management of dental abscess

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 ¹. 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 ¹. Analgesia is recommended as first-line management for symptoms, with ibuprofen or paracetamol being the preferred options if ibuprofen is contraindicated or unsuitable ¹. It is crucial to advise patients not to exceed recommended doses and that analgesics should not delay definitive dental treatment ¹.

Antibiotics are generally not indicated for otherwise healthy individuals without signs of spreading infection ¹. 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 ¹. For penicillin allergy, metronidazole or a macrolide like clarithromycin are alternatives ¹. In severe or spreading infections, metronidazole can be used as an adjunct ¹. 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 ¹.