From the Guidelines
Dental abscesses should be treated with surgical drainage as the primary treatment, and antibiotics should only be prescribed in specific cases, such as severe or extensive disease, systemic illness, or lack of response to incision and drainage alone, as recommended by the European Society of Endodontology (2018) 1. The main findings of a dental abscess include:
- Severe, persistent, throbbing toothache that can radiate to the jawbone, ear, or neck
- Sensitivity to hot and cold temperatures
- Sensitivity to pressure when chewing
- Fever
- Swelling in the face or cheek
- Tender, swollen lymph nodes under the jaw or in the neck
- Sometimes a sudden rush of foul-tasting, salty fluid in the mouth if the abscess ruptures Treatment options for dental abscesses include:
- Draining the abscess through root canal therapy, tooth extraction, or surgical incision
- Antibiotics, such as amoxicillin (500mg three times daily for 5 days) or clindamycin (300mg four times daily for 5 days), should only be prescribed in specific cases, as recommended by Medecins sans frontieres (2019) 1
- Pain management with over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours)
- Home remedies, such as rinsing with warm salt water several times daily and avoiding very hot, cold, or sweet foods and beverages It is essential to note that antibiotics should not be used as a first-line treatment for dental abscesses, and their use should be limited to specific cases, as recommended by the European Society of Endodontology (2018) 1.
From the Research
Findings in Dental Abscess
- A dental abscess is a common condition in the community, and if left untreated, can lead to serious consequences such as airway obstruction and septicaemia 2.
- The infection is typically polymicrobial, comprising of strict anaerobes and facultative anaerobes 3.
- The microflora associated with odontogenic infections are typically mixed and of indigenous origin, with streptococcus, peptostreptococcus, and fusobacterium species being the principle microflora isolated from these infections 4.
Treatment Options
- Prompt assessment and referral to a tertiary hospital is required for cases at risk of airway compromise 2.
- The combination of amoxicillin/clavulanate and metronidazole is a widely-accepted empirical regimen for infections of the odontogenic spaces 5.
- However, metronidazole may not be necessary in the period after drainage, and its prescription should be based on assessment of clinical and laboratory markers of infection 5.
- Penicillin V remains the antimicrobial of choice for the initial empirical treatment of odontogenic infections, while amoxicillin has little indication for the routine treatment of odontogenic infections 4.
- In the management of localized acute apical abscess in the permanent dentition, the abscess should be drained through a pulpectomy or incision and drainage, and antibiotics are of no additional benefit unless there are systemic complications or the patient is immunocompromised 6.
Antibiotic Therapy
- The use of antimicrobials is limited to severe spreading infections, and there is a need for good-quality clinical trials to identify the ideal treatment 3.
- Erythromycin may be used for mild, acute odontogenic infections in penicillin-allergic patients, while tetracycline may be considered as an alternative therapy for penicillin-allergic patients over the age of 13 who cannot tolerate erythromycin 4.
- Clindamycin is very effective against all odontogenic pathogens, but its potential gastrointestinal toxicity relegates it to third- or even fourth-line therapy in general dentistry 4.