What is the recommended treatment for a tooth infection?

From the Guidelines

The most effective treatment for a tooth infection is surgical intervention, such as root canal therapy or extraction of the tooth, with adjunctive antibiotics only recommended in specific cases, as outlined by the European Society of Endodontology 1. When considering treatment options, it's crucial to differentiate between various types of oral and dental infections.

• For acute dental abscesses, the primary treatment is surgical, focusing on root canal therapy or tooth extraction, as suggested by Medecins sans frontieres 1.
• In cases of acute dentoalveolar abscesses, incision and drainage are followed by a course of amoxicillin for 5 days, according to the same guideline 1.
• The European Society of Endodontology recommends against the use of antibiotics in patients with acute apical periodontitis and acute apical abscesses, emphasizing surgical drainage as the key treatment, with adjunctive antibiotics considered only for medically compromised patients, those with systemic involvement, or progressive infections 1. Key points to consider in the treatment of tooth infections include:
• The importance of prompt dental intervention to prevent the spread of infection to surrounding tissues or other parts of the body.
• The role of antibiotics as an adjunct to surgical treatment in specific cases, rather than as a standalone treatment.
• The need for individualized treatment plans based on the type and severity of the infection, as well as the patient's overall health status. In terms of antibiotic therapy, when it is deemed necessary, amoxicillin is often recommended as a first-line option, with the dosage and duration of treatment tailored to the specific infection and patient factors, as indicated by various guidelines, including those from the European Society of Endodontology 1.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and other antibacterial drugs, amoxicillin should be used only to treat infections that are proven or strongly suspected to be caused by bacteria

Table 1 Patients Aged 3 Months (12 Weeks) and Older

Infection Severity	Recommended Dosage for Adult and Pediatrics Patients Aged 3 Months and Older and Weight Greater than 40 kg	Recommended Dosage for Pediatric Patient Aged 3 Months and Older and Weight Less than 40 kg
Ear/Nose/Throat	500 mg every 12 hours or 250 mg every 8 hours	25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
Skin/Skin Structure	500 mg every 12 hours or 250 mg every 8 hours	25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
Genitourinary Tract	500 mg every 12 hours or 250 mg every 8 hours	25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours

The recommended treatment for a tooth infection is not explicitly stated in the provided drug label. However, based on the information provided for Ear/Nose/Throat, Skin/Skin Structure, and Genitourinary Tract infections, it can be inferred that amoxicillin may be used to treat bacterial infections.

• The dosage for adults is 500 mg every 12 hours or 250 mg every 8 hours for mild/moderate infections, and 875 mg every 12 hours or 500 mg every 8 hours for severe infections.
• The dosage for pediatric patients aged 3 months and older and weight less than 40 kg is 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours for mild/moderate infections, and 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours for severe infections. It is essential to consult a healthcare professional for an accurate diagnosis and treatment plan, as the specific dosage and duration of treatment may vary depending on the individual case and the severity of the infection 2.

From the Research

Treatment Options for Tooth Infections

• The recommended treatment for a tooth infection typically involves a combination of antibiotics and dental procedures such as drainage of the abscess, debridement of the root canal, and placement of intra-canal antimicrobial medication 3.
• Systemic antibiotics such as penicillin G, penicillin V, or amoxicillin are commonly used to treat tooth infections, with clindamycin being a suitable alternative for patients allergic to penicillin 3, 4.
• The choice of antibiotic may depend on the type of bacteria causing the infection, with gram-positive anaerobic or facultative bacteria being common causes of odontogenic infections 3.
• In some cases, a combination of antibiotics may be necessary, such as amoxicillin-clavulanate or penicillin and metronidazole 3.

Antibiotic Prescription Patterns

• A review of worldwide antibiotic prescription patterns in endodontic infections found that amoxicillin was the most commonly prescribed antibiotic, with clindamycin and erythromycin being used for patients allergic to penicillin 5.
• The review also found that antibiotics are often overprescribed for endodontic infections, highlighting the need for improved prescribing habits and educational initiatives 5.
• Clindamycin has been shown to be an effective treatment option for dental infections, with high oral absorption and significant tissue penetration 6.

Duration of Antibiotic Treatment

• The optimum length of treatment with systemic antibiotics for dental infections is not well established, with guidelines varying across different countries 7.
• A systematic review found limited evidence to support the use of short-duration courses of antibiotics, with only one small randomized controlled trial comparing three-day and seven-day courses of amoxicillin 7.
• Further research is needed to determine the optimum length of treatment with systemic antibiotics for dental infections, with randomized controlled trials required to investigate the effectiveness of short-duration courses 7.