  • 02Always

    Treat the cause

    Extraction or root canal treatment of the tooth, so the infection does not come back.

  • 03Spreading infection

    Hospital management

    Intravenous antibiotics, drainage in the operating room and, if needed, protection of the airway.

Step by step

From the emergency to the cause.

  1. 01Emergency
    Airway and extent

    Examination and, if the infection is spreading, a CT scan.

  2. 02Same day
    Drainage

    In the practice or in the operating room, depending on how far it has spread.

  3. 03Same day or days later
    Remove the cause

    Extraction or treatment of the tooth that caused the infection.

  4. 04Following days
    Check-up

    Review of the swelling, the drainage and the antibiotics.

After drainage

What to expect

  1. Hours

    Pressure pain eases as the pus drains.

  2. Days 1–3

    Swelling starts to go down; antibiotics if prescribed.

  3. Week 1

    Wound check-up.

  4. Afterwards

    Complete the treatment of the tooth.

  • Dr. Rodríguez and his team in the operating room
  • Working with magnification loupes during surgery
  • Gowning and gloving before surgery
Frequently asked

What patients ask before deciding.

Antibiotics help control the infection, but an abscess does not heal without draining the pus and treating the tooth that caused it.
When it is hard to breathe, speak or swallow, when the swelling reaches the eye or the neck, or if you cannot open your mouth. In those cases, go to the emergency room immediately.
An infection of the floor of the mouth, usually from a lower molar, that spreads quickly and can close the airway. It is treated in hospital.
When it is only partly through, the gum over it traps food and bacteria. If the infection keeps coming back, it is usually extracted.
Not always advisable: often the abscess is drained and the cause treated the same day. The assessment decides.
Related
Wisdom teeth surgery→Apicoectomy→Impacted teeth and complex extractions→All procedures→
Next step

Book your consultation.

One visit to review your case with imaging and leave with a clear plan: procedure, time and recovery.

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