From the Guidelines
The most effective treatment for a tooth infection is surgical, such as root canal therapy or extraction of the tooth, with adjunctive antibiotics like amoxicillin for 5 days in cases of acute dentoalveolar abscesses or infections extending into cervicofacial tissues. According to the most recent guidelines, including those from the European Society of Endodontology 1, antibiotics should not be used as the primary treatment for acute apical periodontitis and acute apical abscesses, but rather surgical drainage. However, adjunctive antibiotics are recommended in specific patient groups, such as medically compromised patients, patients with systemic involvement, and patients with progressive infections.
Some key points to consider when treating tooth infections include:
- The use of amoxicillin for 5 days in cases of acute dentoalveolar abscesses or infections extending into cervicofacial tissues 1
- The recommendation against using antibiotics for chronic periodontitis or peri-implantitis 1
- The importance of surgical treatment, such as root canal therapy or tooth extraction, in addressing the source of the infection 1
- The potential use of phenoxymethylpenicillin as a first-choice antibiotic in specific patient groups 1
It's essential to note that antibiotics alone are not sufficient treatment for most dental infections, and the primary treatment should address the source of infection through dental procedures. Patients should complete the entire course of antibiotics even if symptoms improve and seek immediate dental care if symptoms worsen or don't improve within 2-3 days 1.
From the Research
Antibiotic Treatment for Tooth Infection
The recommended antibiotic treatment for a tooth infection depends on the type and severity of the infection.
- For odontogenic infections, which originate from the dental pulp, the first line of treatment includes penicillin G, penicillin V, or amoxicillin 2.
- In cases where there is no improvement within 2-3 days, second-line regimens such as amoxicillin-clavulanate, cefuroxime, or penicillin and metronidazole are recommended 2.
- For patients allergic to penicillin, clindamycin is preferred over macrolides 2.
- The use of antibiotics in dental practice also depends on the type of bacteria causing the infection, with gram-positive anaerobic or facultative bacteria being the most common cause of odontogenic infections 2, 3.
Duration of Antibiotic Treatment
The optimum length of treatment with systemic antibiotics for dental infections is still a topic of debate.
- A systematic review found that short-duration courses of systemic antibiotics (3-5 days) may be as effective as longer-duration courses (≥7 days) for the treatment of dental infections in adults 4.
- However, more research is needed to determine the optimum length of treatment, and guidelines for the use of antimicrobials in dental infections vary across different countries 4.
Antibiotic Sensitivity Profile
The antibiotic sensitivity profile of bacteria causing tooth infections is an important consideration in the selection of antibiotic treatment.
- A study found that alpha-hemolytic streptococci were the most frequent aerobic bacterial isolate, and anaerobic streptococci and bacteroids were the major anaerobic pathogens in orofacial space infections of odontogenic origin 5.
- The study also found that clindamycin, gentamycin, linezolid, and imipenam were the most effective antibiotics, and that 20% of the aerobes were resistant to penicillin 5.
Severe Odontogenic Infections
Severe odontogenic infections require prompt and effective treatment, including intravenous antibiotics and incision and drainage.
- A prospective study found that penicillin-resistant organisms were identified in 19% of all strains isolated, and that penicillin therapeutic failure occurred in 21% of cases 6.
- The study also found that alternative antibiotics, such as clindamycin, should be considered in hospitalized patients with severe odontogenic infections 6.