From the Guidelines
The first-line antibiotic for a dental abscess is amoxicillin, as recommended by recent guidelines and studies, such as the 2019 guidelines by Medecins sans frontieres, which suggest amoxicillin for 5 days in cases of acute dentoalveolar abscesses after incision and drainage 1.
Key Considerations
- The choice of antibiotic should target the common bacteria found in dental abscesses, which are typically mixed aerobic and anaerobic organisms including streptococci, bacteroides, and prevotella species.
- For patients with penicillin allergies, clindamycin is a recommended alternative, as suggested by various guidelines, although the most recent and highest quality study does not specifically address this scenario.
- In cases of more severe infections or where amoxicillin alone might be insufficient, amoxicillin with clavulanic acid (Augmentin) may be prescribed instead, as the clavulanic acid helps overcome certain bacterial resistance mechanisms, in line with recommendations for skin and soft tissue infections 1.
Important Notes
- While antibiotics help control the infection, definitive treatment of a dental abscess requires dental intervention to remove the source of infection, such as drainage, root canal therapy, or tooth extraction, as emphasized by the European Society of Endodontology and other guidelines 1.
- Patients should complete the full course of antibiotics even if symptoms improve before completion to prevent recurrence and antibiotic resistance.
- The use of antibiotics should be judicious and based on the severity of the infection and the patient's overall health status, considering the potential for adverse effects and the development of antibiotic resistance.
From the Research
First Line Antibiotic for Dental Abscess
- The choice of first-line antibiotic for dental abscess is unclear, with various options available including amoxicillin, amoxicillin/clavulanic acid, cefalexin, clindamycin, erythromycin, metronidazole, moxifloxacin, ornidazole, and phenoxymethylpenicillin 2.
- A systematic review found that all antibiotic regimens showed clinical success, and broad-spectrum antibiotics as first-line empirical therapy are unnecessary 2.
- The American Dental Association recommends against using antibiotics in most clinical scenarios, irrespective of definitive, conservative dental treatment (DCDT) availability, and suggests that antibiotics be used only when systemic involvement is present 3, 4.
- Narrow-spectrum agents appear to be as effective as broad-spectrum agents in otherwise healthy individuals 2.
- The role of antibiotics in primary space odontogenic infections is questioned if drainage can be established 2.
- A review of the literature recommends suitable antibiotic prescribing for adult patients suffering from acute dentoalveolar infections based on evidence, including phenoxymethylpenicillin, amoxicillin, metronidazole, and clindamycin 5.
- Emphasis is made on proper examination of the patient and use of diagnostic aids to provide the correct treatment of choice, including alternative antibiotics for patients with a penicillin allergy 6.