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Remember to check allergy status

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Paediatric Treatment - Dental Infections

This guidance is not designed to be a definitive guide to oral conditions, as GPs should not be involved in dental treatment. Patients presenting to non-dental primary care services with dental problems should be directed to their regular dentist, or if this is not possible, to the NHS 111 service (in England), who will be able to provide details of how to access emergency dental care. Note: Antibiotics do not cure toothache. First line treatment is with paracetamol and/or ibuprofen; codeine is not effective for toothache.[1D]

Acute necrotising ulcerative gingivitis

Refer to dentist for scaling and hygiene advice.[1D,2D] Antiseptic mouthwash if pain limits oral hygiene.[1D] Commence metronidazole in the presence of systemic signs and symptoms.[1D,2D,3B-,4B+,5A-]

Medicine Calendar

Chlorhexidine 0.12 - 0.2% mouthwash

Rinse with 10ml twice daily for 1 min (do not use within 30mins of toothpaste). Always spit out after use.

Until pain allows for oral hygiene

OR hydrogen peroxide 6% mouthwash

Rinse with 15ml in half a glass of warm water 2-3 times daily for 2-3 mins

Until pain allows for oral hygiene

Metronidazole (oral)

See BNFc

3 days

Mucosal ulceration and inflammation (simple gingivitis)

  • Temporary pain and swelling relief can be attained with saline mouthwash 1D
  • Use antiseptic mouthwash: If more severe 1D & pain limits oral hygiene to treat or prevent secondary infection. 1D2A-
  • The primary cause for mucosal ulceration or inflammation (aphthous ulcers, oral lichen planus, herpes simplex infection, oral cancer) needs to be evaluated and treated 1D
Medicine Calendar

Saline mouthwash

½ tsp salt in warm water, always spit out after use.

Use until lesions resolve OR until pain improves enough to allow for oral hygiene

Chlorhexidine 0.12 - 0.2% mouthwash

Rinse with 10ml twice daily for 1 min (do not use within 30mins of toothpaste). Always spit out after use.

Use until lesions resolve OR until pain improves enough to allow for oral hygiene

Hydrogen peroxide 6% mouthwash

Rinse with 15ml in half a glass of warm water 2-3 times daily for 2-3 minutes. Always spit out after use.

Use until lesions resolve OR until pain improves enough to allow for oral hygiene

Dental abscess

Regular analgesia should be the first option[1A+] until a dentist can be seen for urgent drainage,[1A+,2B-,3A+] as repeated courses of antibiotics for abscesses are not appropriate.[1A+,4A+] Repeated antibiotics alone, without drainage, are ineffective in preventing the spread of infection.[1A+,5C]

Patients with severe odontogenic infections (cellulitis,[1A+,3A+] plus signs of sepsis;[3A+,4A+] difficulty in swallowing;[6D] impending airway obstruction)[6D] should be referred urgently for hospital admission to protect airway,[6D] for surgical drainage[3A+] and for IV antibiotics.[3A+]

Antibiotics are only recommended if there are signs of severe infection,[3A+] systemic symptoms,[1A+,2B-,4A+] or a high risk of complications.[1A+] If pus is present, refer for drainage,[1A+,2B-] tooth extraction,[2B-] or root canal.[2B-] Send pus for investigation.[1A+] If spreading infection1A+[4A+] ADD metronidazole.[6D,7B+]

Use clarithromycin in true penicillin allergy[6D] and, if severe, refer to hospital.[3A+,6D]

The empirical use of cephalosporins,[6D] co-amoxiclav,[6D] clarithromycin,[6D]and clindamycin[6D] do not offer any advantage for most dental patients,[6D] and should only be used if there is no response to first line drugs.[6D]

Medicine Calendar

Amoxicillin

see BNFc

Up to 5 days, review at 3 days

OR phenoxymethylpenicillin

see BNFc

Up to 5 days, review at 3 days

Penicillin allergy: clarithromycin

see BNFc

Up to 5 days, review at 3 days

Metronidazole

see BNFc

Up to 5 days, review at 3 days

Pericoronitis

Refer to dentist for irrigation and debridement.[1D]

If persistent swelling or systemic symptoms,[1D] use metronidazole [1D,2A+,3B+] or amoxicillin.[1D,3B+]

Use antiseptic mouthwash if pain and trismus limit oral hygiene.[1D]

Medicine Calendar

Metronidazole (oral)

See BNFc

3 days

OR amoxicillin (oral)

See BNFc

3 days

Chlorhexidine 0.2% mouthwash

Rinse with 10ml twice daily for 1 min (do not use within 30mins of toothpaste). Always spit out after use.

Until pain allows for oral hygiene

OR hydrogen peroxide 6% mouthwash

Rinse with 15ml in half a glass of warm water 2-3 times daily for 2-3 mins. Always spit out after use.

Until pain allows for oral hygiene

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).