Dental abscess
Dental abscess
- Treat dental abscesses in the first instance using local measures to achieve drainage, with removal of the cause if possible.
- Advise optimal analgesia (see Odontogenic pain).
- Antibiotics are required only in cases of spreading infection or systemic involvement.
- The duration of treatment depends on the severity of infection but is usually 3-5 days, with review at 3 days.
- When antibiotics are prescribed, record the reason for this, including the diagnosis, in the clinical notes.
- Advise the patient to contact the practice if the symptoms worsen rapidly or significantly, do not improve, or new symptoms appear before the review appointment (safety netting advice).
- At the review appointment re-assess local measures, confirm the diagnosis, review pain management and provide further safety netting advice (see Bacterial infections 3-day review tool).
- If at review, there is resolution of systemic signs and symptoms, advise the patient to stop taking the antibiotic.
- Do not prolong courses of treatment if there has been resolution of systemic symptoms, as this can encourage the development of antibiotic resistance.
- Transfer patients with significant trismus, floor-of-mouth swelling, difficulty breathing, difficulty swallowing, or other red-flag signs of severe infection to hospital immediately as an emergency.
- For any patient with airway compromise, for example in cases of Ludwig’s angina, or sepsis, call 999 for an ambulance and deliver any necessary emergency life support.
- Ensure that the diagnosis and any appropriate assessments (e.g. temperature, pulse, blood pressure) carried out prior to hospital transfer are recorded in patient’s clinical record.
See the Bacterial infections management guide for a summary of the management of various dental conditions associated with bacterial infections.
More about Dental abscess
Dental abscesses are polymicrobial in nature but are commonly associated with viridans Streptococcus spp. or Gram-negative organisms. Treat dental abscesses in the first instance by using local measures to achieve drainage, with removal of the cause where possible.
Antibiotics are not appropriate in cases where there is no clinical indication, such as when the infection is localised to the peri-radicular tissues as this indicates that the infection is being adequately managed by the immune system. Also, in these cases the abscess is mostly isolated from the circulation, resulting in very little antibiotic penetration. Antibiotics are only required if immediate drainage is not achieved using local measures or in cases of spreading infection (swelling, cellulitis, lymph node involvement) or systemic involvement (fever, malaise), all of which suggest that the immune system alone is not able to adequately manage the infection.
It is good practice to measure the temperature of patients with suspected bacterial infections, with temperatures <36°C or >38°C indicative of systemic involvement. However be aware that the absence of pyrexia does not preclude the prescribing of antibiotics if other signs and symptoms of spreading infection or systemic involvement are present.
Phenoxymethylpenicillin (penicillin V) and amoxicillin are both effective at treating such infections, but the broader spectrum of amoxicillin is more likely to encourage emergence of resistant organisms.3,14 The duration of treatment depends on the severity of the infection and the clinical response, but drugs are usually given for 3 to 5 days, with review at 3 days (see Bacterial infections 3-day review tool). Severe infections include those cases where there is extra-oral swelling, eye closing or trismus but it is a matter of clinical judgement. Where there is significant trismus, floor-of-mouth swelling, difficulty breathing, difficulty swallowing, rapidly spreading cellulitis or involvement of deep or high risk fascial spaces, or any clinical concern in an immunocompromised patient, transfer the patient to hospital as an emergency. For any patient with airway compromise, for example in cases of Ludwig’s angina, or sepsis, call 999 for an ambulance and deliver any necessary emergency life support.
If the patient does not respond to the prescribed antibiotic, check the diagnosis and consider referral to a specialist.