Treatment for Tooth Infection in Adults
The primary treatment for a dental abscess is surgical intervention through root canal therapy, extraction, or incision and drainage, with antibiotics reserved only for specific circumstances such as systemic involvement or medically compromised patients. 1
Primary Treatment Approach
Surgical management is the first-line treatment for dental infections, including:
- Root canal therapy for salvageable teeth
- Extraction for non-restorable teeth
- Incision and drainage for accessible abscesses 1
Acute dental abscesses require immediate surgical intervention to remove the source of infection and establish drainage 1
Adding antibiotics to proper surgical management has not shown statistically significant differences in pain or swelling outcomes 1
When to Consider Antibiotics
Antibiotics should be reserved for specific situations:
- Presence of systemic involvement (fever, malaise, lymphadenopathy) 1
- Medically compromised patients 1
- Infections extending into facial spaces or cervicofacial tissues 1
- Failure to respond to surgical treatment alone 1, 2
- Diffuse swelling that cannot be drained effectively 1
Antibiotic Selection When Indicated
When antibiotics are necessary:
First-line: Penicillin V (phenoxymethyl penicillin) - safe, effective, and inexpensive for odontogenic infections 3
Alternative: Amoxicillin 500 mg three times daily or 875 mg twice daily for 5-7 days 4, 2
- For severe infections: 875 mg every 12 hours or 500 mg every 8 hours 4
For penicillin-allergic patients:
Duration of Treatment
Treatment should continue for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 4
Limited evidence suggests that shorter courses (3-5 days) may be as effective as longer courses (≥7 days) for uncomplicated dental infections 5
If no improvement is seen within 2-3 days of initial antibiotic therapy, consider second-line regimens such as amoxicillin-clavulanate (Augmentin), cefuroxime, or a combination of penicillin and metronidazole 2
Important Considerations
Metronidazole alone is not recommended for acute odontogenic infections as it is only moderately effective against facultative and anaerobic gram-positive cocci 3
For patients with renal impairment (GFR <30 mL/min), dosage adjustment of amoxicillin is necessary 4
Proper infection control practices should be followed during dental procedures to prevent cross-contamination 6
Antibiotics should not be used as a substitute for appropriate surgical intervention, as they do not eliminate the source of infection 1, 7
Common Pitfalls to Avoid
Prescribing antibiotics without surgical intervention - this approach is ineffective and contributes to antibiotic resistance 1, 7
Using antibiotics for pain control - analgesics are more appropriate for managing pain 7
Continuing antibiotics longer than necessary - this increases the risk of adverse effects and antimicrobial resistance 5
Failing to reassess the patient's condition after 2-3 days of treatment 2
Using tetracyclines as first-line therapy due to high incidence of gastrointestinal disturbances and potential for superinfection 3