Merck Manual

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Overview of Dental Emergencies


Michael N. Wajdowicz


Last full review/revision Jun 2019| Content last modified Jun 2019
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Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions:

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 penicillin VK 500 mg orally every 6 hours and clindamycin 300 mg orally every 6 hours.

Prophylactic antibiotics

For prevention of infective endocarditis, 2017 American Heart Association guidelines 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, American Dental Association 2015 guidelines (1) 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 orally 30 to 60 minutes before the procedure. For those who cannot tolerate penicillins, alternatives include clindamycin 600 mg or cephalexin 2 g.

General treatment reference

  • Sollecito TP, Abt E, Lockhart PB, et al: The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners—A report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 146(1):11-16e8, 2015. doi: 10.1016/j.adaj.2014.11.012.

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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