What is the first-line treatment for a tooth abscess?

From the Guidelines

The first-line treatment for a tooth abscess is surgical drainage, which may include root canal therapy or extraction of the tooth, with adjunctive antibiotics recommended only in specific patient groups, such as those with systemic involvement or medically compromised patients. According to the European Society of Endodontology 1, surgical drainage is key, and antibiotics should not be used in patients with acute apical periodontitis and acute apical abscesses unless there are specific indications. The use of antibiotics, such as amoxicillin or phenoxymethylpenicillin, may be considered in cases where there is systemic involvement, progressive infection, or in medically compromised patients 1.

Some key points to consider in the treatment of a tooth abscess include:

• Surgical drainage, such as incision and drainage, or root canal therapy, is essential for the treatment of a tooth abscess 1
• Antibiotics, such as amoxicillin, may be recommended in specific cases, such as systemic involvement or medically compromised patients 1
• Pain management with over-the-counter medications, such as ibuprofen or acetaminophen, is recommended to help alleviate symptoms 1
• Prompt professional treatment is essential to prevent serious complications, such as the spread of infection to other parts of the body 1

It's worth noting that the use of antibiotics alone is not sufficient treatment for a tooth abscess, as they cannot completely eliminate the infection without physical drainage of the abscess 1. Additionally, the choice of antibiotic and duration of treatment should be guided by the severity of the infection and the patient's individual needs 1.

From the Research

First-Line Treatment for Tooth Abscess

The first-line treatment for a tooth abscess involves removal of the source of inflammation or infection by local operative measures.

• According to 2, clinical guidelines recommend that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection or systemic involvement.
• The study 3 suggests that extraction, root canal therapy, and/or drainage of pus are usually indicated for an abscess, and antimicrobial therapy should be considered, especially when local or systemic spread of the infection is suspected.

Role of Systemic Antibiotics

Systemic antibiotics may be prescribed in certain situations, but their use is not always necessary.

• The review 4 found that there is very low-quality evidence to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.
• The study 5 compared the antibacterial activity of penicillin with other advanced broad-spectrum antibiotics against oral pathogens isolated from odontogenic abscesses, and found that penicillin successfully treated the pathogens when adequate surgical treatment was provided.

Empirical Antimicrobial Therapy

Empirical antimicrobial therapy may be used in the treatment of acute dentoalveolar abscess.

• The study 6 investigated the clinical efficiency of amoxicillin and cefalexin in the empirical treatment of acute odontogenic abscess, and found that empirical use of amoxicillin or cefalexin after surgical treatment significantly reduced the time of clinical symptoms duration in acute odontogenic infections.
• The same study found that bacterial strains isolated in early stages of dentoalveolar abscess showed high sensitivity to amoxicillin and cefalexin.