What antibiotic is used to treat a dental abscess (tooth abscess)?

From the Guidelines

For a tooth abscess, surgical intervention such as root canal therapy or extraction of the tooth is the primary treatment, and antibiotics should only be used in specific cases, such as when there is evidence of systemic involvement or the patient is medically compromised. The use of antibiotics for tooth abscesses is generally not recommended as first-line treatment, according to guidelines from the European Society of Endodontology (2018) 1 and the Canadian Collaboration on Clinical Practice Guidelines in Dentistry (2004) 1.

Some key points to consider when treating a tooth abscess include:

• Surgical drainage is key in treating acute apical abscesses, and antibiotics should only be used as an adjunct in specific patient groups, such as those with systemic involvement or who are medically compromised, with phenoxymethylpenicillin as a first choice 1.
• The American Dental Association (2015) recommends the use of systemic sub-antimicrobial dose doxycycline as an adjunct to scaling and root planning for chronic periodontitis, but this is not applicable to acute tooth abscesses 1.
• The Scottish Dental Clinical Effectiveness Programme (2014) and the Canadian Collaboration on Clinical Practice Guidelines in Dentistry (2004) advise against the use of antimicrobials for chronic periodontitis or peri-implantitis, and for acute apical periodontitis and acute apical abscesses, respectively, unless there are systemic complications 1.

In cases where antibiotics are deemed necessary, amoxicillin for 5 days may be considered, as recommended by Medecins sans frontieres for acute dentoalveolar abscesses. However, it is crucial to prioritize dental intervention to address the source of infection and only use antibiotics as an adjunct when necessary, based on the most recent and highest quality evidence available 1.

From the FDA Drug Label

Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin The answer to the question of a tooth abscess antibiotic is clindamycin, as it is used to treat serious infections caused by susceptible anaerobic bacteria, which can be present in tooth abscesses.

• Key points:
  • Clindamycin should be used to treat infections proven or strongly suspected to be caused by susceptible bacteria.
  • Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin 2

From the Research

Tooth Abscess Antibiotic Treatment

• The choice of antibiotic for tooth abscess treatment depends on various factors, including the severity of the infection and the patient's medical history 3, 4, 5.
• Moxifloxacin has been shown to be effective in treating odontogenic infections, with a high penetration into oromaxillary tissue and coverage of causative pathogens 3, 4.
• Clindamycin is also used to treat tooth abscesses, but its efficacy may be lower compared to moxifloxacin, especially in patients with inflammatory infiltrates 3, 4.
• Amoxicillin and amoxicillin-clavulanic acid are commonly used antibiotics for empirical therapy in dentistry, but their use should be based on the severity of the infection and the patient's medical history 5, 6.
• The ideal choice of antibiotic regimen and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections is unclear, and narrow-spectrum agents may be as effective as broad-spectrum antibiotics in otherwise healthy individuals 5.

Antibiotic Efficacy

• Moxifloxacin has been shown to have a high in vitro activity against odontogenic bacteria, with 98% of pathogens susceptible to the antibiotic 4.
• Clindamycin has a lower susceptibility rate, with 60% of pathogens susceptible to the antibiotic 4.
• Amoxicillin and amoxicillin-clavulanic acid have been shown to be effective in preventing bacteremia following dental extractions, with a significant reduction in the prevalence and duration of bacteremia 6.

Clinical Considerations

• The use of antibiotics in tooth abscess treatment should be based on a thorough examination of the patient and the use of diagnostic aids to provide the correct treatment of choice 7.
• The role of antibiotics in primary space odontogenic infections is questioned if drainage can be established, and dental treatment to address the source of infection is the primary factor in successful management 5.