Regular analgesia should be first option until a dentist can be seen for urgent drainage, as repeated courses of antibiotics for abscess are not appropriate. Repeated antibiotics alone, without drainage are ineffective in preventing spread of infection.
Antibiotics are only recommended if there are signs of severe infection, systemic symptoms or high risk of complications.
Severe odontogenic infections; defined as cellulitis plus signs of sepsis, difficulty in swallowing, impending airway obstruction, Ludwigs angina. Refer urgently for admission to protect airway, achieve surgical drainage and IV antibiotics.
The empirical use of cephalosporins, co-amoxiclav, clarithromycin, and clindamycin do not offer any advantage for most dental patients and should only be used if no response to first line drugs when referral is the preferred option.
If pus drain by incision, tooth extraction or via root canal. Send pus for microbiology.
If spreading infection (lymph node involvement, or systemic signs ie fever or malaise) ADD metronidazole.
True penicillin allergy: use clarithromycin
If severe: refer to hospital.
Up to 5 days review at 3 days
500mg – 1g QDS
Spreading infection or allergy:
True penicillin allergy: