How to Recognize a Dog Tooth Abscess and What to Do About It

A dog tooth abscess can be painful for your canine companion. Integrative veterinarian Dr. Julie Buzby explains how tooth root abscesses occur, symptoms to watch for, and what your vet can do to get your pup feeling better in no time.

As soon as I heard that my next appointment was here for “swelling beneath the eye,” I had a strong suspicion that I was going to end up diagnosing my patient with a tooth root abscess.

My suspicions increased once I began to examine Charlie, a lovely 9-year-old neutered male Border Collie. Poor Charlie had a round swelling beneath his left eye. There was some pus draining from the surface of the swelling. Charlie’s mom was understandably worried, especially because the swelling seemed to develop so quickly. Two days ago, he was perfectly normal.

I took a look in Charlie’s mouth and saw that his left fourth upper premolar (i.e. carnassial tooth) didn’t look good. The gums over that tooth were red. Also, it looked like the tooth was broken some time ago. There was more tartar on that tooth than the same one on the other side. This made me concerned that my patient was chewing less on the left side of his mouth.

Also, Charlie had really bad breath—more than just the usual “doggy breath.” Unfortunately, all signs pointed to a tooth root abscess.

What is a dog tooth abscess?

A tooth root abscess is a severe infection that develops when bacteria from the mouth get to the root of a tooth. This can happen for two reasons— either because a tooth is broken or due to severe periodontal disease (i.e. dental disease in dogs). Let’s take a look at both.

Why a broken tooth is an abscess waiting to happen

Broken teeth are very common in dogs. In fact, a study in the Journal of Veterinary Dentistry reported one in four pets have a traumatic dental injury, with fractured teeth making up almost 50% of those injuries. Dogs can break their teeth when they chew on hard materials. These include metal dog crate doors, antlers, bones, or hard plastic toys. It can also happen if they experience some sort of trauma to their face.

A layer of enamel covers a healthy tooth. This protective surface stops bacteria in the mouth from reaching the soft tissues inside the tooth, known as the pulp chamber. However, a broken tooth or chipped enamel allows bacteria to enter the pulp chamber.

The pulp chamber acts as a kind of freeway for bacteria. It allows the bacteria to travel straight to the root of the tooth. Then the infection at the root of the tooth affects the bone and soft tissues around the tooth. The result is an abscess. 

Why severe periodontal disease is another culprit behind a tooth abscess

Dog tooth abscesses can also occur with severe periodontal disease. Dogs with periodontal disease have inflamed gums that are infected with bacteria. Sometimes the bacteria travel along the outside of the tooth all the way to the root. This causes infection of the bone and soft tissues around the root, and can result in an abscess. (On a related note, periodontal disease also may be the culprit behind why your older dog is losing teeth.)

What are the symptoms of a dog tooth abscess?

Dogs with tooth root abscesses may have one or more of the following signs:

• Swelling beneath the eye—the roots of the fourth upper premolar and first upper molar teeth (i.e. large chewing teeth that look like mountains in the upper jaw) lie right beneath the eye. An abscess of these roots can cause swelling beneath the eye and a swollen face. The abscess may burst and release pus. It can be easy to mistake this for a wound on your dog’s face. 
• Swelling under the chin or along the lower jaw—an abscess involving the roots of the lower premolar or molar teeth may cause a swelling along the lower jaw, which can burst and form a wound.
• Red gums—an infection of the tooth causes inflammation and redness of the gums.
• Bad breath—the bacteria involved in a tooth root abscess often cause a nasty odor to the breath.
• Pain—signs can be subtle, but you may notice pawing at the face or chewing more on one side of the mouth than the other.

Dogs are good at hiding dental pain

Let’s focus a little more on the last symptom I mentioned—pain. When I discuss signs of tooth root abscesses with my clients, they commonly ask me, “My dog is still eating. Is he really in pain?” The short answer is yes! The longer answer is that even dogs with extremely painful mouths will continue to eat. Dogs have strong survival instincts, and they know they must eat to live. 

