Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions:
Postextraction problems (eg, bleeding, swelling and pain, alveolitis and osteomyelitis, and osteonecrosis of the jaw [ONJ])
Знеболення та лікування інфекції
Oral analgesics effective for most dental problems include acetaminophen 650 to 1000 mg every 6 hours and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400 to 800 mg every 6 hours. Ibuprofen and acetaminophen also can be used together for a brief period, alternating the drugs every 3 hours. For severe pain, these drugs may be combined with opioids such as codeine 60 mg; hydrocodone 5 mg, 7.5 mg, or 10 mg; or oxycodone 5 mg.
Antibiotics for dental infections include amoxicillin 500 mg orally every 8 hours for 3 to 7 days, or penicillin VK 500 mg orally every 6 hours for 3 to 7 days.
In patients who are sensitive or allergic to penicillin or its analogs, azithromycin 250 mg is recommended with an initial loading dose of 500 mg followed by 4 days of 250 mg. Alternatively, clindamycin 300 mg orally every 6 hours for 3 to 7 days may be prescribed. Patients should be monitored for possible resistance to azithromycin and increased risk of Clostridium difficile infection with clindamycin.
Patients who fail to respond to amoxicillin or penicillin can be switched to amoxicillin clavulanate 500/125 mg 3 times a day for 7 days; those with allergy to penicillins can be given metronidazole 500 mg 3 times a day for 7 days along with their initial regimen (1).
Антибіотики з метою профілактики
For prevention of infective endocarditis, the 2021 American Dental Association guidelines (2), as well as the American Heart Association (3), recommend prophylactic antibiotics in patients undergoing dental procedures only for patients with
Prosthetic cardiac valves, including transcatheter-implanted prostheses or with prosthetic material used for valve repair
Previous infective endocarditis
Specific congenital heart diseases
Cardiac transplant recipients with heart valve problems (valvulopathy)
For patients with prosthetic joint implants, the American Dental Association 2021guidelines (2) state that prophylactic antibiotics are not typically recommended but may be considered for patients with
Immunocompromised state
Uncontrolled diabetes
Past joint infection
Recent joint placement
Dental procedures requiring prophylaxis are those that require manipulation or perforation of gingival or oral mucosa or that involve the root end area of the teeth (ie, those most likely to cause bacteremia). The preferred drug is amoxicillin 2 g once orally 30 to 60 minutes before the procedure. For those who cannot tolerate penicillins, alternatives include cephalexin 2 g, azithromycin or clarithromycin 500 mg, or doxycycline 100 mg. All of these alternatives are also given once orally 30 to 60 minutes before the procedure. Clindamycin is no longer recommended for prophylaxis.
Довідкові матеріали
1. Lockhart PB, Tampi MP, Abt E, et al: Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. J Am Dent Assoc 150(11):906-921.e12, 2019. doi: 10.1016/j.adaj.2019.08.020
2. American Dental Association (ADA) Science and Research Institute, LLC: Antibiotic Prophylaxis Prior to Dental Procedures. Accessed September 15, 2022. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/antibiotic-prophylaxis.
3. Wilson WR, Gewitz M, Lockhart PB, et al: Prevention of viridans group streptocococcal infective endocarditis: A scientific statement from the American Heart Association. Circulation 143(20):e963-978, 2021. DOI: 10.1161/CIR.0000000000000969
