From the Guidelines
Starting antibiotics after a tooth breaks off is generally not necessary unless there are signs of infection such as severe pain, swelling, fever, or pus. Most broken teeth without these symptoms can wait until you can see a dentist without antibiotic treatment. The European Society of Endodontology 1 and other guidelines suggest that antibiotics are not recommended for acute apical periodontitis and acute apical abscesses, and surgical drainage is key.
Some key points to consider:
- The American Dental Association and other organizations recommend against the routine use of antibiotics for dental infections, except in cases where there are signs of infection or systemic involvement 1.
- If signs of infection are present, common dental antibiotics include amoxicillin (500mg three times daily for 7 days) or, if you're allergic to penicillin, clindamycin (300mg four times daily for 7 days) 1.
- While waiting to see a dentist, manage pain with over-the-counter medications like ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours), rinse with warm salt water several times daily, and avoid very hot, cold, or sweet foods that might trigger pain.
- The reason antibiotics aren't routinely recommended is that dental infections are typically best treated by addressing the source (the damaged tooth) rather than just treating symptoms with antibiotics, and unnecessary antibiotic use contributes to antibiotic resistance 1.
It's essential to note that the guidelines emphasize the importance of maintaining good oral hygiene and regular dental review to reduce the risk of infection and other complications 1.
From the Research
Antibiotic Use for Broken Tooth
- The use of antibiotics for a broken tooth is generally not recommended unless there are signs of infection or systemic involvement 2.
- A systematic review of odontogenic infections found that antibiotics were prescribed only in situations of regional and/or systemic body manifestations, and that the choice of antibiotics is not as successful as the local intervention treatment procedure 3.
- Another study found that the combination of amoxicillin and clavulanic acid was more effective than amoxicillin alone in reducing pain and swelling after oral-surgical interventions, but this does not necessarily apply to a broken tooth without infection 4.
Indications for Antibiotic Use
- Antibiotics may be recommended for patients with systemic involvement, such as malaise or fever, due to the dental condition 2.
- The American Dental Association recommends against using antibiotics in most clinical scenarios for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling, unless there is systemic involvement or a high risk of progression to systemic involvement 2.
Evidence Quality and Limitations
- The overall evidence to support the use of prophylactic antibiotics in dental infections is of poor quality, and large randomized controlled trials are needed to guide clinical practice 5.
- A Cochrane review found low-certainty evidence that prophylactic antibiotics may reduce the risk of infection and dry socket following third molar extraction, but the results may not be generalizable to all patients undergoing tooth extractions 6.