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Overview of Dental Emergencies

By

Michael N. Wajdowicz

, DDS, Veterans Administration

Medically Reviewed Oct 2022
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Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions:

Analgesia and treatment of infection

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 ).

Prophylactic antibiotics

  • 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 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

  • 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 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.

References

  • 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

Drugs Mentioned In This Article

Drug Name Select Trade
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
No brand name available
Hysingla ER, Zohydro
Dazidox , Endocodone , ETH-Oxydose, Oxaydo, OXECTA, OxyContin, Oxydose , OxyFast, OxyIR, Percolone, Roxicodone, Roxybond, XTAMPZA
Amoxil, Dispermox, Moxatag, Moxilin , Sumox, Trimox
Azasite, Zithromax, Zithromax Powder, Zithromax Single-Dose , Zithromax Tri-Pak, Zithromax Z-Pak, Zmax, Zmax Pediatric
Cleocin, Cleocin Ovules, Cleocin Pediatric, Cleocin T, CLIN, Clindacin ETZ, Clindacin-P, Clinda-Derm , Clindagel, ClindaMax, ClindaReach, Clindesse, Clindets, Evoclin, PledgaClin, XACIATO
First-Metronidazole 100 , Flagyl, Flagyl ER, Flagyl RTU, MetroCream, MetroGel, MetroGel Vaginal, MetroLotion, Noritate, NUVESSA, Nydamax, Rosadan, Rozex, Vandazole, Vitazol
Biocef, Daxbia , Keflex, Keftab, Panixine
Biaxin, Biaxin XL
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 2x , Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs
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