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Dental abscess - Management
Should I prescribe an antibiotic for a dental abscess?
- In the absence of immediate attention by a dental practitioner:
- Antibiotics are generally not indicated for otherwise healthy individuals or when there no signs of spreading infection.
- Only prescribe an antibiotic:
- For people who are systemically unwell or if there are signs of severe infection (e.g. fever, lymphadenopathy, cellulitis, diffuse swelling).
- For high risk individuals to reduce the risk of complications (e.g. people who are immunocompromised or diabetic or have valvular heart disease).
- Do not routinely provide repeat prescriptions or switch antibiotics in people who fail to respond to first-line treatment. Instead advise the person to see a dental practitioner urgently.
Clarification / Additional information
- For further information regarding choice of antibiotics and duration of treatment:
- When prescribing an antibiotic, explain to the person that:
- Antibiotic therapy is prescribed to reduce the spread of infection. It is not a substitute for dental treatment.
- Regular analgesia should be taken to relieve the symptoms.
- Avoid giving repeat prescriptions for people who continually refuse to see a dental practitioner. Explain that definitive treatment by a trained professional is the only long-term solution, and repeated antibiotics may be masking underlying complications (sinus or dental cyst).
- Always consider an alternative diagnosis or the development of a complication in people with a suspected dental abscess who do not respond, or become systemically unwell after first-line antibiotic treatment. Advise the person to seek urgent dental intervention rather than switching antibiotics.
- The Faculty of General Dental Practitioners does not recommended changing antibiotics because the failure of the antibiotic is not usually due to microbial resistance [Faculty of General Dental Practice, 2000].
Basis for recommendation
- Although there is debate regarding whether or when antibiotics should be used for management of dental abscess [Herrera et al, 2000; Matthews et al, 2003; Wilson and Kornman, 2003], these recommendations are based on guidance issued by the Faculty of General Dental Practitioners [Faculty of General Dental Practice, 2000], the British Society of Antimicrobial Chemotherapy [BSAC, 2007], the Canadian Collaboration on Clinical Practice Guidelines in Dentistry [Canadian Collaboration on Clinical Practice Guidelines in Dentistry, 2004], the American Academy of Periodontology [American Academy of Periodontology, 2004], and the British National Formulary [BNF 54, 2007], as well as expert opinion [Roberts et al, 2000; Dahlen, 2002; Mansour and Cox, 2006].
- CKS found no evidence that specifically looked at antibiotics in the treatment of dental abscess by general medical practitioners.
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