TREATMENT OF DENTAL INFECTIONS IN PRIMARY CARE- QUICK REFERENCE
GUIDE
Principles of Treatment
1. This guidance is based on the best available evidence but professional judgement
should be used and patients should be involved in the decision.
2. It is important to initiate antibiotics as soon as possible in severe infection.
3. A dose and duration of treatment for adults is usually suggested, but may need
modification for age, weight and renal function. In severe or recurrent cases consider a
larger dose or longer course. Please refer to BNF for further dosing and interaction
information (e.g. interaction between macrolides and statins) if needed and please check
for hypersensitivity
4. Lower threshold for antibiotics in immunocompromised or those with multiple morbidities;
consider culture and seek advice.
5. Prescribe an antibiotic only when there is likely to be a clear clinical benefit.
6. Limit prescribing over the telephone to exceptional cases.
7. Use simple generic antibiotics if possible. Avoid broad spectrum antibiotics (eg coamoxiclav, quinolones and cephalosporins) when narrow spectrum antibiotics remain
effective, as they increase risk of Clostridium difficile, MRSA and resistant UTIs.
8. In pregnancy take specimens to inform treatment; where possible avoid tetracyclines,
aminoglycosides, quinolones, high dose metronidazole (2 g) unless benefit out ways
risks. Short-term use of nitrofurantoin (at term, theoretical risk of neonatal haemolysis) is
not expected to cause foetal problems. Trimethoprim is also unlikely to cause problems
unless poor dietary folate intake or taking another folate antagonist eg antiepileptic.
Where a ‘best guess’ therapy has failed or special circumstances exist, microbiological
advice should be obtained .
DOSES: See BNF for dose recommendations. Use the upper end of dosage range to ensure
adequate treatment and prevent emergence of resistance
Refer to full formulary document for more details and uses in specific clinical situations
CONDITION
NO OF DAYS
TREATMENT
FIRST CHOICE
ADDITIONAL TREATMENT
SECOND
CHOICE. If First
Choice therapy
has failed
Chlorhexidine 0.12-0.2%
Mouth Wash (Do not use within
30 minutes of toothpaste) Rinse
mouth for 1 minute BD with 5 ml
diluted with 5-10 ml water.
Use until lesions
resolve or less pain
allows oral hygiene
Simple saline
mouthwash ½ tsp salt
dissolved in glass warm
water
Acute necrotising
ulcerative gingivitis
3 days
Metronidazole
Chlorhexidine or
hydrogen peroxide
mouthwash if pain limits
oral hygiene
Chlorhexidine or hydrogen
peroxide mouthwash if pain
limits oral hygiene
Pericoronitis
3 days
Amoxicillin
Chlorhexidine or hydrogen
peroxide mouthwash if pain
limits oral hygiene
Up to 5 days review at
3 days
Amoxicillin or
Phenoxymethylpenicillin.
For severe infection add
Metronidazole
Mucosal ulceration
and inflammation
(simple gingivitis)
Dental abscess
(5 days for severe
infection)
Hydrogen peroxide 6% Mouth
Wash Rinse mouth for 2 mins
TDS with 15ml diluted in ½
glass warm water
Metronidazole
Clarithromycin
(for true penicillin
allergy)
Page 1 of 2
DentalinfectionQuickRefGUI201501v3.0FINAL
Key messages
• Use of any antibiotic destroys normal flora, an essential immune defence mechanism.
Keep antibiotic prescribing to the essential minimum
• Check whether the patient is currently taking antibiotics prescribed by another health care
practitioner
• If there is no response to the antibiotic within 48 hours the treatment should be changed, if
possible
• Avoid the use of antibiotics if glandular fever is suspected in the patient
• There is no need to use any cephalosporin or clindamycin in general dental practice. The
potential problems outweigh the benefits. They should, therefore, only be used after careful
consideration in individual patients and following discussion with hospital consultants
• Ensure that the full course of treatment is completed by the patient
Title
Document
reference
Author
Consulted with
Reference:
Dental Infection in Primary Care Quick Reference Guide
DentalinfectionQuickRefGUI201501v3.0FINAL
Approved by
Date approved
Next review date
Mid-Essex Area Prescribing Committee
Jan 2015
Jan 2017
Updated by Natalie Leong, Senior Pharmacist Mid Essex CCG
Dr Louise Teare, Microbiology Consultant, MEHT
Management of infection guidance for primary care for consultation and local
adaptation, Public Health England, October 2014
Mid Essex Primary Care Guidelines,
Previous version
Formulary for the Treatment of Dental
Infections Primary Care, March 2013
Key Changes
Updated according to Public Health England
Guidelines
Document management added
Page 2 of 2
DentalinfectionQuickRefGUI201501v3.0FINAL