What is the treatment for an infected tooth?

Treatment for Infected Tooth

The primary treatment for an infected tooth is surgical intervention, including root canal therapy for salvageable teeth or extraction for non-restorable teeth, with antibiotics only indicated when there is systemic involvement or in medically compromised patients. 1

Primary Treatment Approach

• Surgical management is the cornerstone of treatment for dental infections, which includes root canal therapy, extraction, or incision and drainage to remove the source of infection 2, 1
• For dental abscesses, the treatment is primarily surgical (drainage, debridement) and should be performed before considering antibiotic therapy 2, 3
• Acute dentoalveolar abscesses require incision and drainage, followed by tooth extraction or endodontic therapy depending on the restorability of the tooth 2
• Surgical drainage is key for acute apical abscesses, as studies have shown no statistically significant differences in pain or swelling outcomes when antibiotics are added to proper surgical management 2

When to Consider Antibiotics

• Antibiotics should only be prescribed in specific circumstances:
  • Presence of systemic involvement (fever, lymphadenopathy, malaise) 2, 1
  • Medically compromised patients 2, 3
  • Infections extending into facial spaces or cervicofacial tissues 2, 1
  • Diffuse swelling that cannot be effectively drained 3
  • Progressive infections where referral to oral surgeons may be necessary 2

Antibiotic Selection When Indicated

• Amoxicillin is the first-line antibiotic at a dose of 500 mg three times daily for 5 days 3, 4
• For more severe infections or inadequate response to amoxicillin alone, amoxicillin-clavulanic acid should be used 2, 3
• For patients with penicillin allergy, clindamycin is recommended at a dose of 300-450 mg every 6 hours for severe infections 3, 5
• Treatment duration should be for the shortest time possible until clinical cure is achieved, typically 3-7 days 6, 7

Diagnostic Approach

• A thorough clinical investigation should include:
  • Examination for signs of pulp necrosis (color changes, fistula, swelling, abscess) 2
  • Periapical or panoramic radiographs to identify enlarged pulp chambers and periapical bone loss 2
  • If a fistula is present, diagnosis requires an intraoral radiograph with a gutta-percha cone inserted inside the fistula 2

Prevention and Follow-up

• Regular dental visits every 6 months are recommended for prevention 2
• Daily dental hygiene should be emphasized to prevent recurrent infections 2
• Sealing pits and fissures with flowable resin composite on both temporary and permanent teeth can prevent bacterial invasion 2, 8
• Patients with a history of endocarditis or at high risk should receive thorough dental evaluation to eliminate oral diseases that predispose to bacteremia 2

Common Pitfalls to Avoid

• Prescribing antibiotics without surgical intervention is ineffective and contributes to antibiotic resistance 1, 3
• Vigorous excavation of infected dentine in deep cavities of symptomless, vital teeth increases the risk of pulp exposure and should be avoided 8
• Delaying treatment of dental infections can lead to spread of infection into surrounding tissues, resulting in cellulitis or more serious complications 9
• Using antibiotics as the sole treatment modality without addressing the underlying dental issue is inappropriate 1, 7

Special Considerations

• For patients requiring dental implants, immediate implantation in infected tooth sockets can be considered after proper extraction and debridement, though healing time should be extended up to 6 months 2, 10
• Proper infection control practices should be followed during all dental procedures to prevent cross-contamination 2