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Adult Treatment - Dental Infections

Derived from the Scottish Dental Clinical Effectiveness Programme 2011 SDCEP Guidelines. This guidance is not designed to be a definitive guide to oral conditions. It is for GPs for the management of acute oral conditions pending being seen by a dentist or dental specialist.

GPs should not routinely be involved in dental treatment and, if possible, advice should be sought from the patient's dentist, who should have an answer-phone message with details of how to access treatment out-of-hours, or NHS 111 service in England

Mucosal ulceration and inflammation (simple gingivitis)

  • Temporary pain and swelling relief can be attained with saline mouthwash 1 C
  • Use antiseptic mouthwash: If more severe & pain limits oral hygiene to treat or prevent secondary infection. 2-8 C
  • The primary cause for mucosal ulceration or inflammation (aphthous ulcers, oral lichen planus, herpes simplex infection, oral cancer) needs to be evaluated and treated
Medicine Calendar

Simple saline mouthwash 1 C

1⁄2 tsp salt dissolved in glass warm water

Always spit out after use. Use until lesions resolve or less pain allows oral hygiene

Chlorhexidine 0.12-0.2% mouthwash2-6 A+ (Do not use within 30 mins of toothpaste)

Rinse mouth for 1 minute BD with 5 ml diluted with 5-10 ml water

Always spit out after use. Use until lesions resolve or less pain allows oral hygiene

Hydrogen peroxide 6% mouthwash6-8 A- (spit out after use)

Rinse mouth for 2 mins TDS with 15ml diluted in 1⁄2 glass warm water

Always spit out after use. Use until lesions resolve or less pain allows oral hygiene

Dental abscess B

  • 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;1 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.2,3
  • 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, 9 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.6,12 C

If pus, drain by incision, tooth extraction or via root canal. 4-7 B Send pus for microbiology.

If spreading infection (lymph node involvement, or systemic signs ie fever or malaise) ADD metronidazole 8-10 C

True penicillin allergy: use clarithromycin or clindamycin C if severe.

Medicine Calendar

First line:
Amoxicillin 2

500mg2 TDS

Up to 5 days review at 3days11

Or
Phenoxymethylpenicillin 2

500mg2 – 1g QDS

Up to 5 days review at 3days11

True penicillin allergy:
Clarithromycin

500mg BD

Up to 5 days review at 3 days11.

Spreading infection or allergy:
Metronidazole 8-10

400mg TDS

5 days

Acute necrotising ulcerative gingivitisC

Commence metronidazole1-7 and refer to dentist for scaling and oral hygiene adviceC.


Use in combination with antiseptic mouthwash if pain limits oral hygiene

Medicine Calendar

Metronidazole1-7C

400mg TDS

3 days

Chlorhexidine 0.12-0.2% mouthwash2-6 A+ (Do not use within 30 mins of toothpaste)

Rinse mouth for 1 minute BD with 5 ml diluted with 5-10 ml water.

Always spit out after use. Use until oral hygiene possible

OR Hydrogen peroxide 6% mouthwash6-8 A- (spit out after use)

Rinse mouth 2 mins TDS with 15ml diluted in 1/2 glass of warm water

Always spit out after use. Use until oral hygiene possible

Pericoronitis 1B

Refer to dentist for irrigation & debridement 1 C
If persistent swelling or systemic symptoms use
metronidazole. 1-5 A
Use antiseptic mouthwash if pain and trismus
limit oral hygiene

Medicine Calendar

Amoxicillin

500mg 6 TDS

3 days

Metronidazole 1-7 C

400mg TDS

3 days

Chlorhexidine 0.12-0.2% mouthwash2-6 A+ (Do not use within 30 mins of toothpaste)

Rinse mouth for 1 minute BD with 5 ml diluted with 5-10 ml water

Always spit out after use. Use until oral hygiene possible

OR Hydrogen peroxide 6% mouthwash6-8 A- (spit out after use)

Rinse mouth for 2 mins TDS with 15ml diluted in ½ glass warm water

Always spit out after use. Use until oral hygiene possible

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).