12. DENTAL INFECTIONS Indication Comment Drug Dose Duration Dental This section of the guidance should only be used for the management of acute oral conditions pending referral to infections dentist. If possible advice should be sought from the patient’s dentist. Mucosal Simple saline mouthwash ½ tsp salt dissolved in Always Temporary pain and swelling relief can be attained with saline mouthwash glass warm water spit out ulceration and Use antiseptic mouthwash if more severe & pain limits oral hygiene. Can also be after inflammation used to or prevent secondary infection. use. (simple Rinse mouth for one The primary for mucosal ulceration or inflammation (aphthous ulcers, oral lichen Chlorhexidine 0.12-0.2% gingivitis) minute BD with 5 ml planus, herpes simplex infection, oral cancer) needs to be evaluated and treated. (Do not use within Use diluted with 5-10 ml 30 mins of toothpaste) until water. lesions resolve or less pain allows oral hygiene Dental Amoxicillin TDS 5 days Regular analgesia should be first option until a dentist can be seen for urgent Or abscess drainage, as repeated courses of antibiotics for abscess are not appropriate. Phenoxymethylpenicillin to 1g QDS 5 days Repeated antibiotics alone, without drainage are ineffective in preventing spread of infection. True penicillin allergy Antibiotics are recommended if there are signs of severe infection, systemic Clarithromycin 500mg BD 5 days symptoms or high risk of complications. Refer urgently for admission severe odontogenic infections such as cellulitis plus Severe Infection or Spreading signs of sepsis, difficulty in swallowing, impending airway obstruction, Ludwigs infection (lymph node angina. involvement or systemic signs i.e. fever or malaise) Add Metronidazole 400mg TDS 5 days
12. DENTAL INFECTIONS Indication Comment Drug Dose Duration Dental infections This section of the guidance should only be used for the management of acute oral conditions pending referral to dentist. If possible advice should be sought from the patient’s dentist. Mucosal ulceration and inflammation (simple gingivitis) Temporary pain and swelling relief can be attained with saline mouthwash Use antiseptic mouthwash if more severe & pain limits oral hygiene. Can also be used to or prevent secondary infection. The primary for mucosal ulceration or inflammation (aphthous ulcers, oral lichen planus, herpes simplex infection, oral cancer) needs to be evaluated and treated. Simple saline mouthwash Chlorhexidine 0.12-0.2% (Do not use within 30 mins of toothpaste) ½ tsp salt dissolved in glass warm water Rinse mouth for one 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 Dental abscess 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. 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. Refer urgently for admission severe odontogenic infections such as cellulitis plus signs of sepsis, difficulty in swallowing, impending airway obstruction, Ludwigs angina. Amoxicillin Or Phenoxymethylpenicillin True penicillin allergy Clarithromycin Severe Infection or Spreading infection (lymph node involvement or systemic signs i.e. fever or malaise) Add Metronidazole TDS to 1g QDS 500mg BD 400mg TDS 5 days 5 days 5 days 5 days
Doncaster-Bassetlaw-Antimicrobials-Guidelines-for-Primary-Care.docx