Dental Trauma or Infection Clinical Pathway, Emergency Department – Antibiotic Recommendations

Dental Trauma or Infection Clinical Pathway — Emergency Department

Antibiotic Recommendations

General Principles

  • Dental (odontogenic) infections result from dental caries or periodontal disease and are generally caused by oral flora.
  • Prompt, definitive dental care is the cornerstone of treatment for dental infections.
  • Large odontogenic infections of the upper jaw can cause periorbital cellulitis, sinusitis, and in extreme cases, meningitis. Large odontogenic infections of the lower jaw can pose risk to obstructing the airway or severe infections such as Ludwig’s angina.
  • Antibiotics are rarely indicated following dental trauma, with the exception of avulsed permanent teeth, due to risk of contamination of the periodontal ligament with resulting inflammation.

Common Pathogens

Polymicrobial

  • Streptococcus spp. (Streptococcus mutans, viridans group streptococci and Streptococcus anginosus group)
  • Anaerobes, Gram-negative (Prevotella spp., Fusobacterium)
  • Anaerobes, Gram-positive (Peptostreptococcus spp., Actinomyces spp.)
Indications First-Line Therapy Allergy to First-Line β-Lactam
Assess Need for Alternative		 Duration of Treatment
Tooth pain with no swelling No antibiotics are indicated
Dental abscess with localized swelling of gingival mucosa and no systemic symptoms
  • Amoxicillin, PO
    • 22.5 mg/kg/dose twice daily
    • Max: 875 mg/dose
  • Clindamycin, PO
    • 10 mg/kg/dose three times daily
    • Max: 600 mg/dose
  • 5-7 days
    • Continue through the time of outpatient dental follow-up
Dental abscess with systemic symptoms (e.g., fever) or facial swelling
  • Amoxicillin, PO
    • 22.5 mg/kg/dose twice daily
    • Max: 875 mg/dose
  • Clindamycin, PO
    • 10 mg/kg/dose three times daily
    • Max: 600 mg/dose
Dental abscess with severe systemic symptoms (e.g., fever, facial swelling) warranting hospitalization
For children with concern for sepsis, refer to: Sepsis, ED, Inpatient, PICU
  • Ampicillin-sulbactam, IV
    • 50 mg/kg/dose of ampicillin component every 6 hours
    • Max: 1 gram of ampicillin component/dose
  • or
  • Amoxicillin/clavulanate, PO
    • 22.5 mg/kg/dose of amoxicillin component twice daily
    • Max: 875 mg/dose of amoxicillin component
  • Clindamycin, IV
    • 10 mg/kg/dose every 8 hours
    • Max: 900 mg/dose
  • or
  • Clindamycin, PO
    • 10 mg/kg/dose three times daily
    • Max: 600 mg/dose
 5-7 days

Please see the CHOP Formulary monograph for complete information.

Antibiotic Recommendations for Dental Trauma

Indications First-Line Therapy Allergy to First-Line β-Lactam
Assess Need for Alternative		 Duration of Treatment
Avulsions, fractures and luxations of primary teeth
  • No systemic antibiotics
  • Use alcohol-free chlorhexidine gluconate 0.12% mouth rinse applied topically twice a day for one week
Fractures and luxations of permanent teeth
Avulsion of permanent teeth
  • Amoxicillin, PO
    • 22.5 mg/kg/dose twice daily
    • Max: 875 mg/dose
  • Clindamycin, PO
    • 10 mg/kg/dose three times daily
    • Max: 600 mg/dose
 7 days
Use alcohol-free chlorhexidine gluconate 0.12% mouth rinse applied topically twice a day for one week

Please see the CHOP Formulary monograph for complete information.