The management of a dental abscess primarily involves definitive dental treatment, which should be sought as soon as possible to minimize the risk of serious complications NICE CKS. While awaiting dental assessment and treatment, self-care advice can help reduce pain and pressure. This includes using a soft toothbrush, avoiding flossing the affected tooth, consuming soft foods, chewing on the opposite side of the mouth, and avoiding excessively hot or cold food and drink NICE CKS. Analgesia is recommended as first-line management for symptoms, with ibuprofen or paracetamol being the preferred options if ibuprofen is contraindicated or unsuitable NICE CKS. It is crucial to advise patients not to exceed recommended doses and that analgesics should not delay definitive dental treatment NICE CKS.
Antibiotics are generally not indicated for otherwise healthy individuals without signs of spreading infection NICE CKS. However, antibiotics should be prescribed if the person is systemically unwell, shows signs of severe infection (e.g., fever, lymphadenopathy, cellulitis, diffuse swelling), or is considered high-risk due to conditions like immunocompromise or diabetes NICE CKS. For penicillin allergy, metronidazole or a macrolide like clarithromycin are alternatives NICE CKS. In severe or spreading infections, metronidazole can be used as an adjunct NICE CKS. If a dental abscess does not respond to first-line antibiotic treatment, alternative diagnoses or complications should be considered, and urgent dental intervention or specialist advice should be sought rather than switching antibiotics NICE CKS.