What is the treatment for dental infection (periodontal infection)?

From the Guidelines

The most effective treatment for dental infections is a combination of scaling and root planning (SRP) with adjunctive antibiotic therapy, specifically metronidazole/amoxicillin, which has been shown to significantly reduce probing depth and improve clinical attachment level gain 1. When treating dental infections, it is essential to consider the severity of the infection and the patient's overall health.

• For mild to moderate infections, SRP alone may be sufficient, but adjunctive antibiotic therapy with metronidazole/amoxicillin can provide additional benefits, including a greater reduction in probing depth and clinical attachment level gain 1.
• In severe infections, a combination of SRP and antibiotic therapy is often necessary to achieve optimal outcomes.
• The choice of antibiotic should be based on the most recent and highest quality evidence, which currently supports the use of metronidazole/amoxicillin as the most potent combination for treating dental infections 1.
• Pain management is also crucial in treating dental infections, and can be achieved with ibuprofen 400-600mg every 6 hours or acetaminophen 500-1000mg every 6 hours.
• Additionally, warm salt water rinses (1/2 teaspoon salt in 8 ounces of warm water) several times daily can help reduce inflammation and promote healing.
• It is essential to note that antibiotics alone are insufficient for complete treatment, and the source of infection must be addressed through dental procedures such as drainage of abscesses, root canal therapy, or tooth extraction, depending on the severity and location of the infection.
• Proper dental hygiene is also crucial in preventing dental infections, and patients should be advised to practice good oral hygiene habits, including regular brushing and flossing, to reduce the risk of future infections.

From the Research

Treatment of Dental Infections

• Dental infections can result in severe consequences, affecting both soft and hard tissues of the oral cavity, and are commonly presented with symptoms of pain, fever, and swelling 2.
• The management of dental infections typically involves surgical and endodontic treatments, followed by antibiotic therapy, with some alternative methods such as low-level laser therapy and photodynamic therapy also existing 2.
• Antibiotics are generally used in dental procedures to treat odontogenic infections, nonodontogenic infections, local infection, focal infection, and prophylaxis, with antibiotic prophylaxis prescribed for patients with immunosuppressed conditions, infective endocarditis, metabolic disorders, and patients with prosthetic joints 2.

Antibiotic Therapy in Dentistry

• The use of broad-spectrum antibiotics has been a major component in treating common oral diseases associated with a bacterial etiology, but the increasing prevalence of resistant organisms has dramatically affected their efficacy 3.
• Alternative chemical, physical, and mechanical strategies are being developed, including novel narrow-spectrum antimicrobials, antitoxins, bacteriophages, and antibody-conjugated drugs that can target specific microbes while minimizing the emergence of resistant organisms 3.
• Systemic antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection, with evidence suggesting that prophylactic antibiotics may reduce the risk of infection and dry socket following third molar extraction 4.

Novel Approaches for Treatment of Intraoral Microbial Infections

• Novel approaches, such as new broad-spectrum non-antibiotic strategies and probiotics, are aimed at disrupting or altering the composition of oral biofilms and their extracellular matrices to facilitate the elimination of overt pathogens by the host response and/or adjunctive antimicrobials 3.
• Emerging technologies, such as 3D printing for drug delivery of antibiotics and disinfectants, hold promise in enhancing treatment efficacy and patient outcomes by tailoring antimicrobial interventions to individual patient needs 5.

Systemic Antibiotics for Symptomatic Apical Periodontitis and Acute Apical Abscess

• Clinical guidelines recommend that the first-line treatment for symptomatic apical periodontitis and acute apical abscess should be removal of the source of inflammation or infection by local operative measures, with systemic antibiotics only recommended for situations where there is evidence of spreading infection or systemic involvement 6.
• The evidence suggests that preoperative clindamycin for adults with symptomatic apical periodontitis results in little to no difference in participant-reported pain or swelling at any of the time points included in the review when provided with chemo-mechanical endodontic debridement and filling under local anaesthesia 6.