What is the treatment for a tooth infection?

Treatment of Tooth Infections

The primary treatment for tooth infections is surgical intervention (root canal therapy or extraction) rather than antibiotics, as antibiotics alone provide no significant benefit for most dental infections. 1

Types of Dental Infections and Their Management

Acute Dental Abscess

• Surgical treatment (root canal therapy or extraction of the tooth) is the only necessary treatment for most acute dental abscesses 1
• Drainage is the key intervention for successful treatment 1
• Antibiotics have shown no statistically significant differences in pain or swelling reduction compared to placebo when appropriate surgical intervention is performed 1

Dentoalveolar Abscess

• Requires incision and drainage as the primary treatment 1
• If antibiotics are needed, amoxicillin for 5 days is recommended after surgical intervention 1
• Antibiotics should only be used as adjunctive therapy, not as a substitute for proper dental intervention 1

Infections Extending to Soft Tissues

• Requires tooth extraction and treatment as necrotizing fasciitis 1
• These more severe infections may require more aggressive antibiotic therapy 1

When Antibiotics Are Indicated

Antibiotics should be limited to specific clinical scenarios:

• Patients with systemic involvement (fever, lymphadenopathy, malaise) 1, 2
• Medically compromised patients 1
• Patients with progressive infections 1
• Diffuse facial swelling 1
• Infections extending into cervicofacial tissues 1

Antibiotic Selection When Needed

When antibiotics are truly indicated:

• First choice: Amoxicillin (500 mg every 8 hours or 875 mg every 12 hours) for 3-5 days 3, 4
• Second choice: Amoxicillin-clavulanic acid for more severe infections 1
• For penicillin-allergic patients: Clindamycin or azithromycin may be considered 1

Duration of Antibiotic Therapy

• Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 3
• Evidence suggests shorter courses (3-5 days) may be as effective as longer courses (7+ days) when appropriate surgical intervention is performed 4
• Antibiotics should be used for the shortest time possible until clinical improvement is achieved 5

Common Pitfalls to Avoid

• Prescribing antibiotics without surgical intervention: This is ineffective and contributes to antibiotic resistance 1, 2
• Treating dental pain without infection with antibiotics: Research shows no benefit of antibiotics for dental pain without overt infection 6
• Prolonged antibiotic courses: Longer courses don't improve outcomes but increase risk of side effects and resistance 5, 4
• Delaying definitive dental treatment: Immediate dental care should be prioritized in all cases 2

Prevention of Dental Infections

• Regular dental check-ups every 6 months 1
• Thorough daily oral hygiene to prevent gingivitis and periodontitis 1
• Professional dental cleaning by a hygienist 1
• Early intervention for dental caries to prevent pulpal infection 1

Special Considerations

• Patients with a history of infective endocarditis or certain cardiac conditions may require prophylactic antibiotics before invasive dental procedures 1
• Patients should be thoroughly evaluated by a dentist to identify and eliminate oral diseases that predispose to bacteremia 1
• Poor oral hygiene and periodontal diseases are likely responsible for the majority of cases of infection that originate in the mouth 1