Treatment for Tooth Infection
Surgical intervention—not antibiotics—is the primary treatment for tooth infections, including root canal therapy for salvageable teeth, extraction for non-restorable teeth, or incision and drainage for accessible abscesses. 1, 2, 3
Primary Treatment Algorithm
Step 1: Immediate Surgical Management
- Perform definitive surgical treatment first before considering antibiotics, as this addresses the source of infection 1, 2, 3
- For salvageable teeth: Root canal therapy to remove infected pulp tissue 1
- For non-restorable teeth (extensive caries, severe crown destruction, failed previous endodontic treatment): Extraction 1
- For accessible abscesses: Incision and drainage to establish drainage 1, 3
Step 2: Assess Need for Antibiotics
Add antibiotics ONLY if any of the following are present:
- Systemic involvement: Fever, malaise, or lymphadenopathy 1, 2, 4
- Medically compromised patients: Immunosuppressed, diabetic, or requiring cardiac prophylaxis 1, 2
- Diffuse swelling that cannot be adequately drained 2
- Progressive infection extending into cervicofacial tissues or facial spaces 2, 3
- Failure to respond to surgical treatment alone 2
Antibiotic Regimen (When Indicated)
First-Line Choice
- Amoxicillin 500 mg three times daily for 5 days 2, 3, 5
- This is the WHO-recommended first-line agent following surgical drainage 2
Alternative for Penicillin Allergy
For Inadequate Response
- Amoxicillin-clavulanic acid when amoxicillin alone fails 3
Critical Pitfalls to Avoid
Never prescribe antibiotics without surgical intervention—this is ineffective, does not eliminate the infection source, and contributes to antibiotic resistance 1, 2, 7, 4. Studies show that adding antibiotics to proper surgical management provides no statistically significant difference in pain or swelling outcomes when systemic involvement is absent 1, 7.
Do not prescribe antibiotics for irreversible pulpitis alone—definitive dental treatment (root canal or extraction) is required 2, 4. The American Dental Association guideline found negligible benefits and potentially large harms from antibiotics in pulpal conditions without systemic involvement 4.
Treatment Duration
- Continue treatment for minimum 48-72 hours beyond resolution of symptoms 5
- For infections caused by Streptococcus pyogenes, treat for at least 10 days to prevent acute rheumatic fever 5
- Antibiotic course should be 5 days for standard dental infections with systemic involvement 2, 3
Special Considerations
Medically Compromised Patients
- Chronic dental infections can worsen conditions in immunosuppressed patients and those with cardiovascular disease 8, 9
- These patients require prophylactic antibiotics before dental procedures and more aggressive treatment of active infections 2, 8