The Best Antibiotics for Tooth Infection: What Anti-Biotics For Dental Infections

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Depending on what infection you have and what type of bacteria is involved in causing that infection, your dentist will prescribe you antibiotics accordingly.


The most popular antibiotic used in dentistry is amoxicillin, followed by Augmentin because of its high efficacy and lower side effects. 

Antibiotics are the drugs that fight against bacterial infection in your mouth that cause you pain and provide systemic signs like fever, lethargy, and malaise.

The rule of thumb in dentistry is to remove the cause or the stimulus to eliminate the pain. Antibiotic coverages are given as a supplemental aid to get rid of the bacterial overcount that has managed to enter the bloodstream from a local site of infection. 

The antibiotics will disrupt the cellular activity within the bacteria, preventing their spread and multiplication. Once the vital processes within the cell of the bacterium are blocked, cell death occurs. 

This comprehensive guide will provide detailed insights into the most effective antibiotics, their potential side effects, and the importance of seeking professional medical advice. Whether you’re dealing with a mild or severe tooth infection, this informative article will help you make informed decisions about your treatment options.

Introduction to Tooth Infections and Antibiotics

What are tooth infections?

Tooth infection is not considered that serious by many especially if it isn’t causing dental pain or symptoms. Lesser do they know tooth infection causes 1 in 150 deaths on average in the US. 

A tooth infection occurs when the bacteria manages to enter the pulp and then into the bone, either through infected dental caries or the pocket around the tooth. If left untreated, these can spread to other parts of the body, causing severe infections and death.

Tooth infection is majorly caused by the dental cavity that progresses involving the tooth nerves. Once the dental cavity progresses beyond the tooth pulp with the action of Streptococcus mutans bacteria, it causes periapical abscess.

It is formed due to the dying tooth nerve that forms the cyst or an abscess at the tips of the root. It may drain into your gums as the sinus or fistula but it must not be confused with periodontal or gum abscess. 

tooth infections

The abscess sometimes needs drainage, and the antibiotic cover is visible in the mouth, but most of the time, the signs and symptoms are reversed after a root canal treatment or the extraction of the tooth. 

How old are antibiotics? 

Infections that are now considered very straightforward to treat, like pneumonia and diarrhea, once caused many human deaths in the world.

The history dates back to the late 19th century when scientists started to notice the antibacterial actions of some chemicals. Penicillin, or amoxicillin, is the most common antibiotic used in dentistry, and it was discovered by Alexander Fleming in 1928.

Can a dental infection kill you? 

Yes, a tooth infection can kill you by causing life-threatening complications. These complications include:

1) Sepsis: a severe body infection characterized by fever, rapid heart rate, difficulty in breathing, and low blood pressure in response to an existing infection in the body. 

2) Ludwig’s angina: a serious infection that involves the floor of your mouth beneath the tongue characterized by pain, swelling, difficulty in breathing, and fever. 

3) Necrotizing fasciitis: it is a soft tissue infection that causes cellular death of the structures beneath your skin. Skin lesions may quickly appear, followed by weakness, fatigue, and fever. 

4) Mediastinitis: it involves your mediastinum, a space between your lungs, impairing your breathing and body ventilation. 

5) Endocarditis: inflammation of the inner lining of the called endocardium. If left untreated may cause stroke, heart failure, or death. 

6) Cavernous sinus thrombosis: cavernous sinus is in your brain. When a blood clot forms in this sinus, it can damage your eyes and brain. 

7) Osteomyelitis: the spread of infection into the bone, leading to bone death.

All these complications can bring a lot of health challenges that can ultimately lead to death; get your abscessed tooth treated immediately to prevent the tooth infection from spreading to the other parts of the body. 

What are the different classes of antibiotics? 

Antibiotics are broadly classified into broad-spectrum and narrow-spectrum antibiotics

Antibiotics that affect many bacteria, like amoxicillin and gentamicin, are called broad-spectrum antibiotics. 

Meanwhile, antibiotics that destroy only a specific class of bacteria, such as penicillin, are called narrow-spectrum antibiotics. 

Antibiotics work in different ways. Some work by destroying the bacterial cell wall, while some disrupt the intracellular machinery that disrupts their overall function.

The Best Antibiotics for Tooth Infections

Best Antibiotics for Tooth Infections

Several antibiotics are used to kill the common bacteria that cause tooth infections. The best antibiotics are the ones known to fight bacteria most commonly found in the mouth.

Your dentist will prescribe you antibiotics after getting a complete allergic history from you. Individuals who are allergic to penicillin are given cephalosporin as an alternative.

Amoxicillin is the first choice because it’s highly effective and has fewer side effects. 

1) Amoxicillin:

It comes with the brand name Amoxil Trimix in oral capsules of 250mg and 500mg. These are penicillins and are used to treat infections like tooth abscesses, tonsillitis, sinusitis, bronchitis, and diseases of the ear, nose, throat, and skin.

Another famous amoxicillin formulation is amoxicillin clavulanate, which comes with the brand name augmentin.

