The Center For Disease Dynamics, Economics & Policy

Dental Abscess (Including Gingivitis)

Clinical definition:

Tooth infections from cavities, gingivitis, and periodontitis. Common symptoms include severe pain, tooth sensitivity, and inflammation of the face and gums. Most infections are polymicrobial and include anaerobic bacteria.

 

Preferred antibiotic choice(s)
Drug Formulation Dosage Duration
Amoxicillin-clavulanic acid (PO) Oral liquid: 125 mg amoxicillin + 31.25 mg clavulanic acid/5 mL AND 250 mg amoxicillin + 62.5 mg clavulanic acid/5 mL; Tablet: 500 mg (as trihydrate) + 125 mg (as potassium salt)  

500 mg component of amoxicillin 8 hourly

3 days if adequate source control, or 5 days if not
Phenoxymethyl-penicillin (penicillin V) (PO) Powder for oral liquid: 250 mg (as potassium salt)/5 mL; Tablet: 250 mg (as potassium salt) 500 mg 6 hourly 3 days if adequate source control, or 5 days if not
In case of confirmed drug allergy or medical contraindication
Combination therapy with:

Azithromycin (PO)

PLUS

Metronidazole (PO)

Azithromycin- Capsule: 250 mg; 500 mg (anhydrous); Oral liquid: 200 mg/5 mL 500 mg 6 hourly 5 days
Metronidazole- Oral liquid: 200 mg (as benzoate)/ 5 mL; Tablet: 200 mg to 500 mg 400 mg 8 hourly

 

Principles of Stewardship:

  • Dental abscess requires surgical drainage, not just antibiotics.
  • If the abscess is drained and the patient is improving, consider stopping antibiotics after 3 days of treatment.
  • Although gingivitis is a risk factor for dental abscess, only acute necrotizing gingivitis should be treated with antibiotics.
  • For gingivitis without necrosis or abscess, do not treat with antibiotics.

Notes:

  • For acute necrotizing gingivitis:
    • Treat with clindamycin [Dosage: Capsule: 150 mg (as hydrochloride); Injection: 150 mg (as phosphate)/ mL; Oral liquid: 75 mg/5 mL (as palmitate)] for 3 days.
  • For cases of acute necrotizing gingivitis associated with malnutrition, treat with vitamins.