Antibiotics for Dental Pain and Swelling Guideline
ADA Statement
For more information, please refer to the ADA Statement.
JADA Article
Read the detailed JADA Article.
Guideline Overview
This guideline addresses antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling. It is endorsed by the American College of Emergency Physicians.
Key Points:
- Antibiotics are not recommended for most tooth infections (pulpal or periapical conditions). Instead, dental treatment and over-the-counter pain relievers such as acetaminophen and ibuprofen are advised.
- This guideline emphasizes the importance of addressing dental pain and swelling primarily through dental treatment rather than antibiotics.
ADA Video
Watch the video: Why your dentist may not prescribe an antibiotic.
Importance of Antibiotics
Antibiotics are vital for fighting bacterial infections and have been lifesaving for many diseases such as tuberculosis. However, their effectiveness has led to overuse and misuse.
Helping Antibiotics Work:
- Not all dental infections require antibiotics: A toothache might be treated at the site of the infection in the dental office rather than with antibiotics.
- Use only when needed: Consult your dentist or physician. Symptoms like fever can indicate that an infection has spread and might require antibiotics.
- Don’t share medications: Antibiotics should not be shared. They might not be effective and can cause harmful side effects.
Risks of Antibiotic Use
- Side effects: Including diarrhea (from mild to severe cases caused by C. diff), yeast infections, nausea, or vomiting.
- Allergic reactions: Some people may develop a rash or severe reactions to certain antibiotics.
- Antibiotic resistance: Improper use of antibiotics can lead to bacteria that are no longer killed by these medications, making infections harder or impossible to treat. Resistant bacteria can spread, affecting the whole community.
Conclusions
Antibiotics are essential and effective when used correctly. It is crucial to use them wisely to ensure they remain effective against bacterial infections.
Antibiotic Prophylaxis Prior to Dental Procedures
What is Antibiotic Prophylaxis?
Antibiotics are usually used to treat bacterial infections. Sometimes, though, dentists or physicians suggest taking antibiotics before dental treatment to decrease the chance of infection. This is called antibiotic prophylaxis. During some dental treatments, bacteria from the mouth can enter the bloodstream. In most people, the immune system kills these bacteria. However, in some patients, bacteria can travel through the bloodstream and cause an infection elsewhere in the body. Antibiotic prophylaxis may offer these people extra protection.
Who Might Benefit from Antibiotic Prophylaxis?
- Certain Heart Conditions: People with specific heart conditions may be at increased risk of developing infective endocarditis (IE), an infection of the lining of the heart or heart valves. The American Heart Association recommends antibiotic prophylaxis for people who have:
- An artificial heart valve or a repaired heart valve with prosthetic material.
- A history of IE.
- Certain congenital (present from birth) heart conditions, including:
- Unrepaired or incompletely repaired cyanotic congenital heart disease.
- A completely repaired congenital heart defect with prosthetic material or device during the first 6 months after the procedure.
- Any repaired congenital heart disease with residual defects near a prosthetic patch or device.
- Joint Replacement Surgery: The American Dental Association does not routinely recommend antibiotic prophylaxis for people who have had hip, knee, or other joint replacements. However, people with joint replacements who have a weakened immune system should talk to their dentist and orthopedic surgeon. Conditions like diabetes, rheumatoid arthritis, or cancer, and medications such as steroids or chemotherapy, can affect the ability to fight infections.
Why Isn't Antibiotic Prophylaxis Used for Everyone?
Antibiotic prophylaxis is not right for everyone. Antibiotics should only be used when the benefits outweigh the risks. Infections after dental treatments are uncommon, and antibiotics can have side effects, including stomach upset, diarrhea, and allergic reactions. Using antibiotics too often or incorrectly can also make bacteria resistant to them. Therefore, it’s important to use antibiotic prophylaxis only for those at the greatest risk of developing an infection after dental treatment.
What Can You Do?
- Inform Your Dentist: Tell your dentist about any changes in your health since your last visit and all medications you are taking. This information helps your dentist and physician decide if you could benefit from antibiotic prophylaxis.
- Maintain Good Oral Hygiene: Good home care is key to dental health. Brush your teeth twice a day with fluoride toothpaste, clean between your teeth once a day, eat a balanced diet, and visit your dentist regularly.
For more detailed guidelines and information, refer to the ADA Clinical Practice Guideline (https://jada.ada.org/article/S0002-8177(14)00019-1/fulltext?nav=rotatorJanmain&_gl=1*zyj7qw*_ga*MTgwNDAyMzAzOS4xNzA5NDc3NTkz*_ga_X8X57NRJ4D*MTcxNzE2MDAxOC40LjEuMTcxNzE2MTEyMy4wLjAuMA..).