It’s a combination of penicillin and clavulanate potassium that kills bacteria and prevents bacteria from becoming resistant to amoxicillin.

Common amoxicillin side effects include nausea, vomiting, diarrhea, stomach pain, and rash.

2) Penicillin V

Originally produced from penicillium fungi, these are broad-spectrum antibiotics. The brands for these are PC Pen VK and Pen-V.

These are only used if the bacteria is sensitive to Penicillin V and is used in multiple infections, from minor throat infections to rheumatic fever.

The side effects of Penicillin V are diarrhea, fever, chills, bruises, severe skin rash, agitation, headache, or thrush. It shows interaction with methotrexate, a medicine for cancer patients.

3) Cephalexin

Available with the brand name Keflex, Biocef, Zartan is a drug of the cephalosporin class of antibiotics. It is usually given to patients who are allergic to penicillin. These are effective in fighting ear and skin infections and are sometimes used to treat urinary tract infections as well.

The side effects of Cephalexin include severe stomach pain, diarrhea, unusual tiredness, easy bruising, seizure, yellowed skin, fever, and weakness. If you are taking metformin to treat your diabetes, Cephalexin will compete with it in the body while absorption.

4) Clindamycin 

Available with the brand name Cleocin Hcl, Cleocin Phosphate, and ClindaMax belong to the class of lincomycin antibiotics.

These are used to fight severe infections and are provided in the form of salt to the body. Clindamycin hydrochloride salts are usually given orally in tooth infections and phosphate-based Clindamycin is given via IV in severe systemic involvement.

Certain side effects associated with this drug are severe skin rash, swollen glands, flu-like symptoms, muscle aches, severe weakness, and yellowing of eyes and skin. Multivitamins may show interaction with this drug in the body.

5) Azithromycin 


Azithromycin belongs to the class of macrolide antibiotics and is available in the brand names Azasite, Azithromycin 3-Day dose pack, Zithromax, Zmax, and more. These are effective in killing bad bacteria and are also used to treat skin infections, ear infections, and sexually transmitted diseases.

You may suffer from breathing issues or severe skin reactions if you’re allergic to this drug. Common side effects include nausea, diarrhea, and vomiting. Cardiac stimulator digoxin can interfere with azithromycin leading to the retarded absorption of both drugs.

Best Antibiotic For Tooth Infection According to American Dental Association 

Amoxicillin and Augmentin are the drugs of choice in tooth infections because it’s highly effective with fewer gastrointestinal side effects. Different antibiotics are used to provide optimal dental care to the patients. 

ADA recommends oral amoxicillin 500 mg three times a day for 3 to 7 days or oral penicillin 500 mg four times per day for 3 to 7 days if a person is not allergic to penicillin. 

If you have a severe penicillin allergy revealed with symptoms like severe skin reactions drop in blood pressure after penicillin-based antibiotic intake, ADA recommends an alternative.

You will be prescribed either oral azithromycin 500 mg on the first day, followed by 250 mg for the next four days, or oral Clindamycin 300 mg 4 times a day for 3 to 7 days. 

If you’re mildly allergic to penicillin, you will be prescribed oral Cephalexin 500 mg 4 times a day for 3 to 7 days.

With deep neck infections or Ludwig angina, you’ll be prescribed intravenous antibiotics along with pus drainage from the abscess site. 

Choosing the Right Antibiotic for Your Tooth Infection

Opting right antibiotics is crucial to get the desired action and to prevent complications.

Factors to consider when selecting an antibiotic

1) Bacterial susceptibility:

Certain antibiotics target certain bacteria. There are different classes of bacteria, and each class of bacteria is treated with other antibiotics.

Certain antibiotics are sensitive to certain strains of bacteria and are resistant to some. Dentists rely on empirical evidence and clinical trials available to prescribe antibiotics. 

2) Severity of infections: 

Mild infections can be eliminated with a standard dose of antibiotics; however, for severe disease, a combination of IV and oral antibiotic therapy with multiple antibiotics is used.

IV and oral antibiotic therapy

This aims to prevent the spread of infection, which may cause serious complications and death. 

3) Patients Medical and Allergic History: 

At every dental visit, medical and allergic history is obtained to know about the drug interactions and drug allergies. This is to maximize the effect to be obtained with a drug. 

4) Patients Age and Weight: 

The dose of antibiotics depends on the weight and the age of the patient. This has to be decided by the dentist when prescribing any medication. 

5) Pregnancy and Breastfeeding:

Certain antibiotics are contraindicated in pregnancy, like tetracycline, as it cause fetal defects.

Understanding the severity of the infection

The severity of infection is known with a thorough history taking and investigation tools. The dentist will look into your mouth and will do an oral inspection followed by some radiographs or CT scans to know the extent and the severity of the infection.

What is the best way to take antibiotics? 

Follow these steps to use antibiotics most and prevent antibiotic resistance and infection relapse in the long run. 

