Treatment for Oral Infection
For oral infections, surgical intervention (drainage or debridement) is the primary treatment, followed by amoxicillin 500 mg three times daily for 5 days when systemic involvement, immunocompromise, or diffuse swelling is present. 1
Primary Treatment Approach
Surgical management must be performed first before considering antibiotic therapy for dental abscesses and odontogenic infections. 1 This includes:
- Incision and drainage for purulent collections 2
- Debridement of necrotic tissue 2
- Extraction or endodontic treatment depending on tooth viability and infection extent 1
For deciduous teeth with infection, the decision between extraction versus endodontic treatment depends on infection extent, recurrence history, and expected timing of natural exfoliation. 1 For permanent teeth, endodontic treatment or re-treatment is preferred. 1
Antibiotic Therapy Indications
Antibiotics should be prescribed only after appropriate surgical intervention in the following situations:
- Systemic involvement (fever, lymphadenopathy) 1, 3
- Immunocompromised patients 1, 3
- Diffuse swelling or infections extending to cervicofacial tissues 1, 3
- Following surgical drainage of acute dentoalveolar abscesses 1, 3
First-Line Antibiotic Selection
Amoxicillin 500 mg orally three times daily for 5 days is the first-line antibiotic for odontogenic infections. 1, 3 This regimen provides adequate coverage against the predominant pathogens including Streptococci viridans, Prevotella, and Peptostreptococcus species. 4
When to Escalate Therapy
Amoxicillin-clavulanate should be used when:
- Inadequate response to amoxicillin alone 1, 3
- More severe infections present 1, 3
- Patient received amoxicillin in the previous 30 days 3
The enhanced formulation provides sustained plasma concentrations maintaining time above MIC for approximately 49% of the dosing interval, which cannot be achieved with standard amoxicillin formulations. 5
Penicillin Allergy Alternative
Clindamycin is the recommended alternative for patients with penicillin allergy. 1, 3 Dosing is 300-600 mg orally every 8 hours. 2
Common Pitfalls to Avoid
Never prescribe antibiotics as sole treatment without surgical intervention - this approach is insufficient and will lead to treatment failure. 1, 3 The infection source must be eliminated through drainage or debridement. 1
Avoid prolonged antibiotic courses - a 5-day course is typically sufficient for most dental infections following appropriate surgical management. 1, 3
Do not use erythromycin - current evidence shows questionable benefit and increased resistance patterns in orofacial odontogenic infections. 4
Microbiological Considerations
The predominant bacteria in oral infections are Streptococci viridans (64%), Prevotella (43%), Peptostreptococcus (26%), and Fusobacterium (14%). 4 These organisms demonstrate high sensitivity to amoxicillin, amoxicillin-clavulanate, and clindamycin, but increasing resistance to erythromycin. 4
Culture and sensitivity testing is recommended for severe infections, treatment failures, or immunocompromised patients, though empiric therapy based on clinical presentation is appropriate for most cases. 2, 6