Treatment of an Abscessed Tooth
The primary treatment for a dental abscess is incision and drainage, followed by either root canal treatment or extraction of the affected tooth, with antibiotics indicated only when there are systemic symptoms, extensive cellulitis, or in immunocompromised patients. 1
Immediate Management
Step 1: Drainage
- Incision and drainage is the cornerstone of treatment for dental abscesses 1
- For periapical abscesses, this involves either:
- Root canal treatment (endodontic therapy) to save the tooth
- Extraction of the tooth if severely damaged 1
- If a fistula is present, diagnosis requires an intraoral radiograph with a gutta-percha cone inserted inside the fistula 2
Step 2: Antibiotic Therapy
Antibiotics are NOT routinely needed for all dental abscesses but should be prescribed when:
- Systemic symptoms are present (fever, malaise)
- Extensive cellulitis is observed
- Patient is immunocompromised 1
When antibiotics are indicated:
- First-line: Amoxicillin 500 mg every 8 hours or 875 mg every 12 hours for 7-10 days 1, 3
- For penicillin-allergic patients: Clindamycin 300-450 mg three times daily 1, 4
- Treatment should continue for a minimum of 48-72 hours beyond symptom resolution 3
Follow-up Care
- Review patient's condition 2-3 days after initial treatment 1
- If no improvement is seen after 2-3 days, consider:
- Reevaluation of diagnosis
- Culture and sensitivity testing
- Alternative antibiotic regimen 1
- Complete treatment course even after symptoms resolve to prevent recurrence
Special Considerations
For Children
- Amoxicillin dosing: 45 mg/kg/day divided every 12 hours for severe infections in children <40 kg 1, 3
- Dental visits every 6 months are recommended 2
- Sealing pits and fissures with flowable resin composite on both temporary and permanent teeth may be beneficial 2
For Adults with Periodontitis
- Twice-yearly visits for conventional supportive periodontal therapy 2
- Include periodontal risk assessment and supragingival/subgingival debridement if necessary 2
Potential Complications
- Inadequate drainage may lead to spread of infection and worsening of symptoms 1
- Spread to surrounding anatomical structures can cause maxillofacial cellulitis 2, 1
- Life-threatening complications include airway obstruction and septicemia 5
- Deep neck infections and Ludwig's angina are rare but potentially fatal complications 6
Prevention
- Regular dental check-ups
- Good oral hygiene practices
- Prompt treatment of dental caries and other dental issues 1
Important Caution
If treated with antibiotics alone without proper drainage, the infection will not resolve and will become progressively worse 5. Prompt assessment and referral to a dental professional or tertiary hospital is required for cases at risk of airway compromise.