What is the treatment for a dental abscess?

From the Guidelines

The most effective treatment for a dental abscess is surgical, involving drainage of the abscess and elimination of the infection, with antibiotics prescribed only in specific cases, such as systemic involvement or medically compromised patients. When considering treatment options, it's essential to prioritize the most recent and highest quality evidence, which suggests that surgical intervention is the primary approach for managing dental abscesses 1. The European Society of Endodontology guidelines from 2018 1 recommend surgical drainage as the key treatment, with adjunctive antibiotics considered only for specific patient groups, such as those with systemic involvement or medically compromised patients, and suggest phenoxymethylpenicillin as a first-choice antibiotic. Some key points to consider in the treatment of dental abscesses include:

• Surgical drainage is the primary treatment approach
• Antibiotics should be prescribed judiciously, considering the patient's overall health and the severity of the infection
• Medically compromised patients or those with systemic involvement may require adjunctive antibiotic therapy
• Pain management is crucial and can be achieved with over-the-counter medications like ibuprofen or acetaminophen. It's also important to note that delaying professional treatment can lead to serious complications, as dental abscesses will not resolve without intervention and can spread to other parts of the body 1.

From the Research

Treatment for Dental Abscess

The treatment for a dental abscess typically involves a combination of surgical and non-surgical interventions.

• Surgical intervention, such as incision and drainage, is often necessary to remove the source of the infection 2, 3.
• Antibiotics may be prescribed in cases where there is evidence of spreading infection or systemic involvement, such as fever or malaise 4, 3.
• However, the use of antibiotics alone is not sufficient to resolve the infection, and surgical intervention is often necessary 2, 4.

Role of Antibiotics in Dental Abscess Treatment

• The evidence suggests that preoperative antibiotics may not be necessary for adults with symptomatic apical periodontitis or acute apical abscess, unless there is evidence of spreading infection or systemic involvement 4.
• The use of antibiotics in children with odontogenic abscesses in the primary dentition is not supported by current evidence, and well-designed clinical trials are needed to fully understand the impact and necessity of antibiotics in these situations 5.

Importance of Prompt Assessment and Referral

• Prompt assessment and referral to a tertiary hospital is required for cases at risk of airway compromise or other serious complications 2.
• Delayed treatment can lead to increased morbidity and mortality, as well as a higher financial burden on the health system 2.

Microbiology of Dental Abscess

• Dental abscesses are often polymicrobial, comprising of strict anaerobes and facultative anaerobes 6.
• The microbiology of the acute dentoalveolar abscess and its treatment are complex, and further research is needed to identify the ideal treatment 6.