Are antibiotics recommended for tooth fractures?

Antibiotic Recommendations for Tooth Fractures

Antibiotics are NOT routinely recommended for most tooth fractures, except in specific circumstances such as avulsed permanent teeth requiring reimplantation. 1

Types of Tooth Fractures and Antibiotic Indications

Uncomplicated Fractures (No Pulp Exposure)

• Antibiotics are not indicated for enamel-only fractures in permanent or primary teeth 1
• Antibiotics are not indicated for enamel and dentin fractures without pulp exposure 1
• These fractures generally require dental follow-up but not immediate antibiotic therapy 1

Complicated Fractures (With Pulp Exposure)

• Antibiotics are not routinely indicated for crown fractures with pulp exposure 1
• These cases require immediate dental referral for appropriate pulp therapy rather than antibiotics 1

Avulsed Permanent Teeth

• Systemic antibiotics ARE indicated after reimplantation of an avulsed permanent tooth 1
• For children >12 years: doxycycline is the recommended antibiotic 1
• For children <12 years: penicillin is the recommended antibiotic 1
• For penicillin-allergic patients: clindamycin is recommended 1

Special Considerations

Primary vs. Permanent Teeth

• Antibiotics are not routinely indicated in the postoperative care of primary tooth trauma 1
• Primary teeth should NOT be reimplanted after avulsion 1
• Only reimplanted permanent teeth require antibiotic coverage 1

Risk of Infection

• The routine use of systemic antibiotics for tooth fractures without reimplantation does not provide additional benefit 1, 2
• For most dental extractions, prophylactic antibiotics may reduce infection risk, but should be weighed against the risk of antibiotic resistance 3

Common Pitfalls to Avoid

• Prescribing antibiotics for simple enamel or enamel-dentin fractures without pulp exposure 1
• Failing to provide antibiotics after reimplantation of avulsed permanent teeth 1
• Attempting to reimplant primary teeth, which is contraindicated 1
• Delaying dental referral for complicated fractures with pulp exposure while relying solely on antibiotics 1

Management Algorithm

1. Assess type of tooth fracture:

   • If enamel-only or enamel-dentin without pulp exposure: No antibiotics needed 1
   • If crown fracture with pulp exposure: Immediate dental referral without antibiotics 1
   • If avulsed permanent tooth requiring reimplantation: Antibiotics indicated 1

2. For avulsed permanent teeth requiring antibiotics:

   • Age >12 years: Doxycycline 1
   • Age <12 years: Penicillin 1
   • Penicillin allergy: Clindamycin 1

3. Monitor all tooth fractures for signs of pulpal necrosis regardless of antibiotic use 1