What is the treatment for a dental infection?

Treatment of Dental Infections

The primary treatment for dental infections is removal of the source of infection through drainage and/or extraction of the affected tooth, with antibiotics prescribed only when there are regional or systemic manifestations of infection. 1

Source Control: Primary Treatment

• Removal of the source of infection is the cornerstone of treatment for dental infections, which may include:

  • Drainage of the abscess 1, 2
  • Extraction of the infected tooth 2
  • Root canal treatment for salvageable teeth 3

• Immediate extraction of teeth in the setting of acute infection is beneficial as it results in:

  • Faster resolution of infection
  • Decreased pain
  • Earlier return of function and oral intake 2

• The risk of spreading infection to deeper spaces by performing immediate extraction is low 2

Antibiotic Therapy: When Indicated

• Antibiotics should be prescribed only when there are:

  • Regional manifestations (spreading infection, lymphadenopathy)
  • Systemic manifestations (fever, malaise) 1

• For adults with dental infections requiring antibiotics, recommended dosages include:

  • Amoxicillin: 500 mg every 8 hours or 875 mg every 12 hours 4
  • For penicillin-allergic patients: Clindamycin 300-450 mg every 6 hours 5

• For children with dental infections requiring antibiotics:

  • Amoxicillin: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 4
  • Clindamycin: 8-20 mg/kg/day divided into three or four equal doses 5

• Duration of antibiotic therapy:

  • Continue antibiotics for the shortest time possible until clinical cure is achieved 1
  • Typically 48-72 hours beyond the time that the patient becomes asymptomatic 4
  • For streptococcal infections, continue for at least 10 days to prevent acute rheumatic fever 4, 5

Special Considerations

• Dental infections can occasionally present as skin lesions or facial sinuses:

  • Surgical excision of the skin component alone will result in recurrence
  • Recognition and treatment of the underlying dental infection is required 6

• Infection control practices are essential in dental settings to prevent disease transmission:

  • Use proper personal protective equipment (gloves, masks, eye protection)
  • Properly sterilize or disinfect instruments
  • Follow proper handwashing protocols 7

• For patients with infective endocarditis history or risk:

  • Thorough dental evaluation is needed to identify and eliminate oral diseases that predispose to bacteremia
  • Focus on periodontal inflammation, pocketing around teeth, and caries that may lead to pulpal infection 8

Common Pitfalls to Avoid

• Prescribing antibiotics without addressing the source of infection (drainage/extraction) 1
• Delaying extraction due to concerns about spreading infection 2
• Failing to recognize that dental infections can present as skin lesions 6
• Using antibiotics for localized infections without systemic involvement 1
• Continuing antibiotics longer than necessary after clinical improvement 1