Dogs are also very stoic. Their ancestors were pack animals. This means they could be preyed upon by other animals if they showed any sign of weakness. Our canine companions have come a long way from their wolf ancestors. However, they will still hide their pain as much as they can. 

Many times, dogs hide pain so well that it’s not until they are pain free again that the difference is obvious. I can’t tell you how many times I’ve heard dog parents say, “My dog is acting like a puppy again!” during a visit following a tooth extraction.

How is a tooth root abscess diagnosed?

If you notice any of the symptoms listed above, there’s a good chance your dog may have a tooth root abscess. However, the only way to know for certain is to take your canine companion to your vet.

If you’ve ever had a sore tooth, you know just how much it hurts! It’s no different for dogs, so dealing with your dog’s tooth root abscess as soon as possible is crucial.

Initially, your vet will look in your dog’s mouth while he or she is awake, much like I did for Charlie. If your vet suspects your dog has an abscessed tooth, he or she will typically recommend a dental procedure.

During this procedure, your vet will take X-rays of your dog’s teeth. This is a critical diagnostic step. Your vet can’t see the tooth root or surrounding bone by just looking in your dog’s mouth. However, an X-ray makes it easy to find the affected tooth. An abscessed tooth usually has a dark halo visible around the tooth roots on an X-ray.

Your vet will also perform additional X-rays and a full dental examination during the procedure. This lets him or her evaluate the rest of your dog’s teeth for any problems. Then your vet will address any sore or diseased teeth (more on that soon) and a veterinary nurse will clean and polish the remaining teeth.

How is a tooth root abscess treated?

If your vet suspects your pup has a tooth root abscess after the initial exam, he or she will likely start your dog on antibiotics and some pain medication. This can help manage your dog’s symptoms until he or she can have a dental procedure.

However, it is important to remember that while your dog may feel better on these medications, this is a only a temporary “band aid.” Your dog still needs a dental procedure to take care of the abscessed tooth. Otherwise, the symptoms and pain will recur as soon your dog finishes taking the medications.

There is no effective home remedy or treatment that will help your dog with the pain and infection. In fact, some treatments could even be harmful. So always follow the advice of your veterinarian.

Two methods to address a tooth root abscess

Antibiotics and pain medications can temporarily help with the symptoms of a tooth root abscess, and are given as a “bridge” until your dog is scheduled for a dental procedure. It’s important to point out that the only way to bring your dog true relief is through one of the following two procedures:

1. Extraction of the tooth

In this case, your veterinarian will carefully remove the entire infected tooth. Then he or she will clean all the infected material out of the tooth socket. Finally, your vet will suture (stitch) the gums closed. The sutures are absorbable (so they don’t need removed) and your dog’s gums will heal completely in 10 to 14 days. This is the option that most general practice vets will be able to offer.

2. Root canal therapy

Root canals in dogs are very similar to root canals in humans. Performing a root canal requires specialized equipment and training, so your vet will likely refer your dog to a veterinary dentist if you choose to go this route. The veterinary dentist will remove the infected pulp tissue from the tooth and replace it with dental material. 

Veterinary dentists typically do root canal therapy on the largest and most functional teeth—like the canine teeth or the large premolars and molars. It is important to note that not all teeth are candidates for root canal therapy for a variety of reasons. Your veterinary dentist can advise you on the best option based on how much of the crown of the tooth is damaged, how bad the infection is, and the overall health of the tooth.

What are common concerns with these treatment options?

In talking with my clients about both dental procedures, two important questions often come up. You may have the same concerns, so let’s address them next.

1. How will my dog be able to chew if you remove his or her tooth (or teeth)?

This is a very common concern for many dog parents, but please don’t fear. Your dog will be able to eat just fine once your vet removes his or her sore tooth. In fact, many dogs actually eat better once their mouth no longer hurts. Your vet will also use nerve blocks during the procedure and post-op pain medication to ensure your dog is comfortable.

I’ve seen some dogs who have such severe dental disease that they require most or even all of their teeth removed. A switch to a soft food diet is necessary for these dogs. However, they usually eat with great vigor and joy once their mouth is pain and infection-free.

