How should I initiate management for a patient with a dental abscess, including pain relief and antibiotic therapy?

When initiating management for a patient with a dental abscess, the primary focus should be on ensuring they do not have features of serious illness or complications requiring immediate hospital treatment ¹. It is crucial to emphasize the need for the patient to seek definitive treatment from a dentist as soon as possible, as medication alone will not eliminate the source of infection ¹.

Pain Relief:

• Advise the use of an analgesic to relieve symptoms ¹.
• Ibuprofen is recommended first-line ¹.
• If ibuprofen is contraindicated or unsuitable, paracetamol should be used ¹.
• Advise the safe use of analgesics, warning not to exceed the recommended dose and reminding the person that analgesics should not be used to delay appropriate dental treatment ¹.
• Inform the individual to avoid taking combinations of analgesic products without checking with a healthcare professional or the packaging, as many over-the-counter preparations contain similar analgesics ¹.
• Opioid drugs are generally ineffective for dental pain and are rarely required ¹.

Antibiotic Therapy:

• Antibiotics are generally not indicated for otherwise healthy people at low risk of complications when there are no signs of spreading infection ¹.
• Only prescribe an antibiotic in the absence of immediate attention by a dentist if:
  • The person is systemically unwell or has signs of severe infection (e.g., fever, lymphadenopathy, cellulitis, diffuse swelling) ¹.
  • They are a high-risk individual (e.g., immunocompromised, have diabetes) to reduce the risk of complications ¹.
• If an oral antibiotic is indicated:
  • Prescribe either phenoxymethylpenicillin or amoxicillin ¹.
  • If the person has a true penicillin allergy, prescribe metronidazole or a macrolide such as clarithromycin ¹.
  • Consider concomitant treatment with metronidazole if the infection is severe or spreading (e.g., lymph node involvement, systemic signs like fever or malaise) ¹.
• Do not routinely provide repeat prescriptions or switch antibiotics in people who fail to respond to first-line treatment ¹. Instead, advise the person to seek urgent dental intervention ¹.

Self-Care Advice:

• Use a soft toothbrush to reduce discomfort ¹.
• Avoid flossing the tooth with the abscess ¹.
• Consume soft foods and try eating on the other side of the mouth ¹.
• Avoid food or drink that may be too hot or cold ¹.