Will a tooth abscess go away with antibiotics 

Will a tooth abscess go away with antibiotics 

Tooth abscess is an accumulation of pus below the gums from an untreated tooth infection. It needs immediate treatment to avoid any complications. You can’t treat it at home and need proffessional help to heal it. As it results from the spread of bacterial infection so you may ask if tooth abscess will go away with antibiotics like other infections.

There is no, yes or no answer for it. It is rather complex and involves understanding of the tooth abscess. So, let’s get started;

Tooth abscess – a brief overview 

A tooth abscess is a localized accumulation of pus under the gums. The pus enters the bone surrounding the tooth through a small opening at the terminal end of the (infected) tooth. It then follows the path of least resistance. Often, it perforates the thin bony plate (cortex) and spread under the gums, causing gum or jaw swelling.

Occationally, the pus drains into the mouth through the small opening which appears as a gum boil or pimple. 

In the upper molars, the swelling is usually seen on the outer side of the teeth, whereas in the lower molars, you will see it on the inner side of the jaw. 

For a full article on tooth abscesses and how to manage them at home. Click here. 

What is the treatment of tooth abscess?

The swelling from an abscess is quite painful and requires incision and drainage. The dentist gives an incision or cut on the swelling to allow the pus to drain. This method gives instant pain relief to the patient. Occasionally, a rubber drain is placed in the incision to allow an uninterupted drainage of the pus. 

The source of infection, i.e., an infected tooth, also needs management to remove the cause of pus. For that reason, the tooth is either extracted or treated with a root canal treatment. 

In small or hard swellings, where the pus hasn’t perforated the bone, the tooth is opened and root canals are cleaned and disinfected to allow passage for the pus to release. Moreover, teeth with poor prognosis are extracted. After extraction, the pus heals without any treatment.

In the subsequent appointments, the dentist re-evaluates the swelling, and proceeds with the root canal treatment. The root canal filling is delayed untill complete resolution of the swelling.

Why are antibiotics not given for the treatment of tooth abscesses?

Generally, antibiotics aren’t prescribed for the treatment of tooth abscess. However, tooth abscess reduces or goes away with antibiotics, but they alone are not enough to treat the dental abscess. 

A tooth abscess is a bacterial infection, and therefore, antibiotics relieves the pain, swelling, and associated infection. However, if the infected tooth remains untreated, the infection returns as the antibiotic serum (blood) levels falls with more resistant strains of bacteria. 

Tooth abscess requires incision and drainage of the pus, and root canal treatment to remove the source of infection. The body is capable of healing itself once the infection is removed. Therefore, antibiotic are seldom needed for the localized and uncomplicated tooth abscess in healthy patients. Unnecessary use of antibiotics is avoided in uncomplicated tooth abscess to prevent antibiotic resistance.

When do you need antibiotics for a tooth abscess?

Antibiotics are given for dental abscess in healthy patients if the infection involves deep facial or neck spaces. Involvement of these spaces leads to difficulty in breathing or swallowing, and can be life threatening. Elevated body temperature higher than 100 degrees F is also an indication of widespread infection. This widespread infection is known as cellulitis and requires antibiotic therapy. 

The diagnosis of a dental abscess is made after a thorough oral and x-rays examination. 

Most cases of dental abscesses don’t require antibiotics in healthy individuals. In patients with diabetes or compromised immune systems, antibiotics are given to treat and prevent the further spread of infection in localized abscess.

Which antibiotics are used to treat tooth abscess?

A dental abscess usually doesn’t require hospital admission or antibiotics unless there is a fever, difficulty in breathing or swallowing.

Broad-spectrum antibiotics are given to treat tooth abscess, such as 

  • Amoxicillin Plus metronidazole (Flagyl)
  • Amoxicillin/clavulanate (augmentin)
  • Cephalexin (Dexbia, keflex, keftab, biocef) 
  • Cefazolin (Cefamezin, Cefrina, Elzogra)
  • Clindamycin (Cleocin)

Amoxicillin plus metronidazole

Amoxicillin is considered to be the first-line drug for the treatment of tooth infections because of its low cost and less side effects. However, it causes allergic reactions in 10% of the patients. These reactions include nausea, gastric irritation, diarrhea, and skin reactions. 

Does amoxicillin treat tooth abscess?

Amoxicillin is a narrow-spectrum antibiotic and is only effective against gram-positive bacteria. Therefore, it isn’t given alone to treat dental infections, and metronidazole (Flagyl) is added to the therapy to cover gram-negative bacteria. 

The dosage for amoxicillin is 500 mg every 8 hours or 1000 mg every 12 hrs PLUS metronidazole 500 mg every 8 hours. 

Co-amoxiclav (Amoxicillin with clavulanic acid)

It is a broad-spectrum antibiotic and the second most prescribed antibiotics for dental infections. Co-Amoxiclav kills all the tooth abscesses causing bacteria. 

A dosage of co-amoxiclav is 875/125 mg every 8 hours or 2000/125 mg every 12 hours. 

Co-amoxiclav can cause liver damage and should be given cautiously in patients with liver disease. It can also alter the colonies of normal resident bacteria leading to fungal overgrowth (candidiasis) or clostridium difficile infection in the colon.

Cephalosporin (Cephalexin and cefazolin)

They are the group of antibiotics that stops bacterial cell wall formation. They are effective against all the bacteria that are associated with tooth infection. Cephalexin and cefazolin are the most widely prescribed first-generation cephalosporins.

Cephalexin is prescribed for penicillin-allergic patients with a dosage of 2 gm by mouth 1 hour before the dental procedure. Cepazolin is reserved for patients who can’t take medication by mouth. 1 gm Intravenous or intramuscular cepazolin injection is given 30 mins before the procedure. 

These patients are at a higher risk of fungal infections than augmentin. 


Clindamycin is a broad-spectrum antibiotic. It is a substitude for patients allergic to penicillin and the cephalosporins group of antibiotics. It penetrates bone well. Nearly 75% of all bacteria are sensitive to the drug. The dosage of the drug is 300 mg or 600 mg every 8 hours by mouth.

Duration of antibiotics 

The antibiotics are usually prescribed for 5-7 days. However, for severe infections, you may be given antibiotic therapy for 14 days.

When to report to the emergency room (ER)?

If the abscess spreads to deep facial and neck spaces, it is known as cellulitis and can be life threatening. Call or report to emergency room if you develop the one or more of following symptoms:

  • Fever of 100°F (38°C) or higher and lethargy
  • Swelling or redness gets worse 
  • Difficulty in swallowing and breathing
  • Lymph node enlargement
  • Infection in immunocompromised individuals
  • Difficulty in mouth opening

Frequently asked questions:

What happens to the abscess after tooth extraction?  

If the tooth is severely destroyed and can’t be saved, the dentist extracts the tooth. The empty socket provides passage for the abscess to drain. In healthy individuals, antibiotics are not required to treat the dental abscess. Once the source of infection is removed, the body heals on its own. 

the tooth abscess is still swollen after three days of antibiotics so why is the abscess not responding?

Tooth abscess requires incision and drainage and root canal treatment to heal it. Antibiotics may be given in severe abscess or to quickly resolve the infection, but is seldom given as the only treatement.

The swelling usually shows reduction in size three days after antibiotic therapy. However, it often takes 5-7 days or may be longer to completely go away.

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