Treatment of Dental Infections
The primary treatment for dental infections is surgical intervention (drainage, debridement) with adjunctive antibiotic therapy, specifically amoxicillin 500 mg three times daily for 5 days in cases with systemic involvement or risk of spread. 1
Surgical Management
- Surgical intervention (drainage, debridement) is the cornerstone of treatment for dental abscesses and should be performed before antibiotic therapy 1, 2
- Antibiotics alone without proper surgical management are insufficient for treating dental infections 1
- For dental abscesses in deciduous teeth, the decision to extract or treat endodontically depends on the extent of infection, recurrence, and expected timing of normal exfoliation 3
- For permanent teeth with infection, endodontic treatment or re-treatment is the preferred option 3
Antibiotic Therapy
First-Line Treatment
- Amoxicillin is the first-line antibiotic for dental infections at a dose of 500 mg three times daily for 5 days 1, 4
- Treatment should continue for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 4
- For more severe infections, amoxicillin-clavulanic acid should be used when there is inadequate response to amoxicillin alone 1
Alternative Antibiotics
- Clindamycin is the recommended alternative for patients with penicillin allergy 1
- Erythromycin can be considered as a second-choice antibiotic for patients allergic to penicillin 5
Indications for Antibiotic Therapy
Antibiotics should be prescribed in the following situations:
- Patients with systemic involvement (fever, lymphadenopathy) 1, 2
- Immunocompromised patients 2
- Presence of diffuse swelling or infections extending to cervicofacial tissues 2
- Following appropriate surgical intervention for acute dentoalveolar abscesses 1
Duration of Antibiotic Treatment
- A 5-day course is typically sufficient for most dental infections 1, 6
- Avoid prolonged antibiotic courses when not indicated 1
- One small RCT showed that a 3-day course of amoxicillin was clinically non-inferior to a 7-day course for odontogenic infections requiring tooth extraction 6
Preventive Measures
- For patients with dental implants or at risk of periodontitis, preventive measures should be implemented 3
- Sealing the occlusal surfaces of both deciduous and permanent teeth can prevent bacterial invasion of the dentin and pulp via enamel microcracks 3
- Prevention, treatment, and supportive care of periodontitis should follow standard management protocols 3
Common Pitfalls to Avoid
- Prescribing antibiotics without proper surgical intervention (drainage, debridement) 1
- Using antibiotics as the sole treatment modality without addressing the underlying dental issue 2
- Failing to recognize that dental infections can sometimes manifest as skin lesions, leading to misdiagnosis and inappropriate treatment 7
- Overlooking the possibility of antibiotic resistance in oral bacteria, which has been increasing in recent years 8