From the Guidelines
Dental abscess treatment should prioritize surgical intervention, such as root canal therapy or extraction of the tooth, over antibiotic treatment. According to the most recent guidelines, including those from the European Society of Endodontology 1, surgical drainage is key in treating acute apical abscesses, and antibiotics should only be used in specific patient groups, such as those with systemic involvement or medically compromised patients.
Key Considerations
- The primary treatment for acute dental abscesses is surgical, with root canal therapy or extraction of the tooth 1.
- For acute dentoalveolar abscesses, incision and drainage, followed by amoxicillin for 5 days, may be recommended 1.
- Antibiotics should not be used as a first-line treatment for acute apical periodontitis and acute apical abscesses, unless there are systemic complications or the patient is medically compromised 1.
Treatment Approach
- Patients with dental abscesses should be referred to a dentist for urgent evaluation and treatment, which may include drainage of the abscess, root canal therapy, or tooth extraction 1.
- While waiting for dental care, patients can take over-the-counter pain relievers like ibuprofen or acetaminophen and rinse with warm salt water several times daily to help manage symptoms.
- Prevention of dental abscesses includes regular dental checkups, good oral hygiene, and prompt attention to dental pain or swelling.
From the Research
Dental Abscess Treatment
- The primary treatment for dental abscesses involves the removal of the source of inflammation or infection through local operative measures, such as extraction, incision and drainage, or endodontic treatment 2.
- Systemic antibiotics are only recommended for situations where there is evidence of spreading infection or systemic involvement, such as fever, malaise, or lymph node involvement 2, 3.
- The use of antibiotics in the absence of these signs may contribute to the development of antibiotic-resistant bacteria 2.
Antibiotic Use
- A systematic review found that the use of systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults resulted in little to no difference in participant-reported pain or swelling when provided with surgical intervention and analgesics 2.
- The evidence suggests that preoperative clindamycin for adults with symptomatic apical periodontitis results in little to no difference in participant-reported pain or swelling at any of the time points included in the review when provided with chemo-mechanical endodontic debridement and filling under local anaesthesia 2.
- The American Dental Association recommends against using antibiotics in most clinical scenarios, irrespective of the availability of definitive, conservative dental treatment, due to likely negligible benefits and potentially large harms 3, 4.
Microbiology of Dental Abscesses
- Dental abscesses are polymicrobial, comprising of strict anaerobes, such as anaerobic cocci, Prevotella, Fusobacterium species, and facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group 5.
- The microbiology of the acute dentoalveolar abscess and its treatment are reviewed, highlighting the need for good-quality clinical trials to identify the ideal treatment 5.
Clinical Recommendations
- The American Dental Association recommends the use of antibiotics in patients with systemic involvement, such as malaise or fever, due to the dental conditions or when the risk of experiencing progression to systemic involvement is high 3, 4.
- Immediate definitive, conservative dental treatment should be prioritized in all cases, with antibiotics used only when necessary 3, 4.