Treatment of Tooth Infections
The primary treatment for a tooth infection is surgical intervention (root canal therapy or tooth extraction), not antibiotics. 1
Types of Tooth Infections and Primary Treatment
- Acute dental abscess: Treatment is solely surgical - root canal therapy or extraction of the tooth 1
- Acute dentoalveolar abscess: Primary treatment is incision and drainage 1
- Apical periodontitis: Surgical intervention is key; antibiotics are not recommended 1
- Irreversible pulpitis: Antibiotics should not be used 1
Surgical Management Approach
- Remove the source of infection through appropriate dental procedures 2
- For abscesses, drainage is the primary intervention 1, 3
- Root canal therapy preserves the tooth while eliminating infection 1
- Extraction may be necessary for severely damaged teeth 1
When Antibiotics Are Indicated
Antibiotics should only be used as an adjunct to surgical treatment in specific situations:
- Systemic involvement: Fever, malaise, lymphadenopathy 1, 3
- Medically compromised patients 1
- Progressive infections extending to facial spaces 1
- Diffuse swelling that cannot be immediately drained 1
Antibiotic Selection When Indicated
When antibiotics are truly necessary:
- First choice: Amoxicillin 500 mg every 8 hours or 875 mg every 12 hours for 5 days 1, 4
- For penicillin-allergic patients: Clindamycin 300-450 mg every 6 hours 5
Duration of Antibiotic Therapy
- Treatment should continue for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 4
- For dentoalveolar abscesses requiring antibiotics, a 5-day course is typically recommended 1
- Shorter courses (3-5 days) may be as effective as longer courses when appropriate surgical intervention has been performed 6
Common Pitfalls to Avoid
- Prescribing antibiotics without surgical intervention: Studies show no benefit of antibiotics alone over drainage alone 1, 2
- Using antibiotics for pain control: Research demonstrates that penicillin is not beneficial for dental pain without overt infection 7
- Prolonged antibiotic use: This increases risk of antibiotic resistance and adverse effects 3
- Delaying definitive treatment: Surgical intervention should not be postponed in favor of antibiotic therapy 1, 3
Prevention of Tooth Infections
- Regular dental hygiene and professional dental care 1
- Thorough evaluation by a dentist to identify and eliminate oral diseases that predispose to infection 1
- For patients with history of endocarditis: daily dental hygiene and regular dental evaluations are essential 1
Special Considerations
- For infections extending to underlying soft tissues, more aggressive treatment is required, including tooth extraction and treatment as necrotizing fasciitis 1
- Patients with systemic diseases may require more aggressive management and longer antibiotic courses 1
- Blood cultures should be obtained before antibiotic administration if systemic infection is suspected 1