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Dental abscess - Management
View full scenario
Who should treat a dental abscess?
- All people with a dental abscess should have definitive treatment provided by a dental practitioner.
- Advise the person to access services (for emergency treatment) via:
- Their registered Dental Practice, or
- The Accident and Emergency department of a dental hospital (if available), or
- The local Dental Access Centre (if available), or
- The Accident and Emergency department of a district general hospital, if the airway is compromised or only if no other avenues are available.
- Interim treatment by the medical practitioner may be needed while the person is waiting to see a dental practitioner.
In depth
What self-care advice should I recommend for dental abscess?
- Consume cool, soft foods. Avoid food or drink that may be too hot or cold.
- Encourage regular use of analgesics. Warn the person not to exceed the recommended or prescribed dose.
In depth
What analgesia is recommend for dental abscess?
- Ibuprofen, or paracetamol if ibuprofen is contraindicated or unsuitable, is recommended first-line.
- Paracetamol and ibuprofen can be taken together if pain relief with either alone is insufficient.
- For adults, if taking paracetamol and ibuprofen together does not provide enough pain relief, consider adding codeine phosphate or switching to an alternative nonsteroidal anti-inflammatory drug (NSAID) such as naproxen or diclofenac.
- In people at risk of cardiovascular adverse events, ibuprofen up to 1200 mg per day or naproxen up to 1000 mg per day are preferred to diclofenac.
- For women who are pregnant or breastfeeding, paracetamol is preferred. A short course of codeine may be added if paracetamol alone is insufficient.
In depth
Should I prescribe an antibiotic for a dental abscess?
- Only prescribe an antibiotic (amoxicillin or metronidazole up to 5 days):
- 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).
In depth
When should I seek specialist advice or arrange hospital admission?
- Seek further advice or admit a person to hospital if they have a dental abscess and:
- Are unwell with a high temperature and cardio-respiratory compromise (rapid pulse rate or low blood pressure, high respiratory rate).
- Early signs of dysphagia or a significant 'floor of mouth' swelling.
- Are in severe pain despite analgesia (maximum tolerated dosage) prescribed in primary care.
- Have a spreading facial infection.
- Have a history of being immunocompromised.
In depth
Prescriptions
Analgesics: 1st line - use when required
Age from 1 year to 3 years 11 months
Ibuprofen s/f susp: 100mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take one 5ml spoonful three times a day when required for pain relief. Do not exceed the stated dose.
Supply 100 ml.
Age from 1 year to 5 years 11 months
Paracetamol s/f susp: 120mg to 240mg up to four times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 4 years to 6 years 11 months
Ibuprofen s/f susp: 150mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 7.5ml three times a day when required for pain relief. Do not exceed the stated dose.
Supply 150 ml.
Age from 6 years to 11 years 11 months
Paracetamol s/f susp: 250mg to 500mg up to four times a day
Paracetamol 250mg/5ml oral suspension sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 7 years to 9 years 11 months
Ibuprofen s/f susp: 200mg up to three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take two 5ml spoonfuls three times a day when required for pain relief. Do not exceed the stated dose.
Supply 200 ml.
Age from 10 years to 11 years 11 months
Ibuprofen s/f susp: 300mg up to three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take three 5ml spoonfuls three times a day when required for pain relief. Do not exceed the stated dose.
Supply 300 ml.
Age from 12 years to 17 years 11 months
Paracetamol tablets: 500mg to 1g up to four times a day
Paracetamol 500mg tablets
Take one or two tablets every 4 to 6 hours when required for pain relief. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Age from 12 years onwards
Ibuprofen tablets: 200mg to 400mg three to four times a day
Ibuprofen 200mg tablets
Take one or two tablets 3 to 4 times a day when required for pain relief. Do not exceed the stated dose.
Supply 56 tablets.
Age from 18 years onwards
Paracetamol tablets: 1g up to four times a day
Paracetamol 500mg tablets
Take two tablets every 4 to 6 hours when required for pain relief. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Analgesics: 2nd-line (dental abscess)
Age from 12 years onwards
Diclofenac sodium e/c tablets: 25mg three times a day
Diclofenac sodium 25mg gastro-resistant tablets
Take one tablet three times a day.
Supply 21 tablets.
Diclofenac sodium e/c tablets: 50mg three times a day
Diclofenac sodium 50mg gastro-resistant tablets
Take one tablet three times a day.
Supply 21 tablets.
Age from 16 years onwards
Naproxen tabs:500mg immediately then 250mg three to four times a day
Naproxen 250mg tablets
Take two tablets initially, then take one tablet every 6 to 8 hours when required for pain. Maximum of 5 tablets in 24 hours.
Supply 28 tablets.
Age from 18 years onwards
Add on if severe pain: codeine tablets
Codeine 30mg tablets
Take one to two tablets every 4 to 6 hours when required for additional pain relief. Maximum of 8 tablets in 24 hours.
Supply 28 tablets.
Antibiotic: amoxicillin for 5 days
Age from 1 year to 4 years 11 months
Amoxicillin s/f suspension: 125mg three times a day
Amoxicillin 125mg/5ml oral suspension sugar free
Take one 5ml spoonful three times a day for 5 days.
Supply 100 ml.
Amoxicillin s/f suspension: 250mg three times a day
Amoxicillin 250mg/5ml oral suspension sugar free
Take one 5ml spoonful three times a day for 5 days.
Supply 100 ml.
Age from 5 years to 11 years 11 months
Amoxicillin s/f suspension: 250mg three times a day
Amoxicillin 250mg/5ml oral suspension sugar free
Take one 5ml spoonful three times a day for 5 days.
Supply 100 ml.
Amoxicillin s/f suspension: 500mg three times a day
Amoxicillin 250mg/5ml oral suspension sugar free
Take two 5ml spoonfuls three times a day for 5 days.
Supply 200 ml.
Age from 12 years onwards
Amoxicillin 250mg three times a day for five days
Amoxicillin 250mg capsules
Take one capsule three times a day for 5 days.
Supply 15 capsules.
Amoxicillin capsules: 500mg three times a day
Amoxicillin 500mg capsules
Take one capsule three times a day for 5 days.
Supply 15 capsules.
Antibiotic: amoxicillin 3g dose 8 hours apart
Age from 12 years onwards
Amoxicillin: 3g dose 8 hours apart
Amoxicillin 3g oral powder sachets sugar free
Take the contents of one sachet (dissolved in a glass of water) immediately. Repeat the dose after 8 hours.
Supply 2 sachets.
Antibiotic: metronidazole for 5 days
Age from 1 year to 11 years 11 months
Metronidazole suspension: 7.5mg/kg three times a day
Metronidazole 200mg/5ml oral suspension
*WEIGHT REQUIRED* Take 7.5mg per kg bodyweight THREE times a day for 5 days. (Max 400mg per dose.)
Supply 100 ml.
Age from 12 years onwards
Metronidazole 200mg three times a day
Metronidazole 200mg tablets
Take one tablet three times a day for 5 days.
Supply 15 tablets.
Metronidazole tablets: 400mg three times a day
Metronidazole 400mg tablets
Take one tablet three times a day for 5 days.
Supply 15 tablets.
© NHS Institute for Innovation and Improvement