2. Why does my dog have to go under general anesthesia for the dental procedure?

This is another very common and understandable worry for dog parents. The truth is that general anesthesia is absolutely necessary for dental procedures in dogs. You may sit calmly (or maybe not so calmly) in your dentist’s chair while he or she takes X-rays, cleans your teeth, and performs dental surgery. But I don’t know a single dog who would do the same!

So, for your dog’s comfort and safety, and to allow your vet to safely work in your dog’s mouth, general anesthesia is a must. However, rest assured that your veterinary team will do everything in their power to keep your dog safe under anesthesia. To ensure your dog is a good candidate for anesthesia, your vet may recommend:

• Bloodwork to check kidney and liver function (the organs that break down and excrete the anesthetic drugs), red blood cell numbers (to ensure there are enough to carry oxygen to the tissues), and other indicators of your dog’s overall health.
• Chest X-rays to evaluate the size of the heart, diameter of the trachea, and lung patterns. This is especially important if your dog has a heart murmur, collapsed trachea in dogs, laryngeal paralysis in dogs, or other cardiac or respiratory conditions.
• Other tests specific to your dog’s particular medical conditions.

Age-related concerns with anesthesia

Pet parents commonly wonder, “Is my dog too old for anesthesia?” or “Is my dog too old for surgery?” Some conditions like heart disease in dogs, liver disease, or kidney disease are more common in older animals. However, if your veterinarian is aware of these conditions, he or she can often still find a safe anesthetic protocol for your dog.

If you have questions about how your dog would do with anesthesia, your veterinary team is your best resource. They can advise you on whether they feel that the anesthetic plan can be safely modified to meet your dog’s needs. If your dog has a more complicated case, your vet may also refer you to a facility that has a board-certified veterinary anesthesiologist and/or a veterinary dentist on staff.

While it can be scary to consider your dog undergoing anesthesia, it’s also important to know that left untreated, a tooth root abscess also carries risks. The infection in the mouth can sometimes spread to and damage other organs like the heart and kidneys. Not to mention, the abscessed tooth would be a source of dental pain for the rest of your dog’s life.

How can I prevent my dog from getting an abscessed tooth?

Remember the two reasons dogs get tooth abscesses—fractured teeth and periodontal disease? Well, one of the best ways to prevent tooth root abscesses is to make sure your dog isn’t chewing on items that could break his or her teeth. Be careful with hard materials like bones, antlers, or hard plastic toys, especially if your pup is a rough chewer. Try to find safe chew toys for your dog. Also, ask your veterinarian for advice if your dog is anxious when crated and chews on the metal bars of his or her crate.

Preventing periodontal disease in your dog is also critical for preventing tooth root abscesses. Brushing your dog’s teeth daily is the best way to prevent periodontal disease. But you can also talk to your vet about feeding a dental diet or using other dental care products approved by the Veterinary Oral Health Council.

Also, ask your vet how often they recommend your dog have routine dental cleanings to keep periodontal disease at bay. We humans are used to periodically going to the dentist for a professional cleaning and assessment even though we (should) brush our teeth every day. The same theory holds true for our dogs!

The rest of Charlie’s story

After discussing my suspicions with Charlie’s mom, I placed him on antibiotics and anti-inflammatory medication until I was able to schedule a dental procedure for him.

During the procedure, I performed dental X-rays of all his teeth. As I suspected, his left fourth upper premolar (carnassial tooth) was broken and severely infected. I removed this tooth, flushed the sockets, and sutured his gums closed. Then my veterinary nurse scaled and polished the rest of his teeth.

Charlie did very well after the procedure. When he came back to see me 10 days later, his mom reported he had more energy than ever!

If, like Charlie’s owner, you just found out your dear dog has a tooth abscess, take heart. We all hate to see our dogs in pain, and it can be worrisome to think about your dog undergoing general anesthesia. However, dogs often feel so much better once their painful tooth is addressed. Plus, you and your vet can work together to formulate a plan that will hopefully keep your dog from developing another abscessed tooth.

Did your dear dog have a tooth root abscess?

Please comment below to share his or her story.