What antibiotics are used to treat dental pain (odontalgia)?

From the Guidelines

Antibiotics should only be used for dental pain when there are signs of infection such as facial swelling, fever, or lymph node involvement, and amoxicillin 500mg three times daily for 5 days is recommended in such cases, as per the guidelines from Medecins sans frontieres e Dental infections (2019) 1.

Key Considerations

• For acute dental abscesses, the treatment is only surgical (root canal therapy or extraction of the tooth) 1.
• For acute dentoalveolar abscesses, incision and drainage, then amoxicillin for 5 days is recommended 1.
• Antibiotics should not be used for acute apical periodontitis and acute apical abscesses, unless there are signs of systemic involvement or the patient is medically compromised, in which case phenoxymethylpenicillin is the first choice 1.
• The use of systemic sub-antimicrobial dose doxycycline (20 mg twice daily for 3-9 months) as an adjunct to scaling and root planning is recommended for chronic periodontitis by the American Dental Association (2015) 1.

Management of Dental Pain

• Over-the-counter pain relievers like ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) are recommended for most dental pain.
• Salt water rinses (1/2 teaspoon salt in 8 ounces warm water) and avoiding very hot, cold, or sweet foods can help manage discomfort while waiting for dental care.

Importance of Dental Care

• Dental pain usually indicates a problem requiring professional dental treatment, such as a cavity, abscess, or gum disease.
• Seeing a dentist promptly is essential, as antibiotics alone won't resolve the issue.
• Using antibiotics unnecessarily contributes to antibiotic resistance, a growing public health concern.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Antibiotics for Dental Pain

• Antibiotics are only indicated as an adjunct to dental treatment when there are signs of systemic involvement, progressive and rapid spread of infection, or when the patient is immunocompromised 2
• The use of antibiotics for irreversible pulpitis is not supported by evidence, with one low-powered small sample trial showing no significant difference in pain relief between penicillin and placebo groups 3
• There is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics for irreversible pulpitis 3
• Emergency physicians should be comfortable treating most dental and related infections, and antibiotics may be prescribed as part of the management strategy 4
• Antibiotics are an important aspect of care for patients with acute odontogenic infections, but are not a substitute for definitive surgical management 5

Management of Dental Pain

• Paracetamol and ibuprofen are more effective in combination than either of them alone, with or without opioids, for managing dental pain 2
• The dental impaction pain model has been widely used in clinical studies of analgesic agents and is generalizable to many other forms of pain 6
• Postsurgical dental pain may be moderate to severe but typically resolves in a day or two after the extraction, and opioid monotherapy is rarely used in dentistry 6

Use of Antibiotics in Dentistry

• Antibiotics are only indicated in certain situations, such as signs of systemic involvement or immunocompromised patients 2
• The use of antibiotics for dental pain is not always necessary and should be prescribed judiciously to avoid overuse and resistance 3, 4
• Antibiotics are an important aspect of care for patients with acute odontogenic infections, but should be used in conjunction with definitive surgical management 5