Most people believe that if they have a tooth infection, it will hurt. The things they are surprised by are the bulges: the lopsided cheeks in the mirror, the eyelid that won’t open, the jawline that just vanished overnight. Easy to shrug off as a toothache gone wrong and get a bit of sleep and some paracetamol.
That’s not the right choice. The swelling of the face is the stage at which the dental infection can no longer be contained inside the tooth, and begins to spread into the tissue surrounding it. While most are pain-free and do not require an emergency dentist in Sydney immediate attention, they evolve into a serious issue in a matter of hours in a small percentage of cases.
Why a tooth infection makes your face swell
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A dental abscess begins when bacteria gets into the roots of the tooth’s pulp, typically via untreated tooth decay, cracks, worn fillings or deep pockets in the gums. The pulp of the tooth dies, pus builds up at the root of the tooth and the body attempts to isolate the infection.
Pus must have someplace to drain. If it does not drain through a tooth or a gum, it follows along the soft tissue of the cheek, the floor of the mouth or under the jaw. This is the swelling one can see and feel.
That’s where people get tripped up: The pain usually goes away once the infection makes its way out of the tooth. The nerve is dead and the pressure has been removed. Better isn’t good.
If the facial swelling is a medical emergency
Lower tooth infections can spread under the tongue and into the neck, a condition known as Ludwig’s angina that can cause the opening of the airway to become smaller. Infections in the upper teeth can spread towards the eye. Sepsis can also result from bacteria getting into the bloodstream. These outcomes are rare, but occur within hours not weeks.
If any of these symptoms occur you should seek medical help rather than dental treatment:
Go to your nearest emergency department, or call 000, if you notice:
- Trouble breathing, swallowing or controlling saliva
- Voice change, muffled voice
- Swelling under the jaw or in the neck, or swelling pushing the tongue upwards
- Can’t open my mouth more than 2cm.
- If the swelling is moving towards the eye, or if the eye is swollen shut.
- Fever, shivering, rapid heartbeat, confusion or extreme illness
- Visible swelling of about 10 hours duration that becomes progressively worse.
Nothing short of this requires immediate dental treatment, but not a hospital bed.
Why antibiotics alone aren’t the answer
Antibiotics may be used to slow down an infection and give time, but they do not get rid of the source. The dead pulp/pocket of pus remains and the issue often reappears at the end of the course. An old prescription left in the medicine cabinet is a common issue in Australian homes: it’s masking the warning signs and not providing the treatment.
Tips on what to do during the waiting time until you’ve been seen
- Apply cold compresses to the outside of the cheek for short periods
- Follow OTC pain medications as directed on the OTC pain medicine packet
- Wash a few times daily with warm salty water, avoiding the use of soap.
- Sleep propped up o’ extra pillows
- Eat soft foods and drink plenty of fluids.
- Take a picture of the swelling in the morning to see if it is expanding or not.
- Do not squeeze or lance the swelling, do not place aspirin on the gum, do not use heat on the face.
- Proper treatment of the tooth.
The treatment of a dental abscess involves the treatment of the cause. This normally requires an examination and an X-ray, followed by the draining of the abscess (where appropriate), and either root canal treatment, or extraction of the tooth if it can’t be saved.
If you don’t go into a clinic, then an after hours or emergency dental practice is the next step. Although not all practices have this available, it is a service provided at many practices for urgent cases. Sydney Dental Hospital, Surry Hills, will also evaluate dental emergencies; expect to wait depending on their level of activity.
Frequently asked questions
Does swelling around the face because of tooth pain resolve on its own?
If the abscess opens up, the swelling may decrease, but the infection within the tooth will not. Without treatment it tends to flare again, often more severely than the first time.
When should I be seen?
Wherever possible, the same day. If a child is swollen and the swelling is spreading, or is accompanied by fever or difficulty in swallowing, it is an emergency – not tomorrow’s appointment.
Does one of the teeth need to be extracted?
Not always. Root Canal treatment can be used to save many infected teeth. This will depend on the amount of sound tooth structure left and the state of the bone surrounding the root.
Does Medicare Pay for this?
For most adults, general dental care is not covered by Medicare. Part of this is covered by private health extras and public emergency dental care is provided for those who are eligible for concession card.
Don’t wait it out
Swelling in the face is a sign of a tooth issue that is past “toothache” level. Most cases are simple if treated early. Don’t wait to see how it looks tomorrow, book emergency dental care today – if you can’t swallow, breathe or see, head to an emergency department.
