Dental Infections

Localized without systemic symptoms:

Antibiotic use is not recommended

Infection with facial swelling but without severe or systemic symptoms:

Amoxicillin 500mg (child 25mg/kg) PO TID

PLUS

Metronidazole 500mg (child 10mg/kg) PO BID

Alternative:

Amoxicillin/Clavulanic acid 500/125mg (child 25/6.25 mg/kg) PO TID

OR

Clindamycin 300mg (child7.5mg/kg) PO TID

Infection with severe features or systemic involvement (including Ludwig angina):

Arrange urgent transfer to hospital.

Benzylpenicillin 3 million IU (1.8g) (if in ICU 4 million IU (2.4g)) (child 80 000 IU (50mg)/kg) IV Q4H

PLUS

Metronidazole 500mg (child 12.5mg/kg) IV BID

Alternative:

If benzylpenicillin is not available replace with:

Ampicillin 2g (child 50mg/kg) IV Q4H

OR

Cefazolin 2g (child 50mg/kg) IV TID

OR

Clindamycin 600mg (child 15mg/kg) IV TID (no need for metronidazole if clindamycin is used)

For infection requiring hospital admission, take blood cultures and send operative specimens for culture.

Severe features include:

• Significant facial swelling and pain
• Neck swelling
• Trismus
• Dysphagia
• Difficulty breathing

Systemic features include:

• Fever >38 degrees C
• Tachycardia
• Pallor
• Diaphoresis

Duration:

Infection with facial swelling but without severe or systemic symptoms: Treat for 5 days

Infection with severe features or systemic involvement (including Ludwig angina): Change to oral antibiotics once improving. Treat until signs and symptoms of infection have resolved (10-14 days).

Infection following dentoalveolar surgery:

Most infections can be managed by dental treatment alone.

If there are systemic features of infection or the patient is immunocompromised treat as ‘Infection with facial swelling but without severe or systemic symptoms’, or ‘Infection with severe features or systemic involvement’, depending on severity.

See Necrotising Soft Tissue Infection in Skin and Soft Tissue Infections.