From the Research
The treatment for a root canal abscess typically involves root canal therapy performed by a dentist or endodontist, with antibiotics prescribed only in cases of systemic involvement or severe infection, as supported by the most recent and highest quality study 1. The procedure removes the infected pulp tissue from inside the tooth, cleans the canal system, and seals it to prevent reinfection.
Key Considerations
- Before the procedure, antibiotics may be prescribed to control the infection, commonly amoxicillin 500mg three times daily for 7-10 days, or clindamycin 300mg four times daily for patients with penicillin allergies, as suggested by 2.
- Pain management typically includes ibuprofen 400-600mg every 6 hours or acetaminophen 500-1000mg every 6 hours.
- In severe cases, drainage of the abscess may be necessary through an incision or through the tooth itself.
- Following treatment, patients should maintain good oral hygiene, avoid chewing on the treated tooth until restoration is complete, and attend follow-up appointments.
Rationale
The most recent study 1 found 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.
Microbiology and Treatment
The microbiology of acute apical abscesses is complex, with a multispecies community dominated by anaerobic bacteria, as described in 3. The treatment of acute apical abscesses should be focused on removing the source of infection, and antibiotics should be prescribed only in cases of systemic involvement or severe infection, as supported by 4 and 2.