Dental Abscess Treatment
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Dental Abscess
Start a diagnosisBefore you start a diagnosis, please read all of the information below.
A toothache can be caused by many things including tooth decay, gum disease, broken teeth, abscesses or jaw problems. A dental abscess is a collection of pus in or around the tooth and can be a very debilitating and painful condition.
If you think you have a dental abscess then you should see your dentist as soon as possible. Regular analgesia should be the first option to treat a dental abscess. Take painkillers to ease the discomfort. Ibuprofen is the preferred painkiller for dental abscesses, but if you're unable to take it for medical reasons, then take paracetamol instead. It is important to read the information with the painkillers to ensure you take them safely.
Please contact your dentist first to get an emergency appointment. Only use this service if you are having difficulties in accessing an emergency dental appointment, then in the meantime, we may be able to prescribe an emergency antibiotic if clinically appropriate. Antibiotics do NOT cure a toothache, and you will need to be assessed to see whether an antibiotic is appropriate for your dental problem.
A dental abscess will not go away on its own. It will require draining of the pus. A dentist will do this by either piercing the abscess or drilling a small hole to allow the pus to escape. Once the pus has been drained an antibiotic is often unnecessary. If left alone the infection may spread.
Please see the Common Treatments section below for further information.
You may experience some of the following:
- a toothache (usually an intense throbbing pain)
- tenderness of the tooth
- pain that spreads to your ear, jaw and neck on the same side as the affected area
- gum tenderness and swelling
- swelling of the face
- a fever
- swollen glands in your neck
Regular analgesia should be the first option until a dentist can be seen for drainage. Antibiotics are reserved for worsening symptoms as they alone will not cure a dental abscess. If you are prescribed antibiotics then you will be required to see a dentist within 3 days for drainage of the abscess.
Possible treatments we may prescribe if clinically appropriate:
- Amoxicillin 500mg Three Times Daily: 5-day course (£0.82*)
- Clarithromycin 500mg Twice Daily: 5-day course (£1.97*)
- Metronidazole 400mg three times daily: 5-day course
*Prices shown are cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy.
Please click on the medication above to read the Patient Information Leaflet for important information about each drug. We use national prescribing guidelines to select which treatment would be most appropriate for your condition.
There are two main types of dental abscesses:
Periapical abscess (in the tooth)
- This occurs in the dental pulp which is in the centre of the tooth. It usually starts with tooth decay breaking down the outer layers of the tooth (enamel and dentine), allowing bacteria to pass to the pulp causing an infection.
Periodontal abscess (in the gum)
- This starts between the gum and the tooth and often is the result of gum disease. Gum disease can result in the gum separating from the tooth allowing bacteria in between the two.
A dental abscess can be avoided by maintaining good oral care to prevent dental decay and gum disease. This can include the use of:
- regular tooth brushing twice a day for at least 2 minutes
- flossing or using an interdental brush at least once a day to clean between your teeth and under the gumline
- mouthwashes to reduce plaque build up
- reducing sugar intake in food and drink
- eating a healthy balanced diet
- regular dental checkups at least yearly
- avoid smoking
Plaque is made up of bacteria which produce acids that can damage your teeth. It can cause tooth decay or gum disease if not cleaned regularly by brushing.
Contact your registered dentist if you have one. If it is out of hours, they should have an answerphone message with details of how to access emergency care.
The websites listed below have contact information for the dental helplines in your area.
England
You can search local NHS dentists by using the NHS choices website. NHS 111 can also give you information on local dental services available to you.
Wales
You will find a list of dental helpline numbers on NHS Health in Wales Website.
- Search by post code under Find Local Services on the Health in Wales website homepage.
- Search by post code or by the nearest town on the NHS Direct Wales website
Scotland
You can use the NHS 24 website to get a list of dentists near you. If you do not have a regular dentist, advice can be obtained by telephoning your local Health Board Helpline, and the contact details are found on the Scottish Dental Website
You can also contact 111 service which provides urgent health advice out of hours when your GP Practice or Dentist is closed.
Northern Ireland
Information on Out of Hours Emergency Dental Treatment can be found on the HSC Website (Health and Social Care).
You can find a dentist near you by searching the HSC service finder.
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Amoxicillin is recommended as first-line treatment if an antibiotic is prescribed for a dental abscess unless you are allergic to penicillins. If you are allergic to penicillins then Clarithromycin would be used.
Before you start any treatment, you should read the manufacturers leaflet contained with the medication. This has further information and lists the potential side effects.
Take one capsule three times a day, and space out the doses evenly during the day. Swallow the capsule with water, and you can take Amoxicillin either before, during or after your meals.
Do not take Amoxicillin if you are allergic to Penicillin.
Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then speak with your doctor or pharmacist.
The most common ones for Amoxicillin include:
- feeling sick (nausea) or vomiting
- diarrhoea
- redness and itching in the mouth or vagina (thrush)
- a skin rash
Clarithromycin is used if you have an allergy to penicillins.
Always read the manufacturers leaflet contained with the medication. This contains more information and lists all the potential side effects.
The dose is to be taken twice a day. It is important that you space out the doses evenly during the day. Swallow the tablet with water and you can take it either before or after food.
Keep taking Clarithromycin until the full course is finished (unless a doctor tells you to stop), even if you feel that the infection has cleared up. This is to stop the infection from coming back. If you forget to take a dose, take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.
Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then contact us, or speak with your doctor or pharmacist.
The most common ones (occur in about 1 in 10 people) for Clarithromycin include:
- feeling sick (nausea) or vomiting
- diarrhoea
- redness and itching in the mouth or genital area (thrush)
- tooth or tongue discolouration, and changes in the way things taste or smell. This will settle once you finish treatment
- a headache
It is important that you tell your doctor in your assessment of all the medical conditions you have, and all the medications you take. Failure to do so can lead to problems with any treatment you are prescribed. Always read the patient leaflet before you take any medication.
The following groups of people should not take Clarithromycin:
- those allergic to clarithromycin or macrolide antibiotics
- those with QT prolongation or ventricular cardiac arrhythmia, including torsades de pointe
- those with heart disease
- those with hypokalaemia (low potassium)
- those with problems with the way your liver works
- pregnant women or if breastfeeding
The following medications can interact with Clarithromycin:
- Statin for lowering cholesterol: you should stop your statin while you are taking Clarithromycin.
- Colchicine used for gout: clarithromycin should not be taken if you are also taking colchicine.
- Warfarin: Clarithromycin can increase the bleeding risk
- Ergotamine or dihydroergotamine used for migraines: Clarithromycin must not be taken with them
- Sildenafil, tadalafil or vardenafil: Clarithromycin can increase the levels of the erectile dysfunction (ED) medication in the body. Consider reducing the dose of the ED medication while taking Clarithromycin.
Metronidazole is an antibiotic that may be used to treat a dental infection.
Before you start the treatment, please read the manufacturers leaflet contained with the medication. This has further information and lists the potential side effects.
Take one tablet three times a day, and space out the doses evenly during the day. Swallow the tablet with water, and take them with a meal or snack.
Alcohol
Do not drink alcohol whilst you are taking metronidazole and for 48 hours afterward.
Driving and operating machinery
Metronidazole can cause the potential for drowsiness, dizziness, confusion, hallucinations, convulsions or visual disturbances. Do not to drive or operate machinery if these symptoms occur.
Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then speak with your doctor or pharmacist.
The most common ones for Metronidazole include:
- feeling sick (nausea) or vomiting
- loss of appetite
- changes in the way things taste, furred tongue or a sore mouth
- dark urine. This is nothing to worry about. However, if you also experience abdominal pain, or if you feel sick or feel generally unwell, you should let your doctor know.
The following medications can interact with Metronidazole:
- warfarin
- lithium
If your symptoms worsen or you develop any of the following symptoms, then it is important to seek medical advice urgently. This could be from your GP, Out of Hours Service, Urgent care centre, NHS 111. Call an ambulance or go to A&E if the symptoms are severe.
- If you feel unwell and develop a persistent fever (high temperature) which can cause shivers.
- If the pain becomes worse despite taking regular painkillers.
- If you feel increasingly unwell (this may include nausea and vomiting).
- Having difficulty opening your mouth, swallowing or breathing.
- Having a spreading infection affecting your face.
An itchy rash, swollen face or mouth, or difficulty in breathing, may be signs that you are allergic to the medication.
Please note that i-GP DOES NOT TREAT Medical Emergencies.
If you develop any of the symptoms below then you must STOP the medication immediately and seek urgent medical advice. This could be from your GP, Out of Hours Service, Urgent Care Centre or NHS 111. Call an ambulance or go to A&E if the symptoms are severe.
- Wheeze
- Difficulty in Breathing
- Swelling of the eyelids, face or lips
- A rash particularly if affecting your entire body
Antibiotics should be used responsibly and only when really necessary. Overuse and misuse of antibiotics can lead to antibiotic resistance. This is where the antibiotic becomes less effective at treating certain types of bacterial infection, so they do not work when needed.
Antibiotics should be taken as prescribed, and it is important to complete the full course, this can reduce the chance of the bacteria developing an immunity to that antibiotic. It is important not to share antibiotics, and always take unused medication to your local pharmacy for disposal.
