Why Didn’t My Dentist Drain My Abscess

An incision and drainage (I and D) is an essential dental procedure used to treat facial swelling caused by a dental abscess. But have you ever wondered why your dentist didn’t drain your abscess? In this article, we will uncover the reasons behind this decision and shed light on the importance of follow-up treatment to address the root cause. So, let’s dive in!

When a Dental Abscess Needs to Be Drained

Before we explore why your dentist may not have drained your abscess, it’s crucial to understand when this procedure is necessary. Incision and drainage can only be performed on dental abscesses that exhibit swelling. If there is no swelling, there is nothing to drain—plain and simple.

There are various conditions that may result in an abscess with swelling, including untreated root canal infections, gum abscesses, severely decayed teeth, fractured teeth, swollen wisdom teeth, infected dental implants, and swollen gums. These situations can lead to facial swelling and require drainage to alleviate the discomfort.

When Abscesses Do NOT Need to Be Drained

However, there is one situation where drainage may not be necessary. Dental abscesses without swelling can be successfully treated with antibiotics alone if the swelling occurred within the last 48 hours. If antibiotics are administered before this cutoff point, the swelling can potentially subside. However, beyond 48 hours, drainage becomes necessary for effective treatment.

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What to Expect During a Dental Abscess Incision and Drainage

If your dentist has determined that an incision and drainage procedure is required, here’s what you can anticipate during the process:

  1. Administer local anesthesia: To ensure a painless experience, your dentist will apply topical benzocaine (numbing gel) and inject lidocaine with epinephrine.
  2. Wait for anesthesia: It may take a few minutes for the anesthesia to take effect. In some cases, complete numbness may be challenging to achieve due to the severity of the infection.
  3. Make an incision: Using a small scalpel, your dentist will make an incision that corresponds to the size and extent of the abscess, reaching down to the bone level.
  4. Drain the abscess: A closed hemostat is used to open the abscess, allowing the infection to be drained fully. Multiple directions and angles are employed to ensure complete drainage.
  5. Irrigation inside the abscess: The dentist will flush out the entire inside of the abscess to ensure optimal cleanliness.
  6. Place a drain (if necessary): In severe cases, a drain may be inserted into the abscess to aid continuous drainage and prevent the wound from closing prematurely.

It’s important to note that the incision will be left open. The absence of stitches allows the infection to be effectively treated through home massage and the use of antibiotics.

I and D Aftercare

After undergoing a dental abscess incision and drainage, it’s crucial to prioritize your recovery. Here are some helpful instructions to follow:

  • Rest: Take the time to recuperate and avoid making plans for the rest of the day. Bed rest is highly recommended.
  • Stay warm: In some cases, patients may experience chills and shivering due to emotional distress. Bundle up and ensure you take all prescribed medications.
  • Take prescribed medications: Follow your provider’s instructions and complete the entire course of antibiotics along with any pain medication provided.
  • Massage your face: Massaging your face gently during the first day can aid in draining the abscess.
  • Cold compress: Apply an ice pack to your face for 10-15 minutes on and off. This will help numb the area and reduce swelling.
  • Salt water rinse: Starting the day after the procedure, rinse your mouth with salt water after every meal to ensure cleanliness.
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Don’t forget to schedule a follow-up appointment with your dentist. This appointment serves three critical purposes: ensuring your overall well-being, removing any placed drains, and identifying the source of the infection.

Treat the Source of the Dental Abscess

While incision and drainage provide temporary pain relief and swelling reduction, it is essential to address the source of the dental abscess. In most cases, the infection originates from a specific tooth. To treat the abscess effectively, two primary options are available: a root canal or a tooth extraction.

A root canal involves removing the infected nerve, which continuously produces pus and swelling. Leaving the nerve untreated will result in persistent infection, potentially causing reoccurrence of swelling even after drainage. On the other hand, tooth extraction offers an alternative to a root canal. In severe cases, extraction may be the only viable solution.

Regardless of the chosen treatment, it is crucial to take antibiotics to ensure complete elimination of the infection. Antibiotics cover any areas in the mouth that may have been missed visually. However, please note that antibiotics alone cannot treat severe facial swelling that has persisted beyond 48 hours. In such cases, physical drainage is necessary to relieve the pressure.

Alternative to a Dental Abscess Incision and Drainage

When it comes to draining a dental abscess, there is technically no alternative. If drainage is necessary, it is the only way to reduce the swelling. Just like a water-filled balloon, the infection needs to be released for the pressure and swelling to subside.

You may wonder why the dentist does not immediately perform a root canal or extraction instead of drainage. The reason is that, in cases where the swelling is severe, identifying the abscessed tooth becomes challenging. During this time, it is more prudent to drain the abscess, prescribe antibiotics, and schedule a follow-up appointment to properly diagnose the source after the pain and swelling have subsided.

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As with any dental procedure, there is always a risk of complications. This risk is heightened during a surgical procedure like incision and drainage. Potential complications include nerve damage, the return of swelling, and the spread of the infection beyond the mouth, which can be life-threatening. If you experience any complications, seek immediate medical help.


In conclusion, if you require an incision and drainage procedure for a dental abscess, it is crucial to see a dentist promptly. Home remedies and waiting will not make the swelling disappear. Incision and drainage provide temporary relief, but definitive treatment—such as a root canal or tooth extraction—must follow to address the root cause. Antibiotics are essential to ensure complete elimination of the infection.

Remember these key points:

  • Incision and drainage is an emergency palliative treatment for a dental abscess.
  • Definitive treatment is necessary to treat the source of the abscess.
  • Follow your dentist’s instructions and take all prescribed medications.
  • Do not hesitate to seek professional care if complications arise.

For more information on dental health and related topics, visit 5 WS. Stay informed, stay healthy!

Yours in oral health,
David Chen, DDS

The 5 Ws and H are questions whose answers are considered basic in information gathering or problem solving. 5ws.wiki will best answer all your questions

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