What is the treatment for a tooth infection?

Treatment of Tooth Infection

The primary treatment for a dental abscess is surgical intervention through root canal therapy, tooth extraction, or incision and drainage, with antibiotics reserved only for specific circumstances such as systemic involvement or medically compromised patients. 1, 2

Primary Management Approach

• Surgical drainage is the cornerstone of treatment and should not be delayed as it removes the source of inflammation 1
• Treatment options include:
  • Root canal therapy for salvageable teeth 2
  • Extraction for non-restorable teeth 2
  • Incision and drainage for accessible abscesses 1, 2
• For dentoalveolar abscesses, incision and drainage is the first step in management 1
• Immediate extraction of teeth in acute infection settings has shown to be beneficial for faster resolution of infection, decreased pain, and earlier return of function 3

Indications for Antibiotic Therapy

Antibiotics should only be used as an adjunct to surgical treatment in specific situations:

• Presence of systemic symptoms (fever, malaise) 1, 2
• Evidence of spreading infection or cellulitis 1
• Medically compromised or immunosuppressed patients 1
• Infections extending into cervicofacial tissues 1

Antibiotic Selection (When Indicated)

• First-line options:
  • Phenoxymethylpenicillin or amoxicillin for 5 days 1, 2
  • For adults: 500 mg amoxicillin every 8 hours or 875 mg every 12 hours 4
• For penicillin-allergic patients:
  • Clindamycin is an effective alternative 1
  • Adults: 300-450 mg every 6 hours for severe infections 5
• For treatment failures:
  • Consider adding metronidazole to amoxicillin 1, 2

Evidence Against Routine Antibiotic Use

• Multiple systematic reviews show no statistically significant differences in pain or swelling outcomes when antibiotics are added to proper surgical treatment 1, 2
• Treatment should continue for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 4
• For infections caused by Streptococcus pyogenes, at least 10 days of treatment is recommended to prevent acute rheumatic fever 4

Special Considerations

• Dental infections are typically caused by normal oral flora bacteria, which can include more than 300 different species 6
• Poor oral hygiene and periodontal diseases are likely responsible for the majority of cases of infective endocarditis that originate in the mouth 7
• Patients with IE should be thoroughly evaluated by a dentist to identify and eliminate oral diseases that predispose to bacteremia 7
• Patients should be instructed to seek immediate medical evaluation for persistent fever, as IE can mimic various febrile illnesses 7
• Occult dental infections can cause persistent fever that may escape detection 8

Prevention

• Daily dental hygiene should be stressed, with serial evaluations by a dentist 7
• For children with high risk of dental issues, sealing the occlusal surfaces of both deciduous and permanent teeth can help prevent bacterial invasion 7
• Thorough dental cleaning by a hygienist who will review the importance of maintaining scrupulous oral hygiene 7

Treatment Algorithm

1. Assess severity of infection:

   • Localized abscess without systemic symptoms → Surgical drainage only 1, 2
   • Presence of systemic symptoms or spreading infection → Surgical drainage plus antibiotics 1, 2

2. Perform appropriate surgical intervention:

   • Root canal therapy for salvageable teeth 2
   • Extraction for non-restorable teeth 2
   • Incision and drainage for accessible abscesses 1, 2

3. Consider antibiotics only if:

   • Systemic involvement is present 1
   • Patient is immunocompromised 1
   • Infection is spreading beyond localized area 1
   • Surgical drainage is incomplete or difficult 1