Overview of Dental Emergencies

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 References Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions: Fractured and avulsed teeth Mandibular dislocation Postextraction... read more ).

For prevention of infective endocarditis Prevention Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. It may cause fever, heart murmurs, petechiae, anemia, embolic... read more , the 2021 American Dental Association guidelines (2 References Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions: Fractured and avulsed teeth Mandibular dislocation Postextraction... read more ), as well as the American Heart Association (3 References Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions: Fractured and avulsed teeth Mandibular dislocation Postextraction... read more ), recommend prophylactic antibiotics in patients undergoing dental procedures only for patients with

For patients with prosthetic joint implants, the American Dental Association 2021guidelines (2 References Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions: Fractured and avulsed teeth Mandibular dislocation Postextraction... read more ) state that prophylactic antibiotics are not typically recommended but may be considered for patients with

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 Bacteremia Bacteremia is the presence of bacteria in the bloodstream. It can occur spontaneously, during certain tissue infections, with use of indwelling genitourinary or IV catheters, or after dental... read more ). 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.