From the Guidelines
Antibiotics should only be used to treat tooth infections in specific cases, such as acute dentoalveolar abscesses, infections extending into cervicofacial tissues, or in patients with systemic involvement, and amoxicillin is recommended as the first-line treatment. According to the European Society of Endodontology 1, surgical drainage is key in treating acute apical abscesses, and adjunctive antibiotics are only recommended in specific patient groups, such as medically compromised patients or those with systemic involvement. The American Dental Association 1 also recommends against using antibiotics for chronic periodontitis, except in cases where systemic sub-antimicrobial dose doxycycline is used as an adjunct to scaling and root planning.
Some key points to consider when treating tooth infections with antibiotics include:
- Amoxicillin is recommended as the first-line treatment for acute dentoalveolar abscesses and infections extending into cervicofacial tissues 1
- Antibiotics should not be used to treat acute apical periodontitis and acute apical abscesses, except in cases where surgical drainage is not possible or in patients with systemic involvement 1
- Patients with chronic periodontitis should not be treated with antibiotics, except in cases where systemic sub-antimicrobial dose doxycycline is used as an adjunct to scaling and root planning 1
- Antibiotics alone are not sufficient treatment for most dental infections, and definitive treatment typically requires dental procedures like root canal, drainage, or tooth extraction to remove the source of infection 1
In terms of specific antibiotic regimens, amoxicillin (500 mg three times daily for 5 days) is recommended for acute dentoalveolar abscesses and infections extending into cervicofacial tissues 1. Other options, such as clindamycin, azithromycin, or metronidazole, may be used in patients allergic to penicillin or in cases where amoxicillin is not effective 1. However, these alternatives should be used with caution and only in consultation with a dental professional.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Amoxicillin has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections
The antibiotics used to treat a tooth infection are clindamycin and amoxicillin.
- Clindamycin is used for serious infections caused by susceptible anaerobic bacteria.
- Amoxicillin is active against most isolates of Gram-Positive and Gram-Negative bacteria, including those that may cause tooth infections 2 3.
From the Research
Antibiotics for Tooth Infection
- The use of antibiotics in dental practice has changed dramatically with the discovery of penicillin and the development of other antibacterial agents 4.
- Dental infections can be divided into two main groups: odontogenic infections and periodontal infections.
Odontogenic Infections
- Odontogenic infections are most commonly caused by gram-positive anaerobic or facultative bacteria 4.
- Systemic antibiotic therapy is often necessary, and the first-line antibiotics used are penicillin G, penicillin V, or amoxicillin 4.
- In cases where there is no improvement within 2-3 days, second-line regimens such as amoxicillin-clavulanate, cefuroxime, or penicillin and metronidazole may be recommended 4.
Periodontal Infections
- Periodontal infections are usually caused by gram-negative anaerobes bacilli, and systemic antibiotics are only infrequently indicated 4.
- When systemic antibiotics are necessary, augmentin, metronidazole, or metronidazole in combination with penicillin or amoxicillin may be recommended 4.
Other Antibiotics
- Clindamycin is a preferred antibiotic for patients allergic to penicillin 4, 5.
- Tetracyclines may be used for cases of acute necrotizing ulcerative gingivitis requiring systemic antibiotic therapy when penicillin is precluded 5.
- Vancomycin and streptomycin may be used prophylactically for prevention of infective endocarditis in patients with prosthetic heart valves 5.
Recent Studies
- A 2014 study found that clindamycin, gentamycin, linezolid, and imipenem were effective antibiotics for orofacial space infections of odontogenic origin 6.
- A 2024 review found that systemic antibiotics may not be necessary for symptomatic apical periodontitis and acute apical abscess in adults, and that surgical intervention and analgesics may be sufficient 7.