What criteria should I use to determine whether a patient with a dental abscess requires referral to a dental specialist?

A patient with a dental abscess requires referral to a dental specialist for definitive treatment, as medication alone will not eliminate the source of infection and serious complications may occur if not treated correctly NICE CKS.

• Urgent Dental Intervention: Patients should seek urgent dental intervention if they do not respond to first-line antibiotic treatment or become systemically unwell after it NICE CKS. If urgent dental intervention is unavailable, advice should be sought from an oral and maxillofacial specialist NICE CKS.
• Severe Pain: Clinical judgement should be used to consider seeking specialist advice for individuals experiencing severe pain despite analgesia prescribed in primary care NICE CKS.
• Systemic Unwellnes or High-Risk Individuals: While antibiotics may be prescribed for people who are systemically unwell (e.g., fever, lymphadenopathy, cellulitis, diffuse swelling) or are high-risk individuals (e.g., immunocompromised, diabetic), definitive dental treatment by a specialist is still essential NICE CKS. Failure to respond to first-line antibiotic treatment in these cases necessitates urgent dental intervention NICE CKS.

It is important to ensure the person does not have features of serious illness or complications requiring immediate hospital treatment, such as signs of airway compromise, rapidly progressing infection, or significant facial swelling, which would warrant emergency hospital admission NICE CKS.