  1. Take antibiotics only when prescribed by your doctor.
  2. Take them at the right time. Take it as long as your doctor advises you to do so. It is necessary to complete your antibiotic course to prevent antibiotic resistance and prevent infection relapse. 
  3. Don’t keep leftover antibiotic pills with you for later use. Return it to the pharmacy for disposal. 
  4. Don’t share antibiotics. Your type of infection might be different than your friends and siblings.

What are the side effects of antibiotics? 

Just like any other medicine, antibiotics can cause side effects, especially when taking them without a need. Up to 10% of patients face similar antibiotic side effects: 

  1. Stomach problems: Your stomach has a lot of bacteria, too. Taking antibiotics would upset the bacterial count in your stomach and cause problems like diarrhea, nausea, and vomiting. 
  2. Thrush infection: Usually, thrush infection occurs in the mouth and sometimes in the vagina. It appears as white patches that cause pain and itching as well. 
  3. Photosensitivity: Certain antibiotics make the skin more sensitive to sunlight, causing sunburn, discoloration, itching, or dry patches. These side effects are seen with doxycycline and ciprofloxacin prescribed in dentistry.

Threats From Antibiotics 

Antibiotic Resistance

According to the Centers for Disease Control and Prevention. Antibiotic Resistance Report in 2019 says: “Stop referring to a coming post-antibiotic era—it’s already here. You and I are living in a time when some miracle drugs no longer perform miracles, and families are being ripped apart by a microscopic enemy.”

In the US, antibiotic-resistant bacteria infect one individual every 11 seconds and kill someone every 15 minutes in the US. It means 3 million people are infected every year, with 35000 deaths annually. 

Over prescribing of antibiotics is becoming popular in the US, although over-the-counter antibiotics are not sold in the region. 

What are the American Dental Association Guidelines for Antibiotics Use? 

The American Dental Association released new guidelines in 2019 stating that antibiotics will only be prescribed to patients showing signs or symptoms of systemic involvement like fever or swollen lymph nodes. When needed, local infection and pain will only be treated with acetaminophen or ibuprofen.

Antibiotics, when used for target conditions, will provide little benefits and more harm. Targeted conditions like gingivitis and periodontitis result from biofilm-induced inflammation.

The microorganisms of these oral infections live in a complex community and thus resist antibiotics. In such cases, oxidative agents like hydrogen peroxide work well by providing targeted therapy to the affected infectious area. This will also decrease the bacterial load by disrupting the biofilm matrix.

Seeking Professional Medical Advice for Tooth Infections

Importance of consulting a dentist or healthcare professional

Tooth infections warrant proper care and investigation by the dentist to prevent undue complications and death.  The professionals will diagnose the root cause of the disease with diagnostic tools.

The precise diagnosis is essential to provide effective treatment with antibiotics or treatments like root canals or filling. The dentist will look for the factors that exacerbate the infection and will conduct a thorough history to prevent complications.

Proper dosage and duration of antibiotic treatment

Appropriate antibiotic selection, depending on the need is crucial to eliminate the bacterial load in the mouth. The choice will vary depending on past allergies and current medical conditions.

The dose given depends on body weight and previous resistance to certain antibiotics. Completing a full course is necessary to prevent relapse or bacterial resistance.

Alternatives to antibiotics for tooth infections

There are adjunctive therapies that are used in combination with antibiotics to treat the tooth infection.

Root Canal Treatment

These include abscess drainage, root canal treatment, or tooth extraction if needed. Warm salt water rinses reduce inflammation and prevent healing as well.


Q) When should you go to a dentist for a tooth infection? 

A tooth infection doesn’t go away that easily. With its life-threatening complications, it’s better to see your dentist as soon as possible, especially when you witness the following signs and symptoms:

1) Throbbing pain 
2) swollen gums
3) pus discharge from the gums 
4) bad breath
5) metallic taste
6) discoloration of the affected tooth
7) tooth sensitivity
8) fever
9) malaise 
10) swollen lymph nodes
11) headache
12) lethargy 
13) swelling around the face, neck, or eye
14) inability to open mouth
15) trouble speaking and chewing
16) difficulty breathing
17) rapid heart rate

Q) Can home remedies help treat tooth infections? 

Certain home remedies can reduce the symptoms associated with abscesses; however, a definitive treatment can only be provided by a dentist.

You may use acetaminophen or ibuprofen for pain relief. Have a soft diet and chew from the side that’s not affected. Avoiding acidic, spicy, and hard food can lessen the pain on the affected side.

Q) How to prevent tooth infection? 

A tooth infection or a tooth abscess develops over months and years. The key to preventing it is to schedule routine appointments with your dentist regularly, at least twice a year.

Early inspection and diagnosis of caries can keep you safe from the sufferings and risks that come along with tooth infections.

 Other than this, maintaining optimal oral hygiene by brushing twice daily and once daily can help prevent tooth decay.

Maintaining a healthy, balanced diet with less sugar intake can help lower the harmful bacterial count in your mouth.

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