What is the treatment for a dental abscess?

Treatment of Dental Abscess

The primary treatment for dental abscess is surgical drainage of the purulent material, which is essential for effective treatment and should be performed promptly to prevent life-threatening complications. 1

Initial Management

1. Surgical Intervention

   • Complete evacuation of purulent material is the cornerstone of treatment 1
   • Immediate aggressive surgical debridement for spreading infections 1
   • Without proper drainage, the infection will not resolve even with antibiotics 2

2. Antibiotic Therapy

   • After surgical drainage, antibiotics should be prescribed to address the polymicrobial infection 3
   • First-line oral antibiotic option:
     • Amoxicillin-clavulanic acid: 875/125 mg PO every 12 hours 1
   • Alternative oral options:
     • Trimethoprim-sulfamethoxazole (TMP-SMX): 160-320/800-1600 mg PO q12h (for MRSA, but limited activity against β-hemolytic streptococci) 1
     • Doxycycline: 100 mg PO q12h (for MRSA, but limited activity against streptococci) 1

3. For Severe Infections Requiring Hospitalization

   • Intravenous antibiotics:
     • Cefoxitin: 2g IV every 6 hours 1
     • Vancomycin: 30-60 mg/kg/day IV in 2-4 divided doses (for MRSA) 1

Monitoring and Follow-up

• Daily assessment during treatment is essential, especially for hospitalized patients 1
• Monitor for potential complications:
  • Airway obstruction
  • Deep neck space involvement
  • Ludwig's angina
  • Mediastinitis
  • Septicemia
  • Cavernous sinus thrombosis 1, 2

Supportive Care

• Pain management: Acetaminophen or NSAIDs (avoid aspirin in children) 1
• Oral hygiene:
  • Soft toothbrush or swab after meals and before sleep
  • Alcohol-free antimicrobial mouthwash
  • Adequate hydration 1

Important Considerations

• Dental abscesses are polymicrobial infections, comprising strict anaerobes (Prevotella, Fusobacterium species) and facultative anaerobes (viridans group streptococci) 3
• If treated with antibiotics alone without drainage, the infection will progressively worsen 2
• Dental abscess can lead to serious complications and even death if not properly managed 2
• Patients with dental abscesses often initially seek care from primary health providers, making prompt assessment and referral critical 2

Prevention

• Regular dental check-ups
• Good oral hygiene practices
• Prompt treatment of dental caries and periodontal disease
• Completing the full course of prescribed antibiotics 1

Special Considerations

• In patients with X-linked hypophosphataemia (XLH), dental abscesses may occur as a manifestation of the disease
• For these patients, treatment with burosumab might be superior to oral phosphate and active vitamin D for prevention of dental abscesses, especially in young children 4