Treatment of Dental Abscess
The cornerstone of dental abscess treatment is surgical drainage of the abscess combined with appropriate antibiotic therapy, as treating with antibiotics alone will not resolve the infection and may lead to life-threatening complications. 1, 2
Immediate Management
Surgical Intervention
- Surgical drainage is essential and should be performed promptly 1
- Complete evacuation of all purulent material is necessary for effective treatment
- For spreading infections, immediate aggressive surgical debridement of all necrotic tissue is required
- Depending on the location and severity:
- Incision and drainage
- Tooth extraction
- Root canal treatment (if the tooth can be saved)
Antibiotic Therapy
First-line oral antibiotic options:
- Amoxicillin-clavulanic acid: 875/125 mg PO every 12 hours 1
- Provides coverage for both aerobic and anaerobic organisms
Alternative oral antibiotics (especially for penicillin allergies or suspected MRSA):
- Trimethoprim-sulfamethoxazole: 160-320/800-1600 mg PO q12h
- Note: Limited activity against β-hemolytic streptococci
- Contraindicated in pregnant women in third trimester and children <2 months
- Doxycycline: 100 mg PO q12h
- Note: Limited activity against streptococci
- Contraindicated in children <8 years and pregnant women
- Cefuroxime axetil: 250-500 mg PO twice daily 1
For severe infections requiring hospitalization:
- Vancomycin: 30-60 mg/kg/day IV in 2-4 divided doses
- Teicoplanin: 6-12 mg/kg/dose IV q12h for three doses, then daily
- Cefoxitin: 2g IV every 6 hours 1
Pain Management
- Analgesics and antipyretics:
- Acetaminophen or NSAIDs for pain control
- Avoid aspirin in children (risk of Reye's syndrome) 1
Monitoring for Complications
Daily assessment is crucial, especially for hospitalized patients, to monitor for:
- Airway obstruction (potentially life-threatening)
- Deep neck space involvement
- Ludwig's angina
- Mediastinitis
- Systemic sepsis
- Cavernous sinus thrombosis 1, 2
Microbiology Considerations
Dental abscesses are typically polymicrobial infections with:
- Strict anaerobes (anaerobic cocci, Prevotella, Fusobacterium species)
- Facultative anaerobes (viridans group streptococci, Streptococcus anginosus group) 3
This polymicrobial nature explains why broad-spectrum antibiotics like amoxicillin-clavulanic acid are preferred first-line options.
Post-Treatment Care
- Soft toothbrush or swab after meals and before sleep
- Alcohol-free antimicrobial mouthwash
- Adequate hydration 1
- Follow-up dental evaluation to address the underlying cause
Prevention
- Regular dental check-ups
- Good oral hygiene practices
- Prompt treatment of dental caries and periodontal disease 1
Important Cautions
- Never treat with antibiotics alone - the infection will not resolve and will become progressively worse 2
- Dental abscesses can lead to serious systemic complications including death if not properly managed 2, 4
- Patients with signs of spreading infection or systemic involvement require immediate referral to a hospital setting 1, 2
- Even after apparent resolution, complications like jaw osteonecrosis can develop months later, requiring additional surgical intervention 4