Dental pain and toothache are common problems and can arise from a number of issues including progressive decay, nerve damage or mouth trauma. When tissues around the end of a tooth’s root become inflamed and aren’t treated, they can become infected and lead to acute pain.
So it’s an obvious solution that you should see your dentist as soon as pain occurs, however, should you be prescribed antibiotics for toothaches? Let’s look at some of the debate around the issue.

Do antibiotics actually work for tooth pain?

The simple answer is … there is really no simple answer. Prescribing antibiotics for toothaches is somewhat of a contentious issue, mainly because first and foremost, the recommended treatment for tooth pain is actually intervention. From your dentist’s perspective, it will involve examining the tooth, cleaning the gums, removing dead nerves and associated bacteria, or in some cases a dental extraction or root canal treatment.

From a patient’s perspective, it involves pain control, either with the use of analgesics or other over-the-counter dental treatments that can help relieve some of the symptoms.

Many dentists (and others in the general population in fact) believe that antibiotics should only be prescribed in ‘worst case’ scenarios where severe infection has actually spread further from the tooth itself. But let’s look at why the over-prescribing of antibiotics is an issue in the first place.

Why should we minimise our use of antibiotics?

Many experts believe minimising the inappropriate prescribing of antibiotics plays a key role in limiting the development of antibiotic-resistant bacteria in our society. In basic terms, that means that the misuse and overuse of antibiotics are making bacterial infections harder to treat, so much so that the World Health Organisation has called antibiotic resistance “one of the biggest threats to human health today”.

In 2014, the National Prescribing Service (NPS) launched Antibiotics Awareness Week, a global initiative to ‘help raise awareness of antibiotic resistance and promote the responsible use of antibiotics’. As part of this initiative, the Australian Dental Association (ADA) called on all health professionals and their patients to exercise care in the prescription and use of antibiotics.

The Chair of the ADA’s Oral Health Committee at the time, Dr Peter Alldritt, explained that often medical GPs are at fault as well, as almost 60% of them prescribe antibiotics to meet patient demands or expectations, even though it’s not strictly medically appropriate.

As Dr Alldritt said, “When it comes to oral health, many patients present to GPs looking for antibiotics to address problems such as a toothache. However, the right advice would be to see a dentist”.

He also stressed that “health professionals have a responsibility to ensure that the correct referral pathways are followed to address oral health problems” and that “antibiotics should never be the default response.”

But why exactly is antibiotic overuse so dangerous?

According to experts, there are a variety of reasons:

  • If you have just finished a course of antibiotics and are prescribed another, you may not properly respond to it, which could put you at risk of contracting other severe and untreatable infections.
  • Bacteria build resistance to antibiotics, which can make less harmful bacteria even more harmful as more potent antibiotics are required to eradicate them. In some cases, these types of antibiotics haven’t even been developed yet!
  • Resistance to antibiotics does not only build in people, but also in the community. In our environment, bacteria can be exposed to traces of antibiotics due to leftover drug disposal.

When do dentists still use antibiotics for tooth pain?

There are some circumstances when antibiotics for toothaches are not only effective but necessary. Of course, these depend on individual circumstances, but they can include:

  • Fever and acute, painful teeth or gum infections that cause considerable swelling of the nearby area (that are not just localised to one tooth).
  • Acute, painful infections and tissue swelling around an impacted wisdom tooth, particularly when associated with severe pain and the impairment of normal jaw functioning.
  • Post-operative secondary infections following surgical procedures including the extraction of teeth. These don’t automatically put you at risk of infection, but in a small number of patients, altered healing can lead to an infection of the vulnerable site.
  • Tooth or gum infections that have progressed to the stage where they’ve caused facial cellulitis, which is a swelling of the neck, face and eye area, which sometimes even obstructs the airways. This type of antibiotic treatment would require an immediate referral to an emergency department!

How can I ensure I’m doing the right thing?

It’s important that we’re all vigilant when it comes to our use of antibiotics for dental infections, however, there are a number of things you can do to alleviate the need and/or improper use of them. These include:

  • Visiting your dental professional as soon as possible if you need advice on pain relief for toothaches. Regardless of whether the issue is serious or not, your dentist will be able to quickly assess you and help you resolve it.
  • Try to relieve pain by using over the counter pain relief products first. Antibiotics are not painkillers – even though pain associated with a serious infection can often subside after a round of antibiotics, it’s a slower way to relieve pain.
  • If you are administered antibiotics, follow the advice of your dentist regarding the type, duration and frequency of your treatment.
  • Finish the whole course of antibiotics.
  • Don’t self-medicate. If you have leftover antibiotics in your medicine cabinet, return them to your chemist.
  • Don’t insist on antibiotics. In dentistry, intervention is the only real ‘cure’ for tooth pain. Diagnosing some conditions can take time, but it’s important that you trust your dentist to administer the recommended treatment.

Confused about whether you should be prescribed antibiotics or not? Contact the experts at the Dental Implant & Specialist Centre today on (07) 5503 1744.