From the Guidelines
Dental infections should be treated promptly with a combination of dental intervention and antibiotics when appropriate, with the primary approach being surgical, such as root canal therapy or extraction of the tooth, as recommended by Medecins sans frontieres 233 and the European Society of Endodontology 234. For acute dental abscesses, the treatment is only surgical, and for acute dentoalveolar abscesses, incision and drainage followed by amoxicillin for 5 days is recommended 1.
- Key considerations include:
- The use of antibiotics should be limited to specific cases, such as infections extending into cervicofacial tissues or in medically compromised patients, with first-choice antibiotics being phenoxymethylpenicillin or amoxicillin [1, @2@ is not provided but based on the evidence, 1 is the most recent].
- Surgical drainage is key in the treatment of acute apical abscesses and acute apical periodontitis, with antibiotics used adjunctively in specific patient groups, such as those with systemic involvement or progressive infections.
- For chronic periodontitis, the use of systemic sub-antimicrobial dose doxycycline as an adjunct to scaling and root planning may be considered, but antimicrobials should not be used for chronic periodontitis or peri-implantitis, as recommended by the Scottish Dental Clinical Effectiveness Programme 236.
- Patients should also be advised on proper pain management and oral hygiene practices, including the use of over-the-counter pain relievers like ibuprofen or acetaminophen, and warm salt water rinses to reduce inflammation.
- It is crucial to address the source of infection through proper dental treatment to prevent the spread of infection, which can become life-threatening if left untreated, as bacteria can enter the bloodstream and affect vital organs, highlighting the importance of prompt and appropriate treatment, as implied by the guidelines from Medecins sans frontieres 233 and the European Society of Endodontology 234.
From the Research
Definition and Causes of Dental Infection
- Dental infection originates in the tooth or in the tissues that closely surround it, as stated in the study 2.
- These infections are common and generally resolve by spontaneous drainage through the gingival tissues of the tooth.
- Dental caries is caused by bacteria that destroy the enamel and dentin, and can be detected by an oral examination that shows stained pits or fissures on the tooth surface 3.
- Periodontal infections are caused by bacteria in the subgingival dental plaque, and can lead to conditions such as gingivitis and periodontitis 3.
Clinical Presentation and Evaluation
- A dental source of infection should be suspected in patients presenting with an acute cervicofacial swelling or trismus 2.
- Severe dental infections extend beyond the jawbone into potential spaces around the jaw and into the neck, and can lead to life-threatening complications such as airway compromise, cavernous sinus thrombosis, and mediastinitis 2.
- Emergency physicians should be comfortable treating most dental and related infections, and should be able to perform a dental examination and recommend pain and antibiotic management strategies 4.
Management and Treatment
- The aim of treatment is to eliminate the source of infection, and this can be achieved through definitive, conservative dental treatment (DCDT) such as root canal therapy or extraction of the infected tooth 5.
- Antibiotics may be recommended in patients with systemic involvement (for example, malaise or fever) due to the dental conditions, or when the risk of experiencing progression to systemic involvement is high 5.
- The use of antibiotics should be judicious, as they may provide negligible benefits and contribute to large harms such as antibiotic resistance 5.
- Emerging technologies such as 3D printing for drug delivery of antibiotics and disinfectants hold promise in enhancing treatment efficacy and patient outcomes 6.