Treatment for Tooth Infection
The primary treatment for dental infections is surgical intervention, including root canal therapy for salvageable teeth, extraction for non-restorable teeth, and incision and drainage for accessible abscesses, with antibiotics reserved only for cases with systemic involvement or risk of spread. 1
Surgical Management (First-Line Treatment)
- Surgical intervention is the cornerstone of treatment for dental infections and should be performed before considering antibiotic therapy 1, 2
- For salvageable teeth, root canal therapy (endodontic treatment) is the preferred option 2
- For non-restorable teeth, extraction is recommended 1, 3
- Immediate extraction of teeth in acute infection settings has shown to be beneficial, resulting in faster resolution of infection, decreased pain, and earlier return of function 3
- Incision and drainage should be performed for accessible abscesses 1
When Antibiotics Are Indicated (Adjunctive Treatment)
Antibiotics should be prescribed only in the following situations:
- Presence of systemic involvement (fever, malaise, lymphadenopathy) 1, 2
- Immunocompromised patients 1, 2
- Infections extending into facial spaces or cervicofacial tissues 1, 2
- Failure to respond to surgical treatment alone 1
- Diffuse swelling that cannot be drained effectively 1, 4
Antibiotic Selection
When antibiotics are indicated:
- Amoxicillin is the first-line antibiotic at a dose of 500 mg three times daily for 5 days 2, 5
- For more severe infections, amoxicillin-clavulanic acid should be used when there is inadequate response to amoxicillin alone 2, 6
- For patients with penicillin allergy, clindamycin is the recommended alternative at a dose of 150-300 mg every 6 hours for serious infections 2, 7, 4
- Treatment should continue for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 5
Important Considerations
- Proper infection control practices must be followed during dental procedures to prevent cross-contamination 8, 1
- Antibiotics should not be used as a substitute for appropriate surgical intervention, as they do not eliminate the source of infection 1, 4
- For infections caused by Streptococcus pyogenes, treatment should continue for at least 10 days to prevent acute rheumatic fever 5
- In patients with renal impairment (GFR <30 mL/min), dosage adjustments for amoxicillin are necessary 5
Common Pitfalls to Avoid
- Prescribing antibiotics without surgical intervention is ineffective and contributes to antibiotic resistance 1, 4
- Using antibiotics as the sole treatment modality without addressing the underlying dental issue 2, 9
- Overuse of broad-spectrum antibiotics in cases where they are not indicated (such as symptomatic irreversible pulpitis, necrotic pulps, and localized acute apical abscesses) 4