Drug Prescribing For Dentistry

Question 1

Dental Abscess: Local Measures (2)

Answer 1

If pus is present in a dental abscess, drain by extraction of the tooth or through the root canals.
If pus is present in any soft tissue, attempt to drain by incision.

Question 2

Dental Abscess: First Line ABx in Adults (3)

Answer 2

5 day regimen of either:

1. Amoxicillin Capsules, 500mg, TDS.
2. Phenoxymethylpenicillin Tablets, 250mg, 2 tabs QDS.
3. Metronidazole Tablets, 200mg, TDS (must advise pt to avoid alcohol & do NOT prescribe for pts taking warfarin).

Note: Metronidazole can also be used as an adjunct to amoxicillin in pts with spreading infection or pyrexia.

Question 3

Dental Abscess: Second Line ABx in Adults (3)

Answer 3

If pts do not respond to 1st line amoxicillin or metronidazole Tx or in cases of severe infection with spreading cellulitis, an appropriate 5 day regimen of either:

1. Clindamycin Capsules, 150mg, QDS (with water & not to be prescribed to pts with diarrhoeal states).
2. Co-amoxiclav, 250/125 tablets, TDS (250mg amoxicillin and 125mg trihydrate & clavulanic acid (potassium salt)) (do NOT prescibe to pts with history of co-amoxiclav-associated or penicillin-associated jaundice or hepatic dysfunction).

Or 7 Day Regimen of:
3. Clarithromycin tablets, 250mg, 2x/day (NOT for pregnant or nursing mothers or for pts taking warfarin or statins).