What is the treatment for a tooth abscess?

Treatment of Tooth Abscess

The primary treatment for a dental abscess is surgical intervention, which includes root canal therapy for salvageable teeth, extraction for non-restorable teeth, and incision and drainage for accessible abscesses. 1, 2

Primary Treatment Approach

• Surgical management is the first-line treatment for dental abscesses to remove the source of infection and establish drainage 1, 2
• For teeth that can be saved, root canal therapy is the preferred surgical intervention 1
• Non-restorable teeth should be extracted to eliminate the source of infection 1, 2
• If a fistula is present, diagnosis requires an intraoral radiograph with a gutta-percha cone inserted inside the fistula to identify the source tooth 3
• Acute abscesses require immediate surgical intervention as antibiotics alone will not resolve the infection 4

When to Consider Antibiotics

• Antibiotics should only be used as an adjunct to surgical treatment in specific situations, not as a primary treatment 1, 2
• Indications for antibiotic therapy include:
  • Presence of systemic involvement (fever, malaise, lymphadenopathy) 1, 2
  • Medically compromised patients 1
  • Infections extending into facial spaces or cervicofacial tissues 1
  • Diffuse swelling that cannot be effectively drained 1
  • Failure to respond to surgical treatment alone 1

Antibiotic Selection When Indicated

• Amoxicillin is commonly recommended when antibiotics are necessary:
  • For adults: 500 mg every 8 hours or 875 mg every 12 hours for 5-7 days 5
  • For children: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours 5
• Treatment should continue for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 5
• For patients with severe renal impairment (GFR 10-30 mL/min), dosage should be adjusted to 500 mg or 250 mg every 12 hours 5

Special Considerations

• Adding antibiotics to proper surgical management has not shown statistically significant differences in pain or swelling outcomes in most cases 1, 6
• Studies have shown that simultaneous abscess incision and tooth extraction leads to shorter hospital stays (average 8 days) compared to when these procedures are performed at different times (average 11 days) 7
• For patients with fistulas, an intraoperative X-ray should be taken to precisely confine clinical maneuvers within the endodontium 3

Common Pitfalls to Avoid

• Prescribing antibiotics without surgical intervention is ineffective and contributes to antibiotic resistance 2
• Delaying surgical intervention can lead to spread of infection beyond the jaws, increasing risk of airway obstruction and septicemia 4
• Failure to identify the causative tooth can lead to recurrent infections 3
• Inadequate drainage of the abscess will result in persistent infection despite antibiotic therapy 1

Follow-up Care

• Patients should be monitored for resolution of symptoms and potential complications 1
• If symptoms persist despite appropriate treatment, reassessment and potentially different interventions may be necessary 1
• In some infections, treatment may be required for several weeks with clinical and/or bacteriological follow-up for several months after cessation of therapy 5