By Lisa Rapaport

(Reuters Health) – In most cases, adults don’t need to take antibiotics for a toothache, according to new guidelines from the American Dental Association (ADA).

Even though patients with toothaches are often prescribed antibiotics to help ease symptoms and prevent worsening of the problem, healthy adults should generally have dental treatment instead of antibiotics, according to the ADA guidance published in the Journal of the American Dental Association.

“Antibiotics should not be used until an infection progresses enough that it can no longer be treated with only dental treatment like a nonsurgical root canal,” said Peter Lockhart, chair of the ADA expert panel that developed the guidelines and a research professor at Carolinas Medical Center – Atrium Health in Charlotte, North Carolina. “Signs and symptoms of this progression include fever, swollen lymph nodes, facial swelling and extreme tiredness.”

These recommendations apply to healthy adults, and are not intended to stop antibiotic use altogether, according to the ADA guidelines. The intent is to minimize overuse and the rise of more antibiotic-resistant infections by limiting antibiotic use to cases when these drugs are absolutely necessary.

Dental pain and swelling are the most common reason that patients go to the emergency room or doctor’s office for oral health problems, according to the ADA. Patients may have occasional sharp pain and a fever, or they might experience constant dull or severe pain.

Dentists and physicians often prescribe antibiotics to relieve dental pain and intraoral swelling. General and specialty dentists are the third highest prescribers of antibiotics in all outpatient settings in the United States, according to the ADA.

Studies have shown that antibiotics, which are designed to stop or slow the growth of bacterial infections, don’t necessarily help patients experiencing a toothache, according to the ADA. In addition, antibiotics can cause serious side effects, and overuse has resulted in bacterial strains that are resistant to antibiotics.

Antibiotics may still make sense when dental treatment isn’t immediately available and the patient has signs and symptoms of an urgent problem like a fever, swollen lymph nodes, or extreme exhaustion, according to the ADA.

But in most cases when adults have a toothache and access to dental treatment, antibiotics may actually do more harm than good, Lockhart said.

“While evidence on the benefits of antibiotics for toothaches is limited, it does show that antibiotics can harm patients,” Lockhart said by email. “Furthermore, we know that dental treatments can treat toothaches with little to no risk to the patient or community.”

Pain from a toothache may be eased by over-the-counter remedies like acetaminophen and ibuprofen, the ADA advises.

“Additionally, the purpose of a dental procedure, like a nonsurgical root canal, is to remove the source of the infection,” Lockhart said. “It is similar to removing a small infected splinter from under the skin, eliminating the need for antibiotics.”

SOURCE: Journal of the American Dental Association, online October 28, 2019.