What is the treatment for a tooth abscess?

Treatment of Tooth Abscesses

The primary treatment for tooth abscesses is surgical intervention (root canal therapy, incision and drainage, or tooth extraction), not antibiotics. 1 Antibiotics alone will not resolve the infection and should only be used as adjunctive therapy in specific circumstances.

Diagnosis and Classification

Tooth abscesses are localized collections of pus resulting from bacterial infection of:

• Dental pulp (pulpal infection)
• Periapical tissues (apical abscess)
• Surrounding gingival tissues (periodontal abscess)

Signs and symptoms include:

• Severe, persistent, throbbing pain
• Swelling and redness of gums
• Sensitivity to temperature
• Bad taste in mouth
• Fever
• Facial swelling
• Lymphadenopathy

Treatment Algorithm

1. Acute Dental Abscesses

Primary treatment: Surgical intervention only 1

• Root canal therapy (preserves the tooth)
• Tooth extraction (if tooth cannot be saved)

2. Acute Dentoalveolar Abscesses

Primary treatment:

• Incision and drainage
• Then amoxicillin for 5 days 1

3. Infections Extending to Underlying Soft Tissues

Treatment:

• Tooth extraction
• Treat as necrotizing fasciitis 1

When to Use Antibiotics

Antibiotics are not recommended for routine treatment of apical abscesses 1. They should be used only as adjunctive therapy in specific situations:

1. Medically compromised patients 1
2. Patients with systemic involvement (fever, lymphadenopathy) 1
3. Progressive infections requiring referral to oral surgeons 1
4. Diffuse swelling 1

When antibiotics are indicated:

• First choice: Amoxicillin 500 mg every 8 hours or 875 mg every 12 hours for 5 days 1, 2
• For penicillin allergies: Clindamycin 300-450 mg every 6 hours 3

Special Considerations

For Children

• Surgical drainage remains the primary treatment 1
• For deciduous teeth with abscess, the decision to extract or treat endodontically depends on:
  • Extent of infection
  • Recurrence
  • Expected timing of normal exfoliation 1

For Permanent Teeth

• Endodontic treatment or re-treatment is preferred 1
• Healing after endodontic treatment may be less favorable in compromised patients 1

Important Caveats

1. Antibiotics alone will not resolve the infection 4

   • Without surgical intervention, the infection will progressively worsen

2. Delayed treatment risks serious complications 4

   • Airway obstruction
   • Septicemia
   • Potential death in severe cases

3. Systemic spread requires immediate referral

   • Facial swelling
   • Difficulty swallowing
   • Fever
   • Malaise

4. No antibiotic has been proven superior to another for dental abscesses 1, though systematic reviews suggest amoxicillin is appropriate for most cases.

Follow-up Care

• After surgical treatment, monitor for resolution of symptoms
• If symptoms persist or worsen despite treatment, reevaluation is necessary
• Preventive dental care is essential to avoid recurrence

By prioritizing surgical intervention and using antibiotics judiciously, tooth abscesses can be effectively managed while minimizing complications and antibiotic resistance.