What oral medications are used to treat dental issues?

Oral Medications for Dental Issues

For dental infections with systemic involvement (fever, malaise, lymphadenopathy, or cellulitis), amoxicillin 500 mg orally three times daily for 5-7 days is the first-line antibiotic choice, but only after surgical intervention (incision and drainage) has been performed, as antibiotics alone are insufficient. 1, 2

Antibiotics for Dental Infections

When Antibiotics Are Indicated

• Systemic involvement including fever, malaise, lymphadenopathy, or cellulitis requires antibiotic therapy 1, 2
• Spreading infection with diffuse swelling beyond the extraction site or cellulitis extending into cervicofacial tissues 1, 2
• Medically compromised patients including immunosuppressed individuals, diabetics, or those requiring cardiac prophylaxis 1, 2
• Failure to respond to surgical treatment alone after adequate drainage 2

First-Line Antibiotic Regimens

• Amoxicillin 500 mg orally three times daily for 5-7 days is the standard first-line treatment for dental infections in non-allergic patients 1, 2, 3
• Treatment should continue until 2-3 days after resolution of symptoms, typically totaling 5-7 days 1
• For penicillin-allergic patients, clindamycin 600 mg orally 1 hour before intervention, followed by 300-400 mg three times daily for 5-7 days is the preferred alternative 4, 5

Special Population Considerations

• Post-radiation patients (≥50 Gy) require amoxicillin 500 mg three times daily starting 1 hour to 1 day pre-extraction, continuing 5-7 days post-extraction, plus chlorhexidine gluconate 0.12% or 0.2% mouth rinse twice daily until adequate healing 1
• Hemodialysis patients should take 2 g of amoxicillin orally 1 hour before dental treatment, with dosing interval prolonged to every 24 hours (instead of every 8 hours) 4

Critical Pitfall to Avoid

Never prescribe antibiotics without surgical intervention - this is ineffective for dental abscesses and contributes to antimicrobial resistance 2. Surgical drainage is the primary treatment; antibiotics are only adjunctive 1, 2.

Pain Management for Dental Issues

First-Line Analgesics

• Ibuprofen 400 mg is the most effective single-agent analgesic for dental pain, providing superior pain relief compared to aspirin 600-900 mg or paracetamol, with a duration of action of at least 6 hours 6, 7
• NSAIDs are first-line therapy due to their combined anti-inflammatory and analgesic action, which is particularly effective for dental pain caused by inflammation 6

Combination Therapy for Enhanced Pain Relief

• Fixed-dose combination of ibuprofen 400 mg/paracetamol 1000 mg provides significantly superior pain relief compared to either agent alone in moderate to severe dental pain 8
• This combination is also significantly more effective than ibuprofen 400 mg alone (P = 0.02) or paracetamol 1000 mg alone (P < 0.001) 8
• Ibuprofen 200 mg/paracetamol 500 mg combination is significantly more effective than either ibuprofen 200 mg or paracetamol 500 mg monotherapy 8

Dosing Strategy

• On-demand dosing of ibuprofen 400 mg (single dose after treatment with rescue medication available as needed) is as effective as regular scheduled dosing every 6 hours for 24 hours in patients with irreversible pulpitis undergoing root canal treatment 9
• Regular scheduled dosing results in significantly more medication use without additional pain relief benefit 9
• Ibuprofen 200 mg is the smallest clinically useful dose, but 400 mg provides longer duration of action (6 hours vs 4-6 hours) 7

Opioid Analgesics

• Reserve opioids for severe pain only due to significant side effects 6
• The most commonly used opioid is codeine, usually in combination with paracetamol 6
• The combination of ibuprofen and hydrocodone is more effective than either drug alone in postoperative pain 7

Oral Antisepsis and Topical Agents

Preoperative Antisepsis

• Chlorhexidine 0.12%-0.20% mouthwash for 3 minutes before surgery is recommended for oral antisepsis 4

Topical Anesthetics

• Viscous lidocaine or high-potency topical steroids (gel or dental paste preferred) can be used for moderate to severe oral dysesthesia (burning mouth sensation) 4
• Topical anesthetics provide short-term pain relief for oral mucositis on an empirical basis 4

Corticosteroids for Oral Lesions

• Dexamethasone mouth rinse (0.1 mg/mL) for multiple or difficult-to-reach oral ulcerations 4
• Clobetasol gel or ointment (0.05%) for limited, easily accessible ulcers 4
• Prednisone 20-40 mg daily for 2-4 weeks, then taper for moderate to severe dry mouth (sicca syndrome) 4

Medications for Specific Dental Conditions

Temporomandibular Disorder (TMD) Pain

• NSAIDs are first-line pharmacotherapy for TMD pain 2
• Neuromodulatory medications (amitriptyline, gabapentin) may be considered for chronic TMD pain 2
• Paracetamol is an option but NSAIDs are preferred 2

Oral Dysesthesia/Burning Mouth Syndrome

• Gabapentin has demonstrated effectiveness in reducing burning sensation in 50% of patients in randomized controlled trials 4
• High-potency topical steroids or viscous lidocaine are alternative options 4

Chronic Periodontitis

• Sub-antimicrobial dose doxycycline (20 mg twice daily for 3-9 months) as an adjunct to scaling and root planing is the only antimicrobial with demonstrated benefit in chronic periodontal disease 2

Medications to Avoid in Renal Failure Patients

• Avoid aspirin, ibuprofen, and diclofenac in patients on dialysis 4
• Paracetamol 300-600 mg with dosing interval prolonged to every 8-12 hours (instead of every 4 hours) is the preferred analgesic for dialysis patients 4
• Codeine and alprazolam are not recommended in dialysis patients 4