What is the treatment for a dental abscess?

From the Guidelines

The primary treatment for a dental abscess is surgical, involving either root canal therapy or extraction of the tooth, with antibiotics only considered in specific cases such as systemic involvement or medically compromised patients. The management of dental abscesses prioritizes eliminating the source of infection, which is typically achieved through dental procedures. According to the European Society of Endodontology 1, surgical drainage is key, and adjunctive antibiotics are recommended in specific patient groups, such as those who are medically compromised, have systemic involvement, or have progressive infections.

For acute dental abscesses, the treatment is primarily surgical, with options including root canal therapy to remove infected pulp tissue or extraction of the tooth if it cannot be saved 1. The use of antibiotics like amoxicillin may be considered in cases where there is significant systemic involvement or in medically compromised patients, but this should be determined on a case-by-case basis 1.

While waiting for dental treatment, patients can manage pain with over-the-counter pain relievers such as ibuprofen or acetaminophen, and warm salt water rinses can provide temporary relief 1. However, it's crucial not to delay professional treatment, as dental abscesses will not resolve without addressing the underlying cause and can potentially become life-threatening if the infection spreads to other parts of the body.

Key considerations in the treatment of dental abscesses include:

• Prompt dental care to drain the infection and eliminate the source
• Surgical intervention, such as root canal therapy or tooth extraction
• Limited use of antibiotics to cases with systemic involvement or medically compromised patients
• Pain management with over-the-counter medications and warm salt water rinses
• The importance of not delaying professional treatment to prevent potential complications.

In line with the most recent guidelines, such as those from the European Society of Endodontology 1, the approach to treating dental abscesses emphasizes the role of surgical intervention as the primary treatment, reserving antibiotics for specific situations where they are most beneficial.

From the Research

Treatment for Dental Abscess

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

• Surgical intervention, such as incision and drainage, is often necessary to remove the source of the infection 2, 3.
• Antibiotic therapy may be prescribed to help manage the infection, particularly in cases where the infection has spread beyond the confines of the jaws or is causing systemic symptoms such as fever or malaise 2, 4, 5.
• The choice of antibiotic should be guided by the suspected or confirmed causative organisms and their antibiotic susceptibility patterns 5.
• In some cases, extraction of the affected tooth may be necessary to eliminate the source of the infection 2, 6.

Antibiotic Therapy

• The use of systemic antibiotics for dental abscesses is generally recommended only in cases where there is evidence of spreading infection or systemic involvement 4.
• Studies have shown that the use of antibiotics such as clindamycin or penicillin may not always be effective in resolving the infection, and may contribute to the development of antibiotic-resistant bacteria 4, 5.
• 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 4.

Surgical Intervention

• Incision and drainage of the abscess is often necessary to remove the source of the infection and prevent further complications 2, 3.
• Primary suture of the incision site may be performed under antibiotic cover to promote healing and reduce the risk of further infection 3.
• Extraction of the affected tooth may be necessary in some cases to eliminate the source of the infection 2, 6.