Regular analgesia should be first option until a dentist can be seen for urgent drainage, as repeated courses of antibiotics for abscess are not appropriate. Repeated antibiotics alone, without drainage are ineffective in preventing spread of infection.

Antibiotics are recommended if there are signs of severe infection, systemic symptoms or high risk of complications.

Severe odontogenic infections; defined as:

• Cellulitis plus signs of sepsis
• Difficulty in swallowing
• Impending airway obstruction
• Ludwigs angina

Refer urgently for admission to protect airway, achieve surgical drainage and IV antibiotics.

The empirical use of cephalosporins, co-amoxiclav, clarithromycin, and clindamycin do not offer any advantage for most dental patients and should only be used if no response to first line drugs when referral is the preferred option.

If pus drain by incision, tooth extraction or via root canal. Send pus for microbiology.

Metronidazole is a suitable alternative for the management of dental abscess in patients who are allergic to penicillin. It can also be used as an adjunct to amoxicillin in patients with spreading infection (lymph node involvement, or systemic signs i.e. fever or malaise) or pyrexia.

Amoxicillin

• 500mg every 8 hours for up to 5 days, review at day 3 or

Phenoxymethylpenicillin

• 500-1000mg every 6 hours for up to 5 days, review at day 3

True penicillin allergy

Metronidazole

• 400mg every 8 hours for 5 days or

Clarithromycin

• 500mg every 12 hours for up to 5 days, review at day 3