What are the symptoms and treatment options for a dental infection (tooth infection)?

From the Guidelines

For a tooth infection, the most effective treatment is surgical, either through root canal therapy or extraction of the tooth, and antibiotics such as amoxicillin may be prescribed for 5 days in cases of acute dentoalveolar abscesses or infections extending into cervicofacial tissues. When considering treatment options, it's essential to prioritize the most recent and highest quality guidelines, such as those from the Medecins sans frontieres e Dental infections (2019) 1. According to these guidelines, for acute dental abscesses, treatment is only surgical, while for acute dentoalveolar abscesses, incision and drainage followed by amoxicillin for 5 days is recommended. Some key points to consider in the treatment of tooth infections include:

• Surgical drainage is key in the treatment of acute apical abscesses, as recommended by the European Society of Endodontology (2018) 1
• Antibiotics should only be used in specific patient groups, such as those with systemic involvement or progressive infections, as stated by the European Society of Endodontology (2018) 1
• The use of systemic sub-antimicrobial dose doxycycline as an adjunct to scaling and root planning is recommended for chronic periodontitis by the American Dental Association (2015) 1
• Antimicrobials should not be used for chronic periodontitis or peri-implantitis, according to the Scottish Dental Clinical Effectiveness Programme (2014) 1. In terms of pain management, over-the-counter pain relievers like ibuprofen or acetaminophen can be taken to manage pain, and rinsing the mouth with warm salt water can help reduce bacteria and soothe discomfort. It's crucial to seek immediate dental attention to prevent complications and ensure proper treatment.

From the Research

Tooth Infection Management

• Immediate extraction of teeth in the setting of an acute infection has shown to be beneficial for many reasons, including faster resolution of the infection, decreased pain, and earlier return of function and oral intake 2.
• The risk of seeding the infection into deeper spaces by performing immediate extraction is low 2.

Antibiotic Use

• An expert panel convened by the American Dental Association recommended against using antibiotics in most clinical scenarios, irrespective of definitive, conservative dental treatment (DCDT) availability, due to likely negligible benefits and potentially large harms 3.
• Antibiotics are 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 3.
• A systematic review found that the ideal choice, regimen, and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections are unclear, and broad-spectrum antibiotics as first-line empirical therapy are unnecessary 4.
• Narrow-spectrum agents appear to be as effective in an otherwise healthy individual, and the primary factor in the successful management of dentoalveolar abscesses is dental treatment to address the source of infection 4.

Treatment Approaches

• Emergency physicians should be comfortable treating most dental and related infections, and recommended techniques include performing a dental examination, exploring common pathologies, and recommending pain and antibiotic management strategies 5.
• A review of the literature found that there is a need for appropriate prescribing guidelines for antibiotics in the management of acute dentoalveolar abscesses, considering best practice and current empirical treatment regimes 6.