With the discovery of
penicillin and entrance into the
antibiotic era, the capability of dentists to treat dental
infections have changed dramatically. Many
antibacterial agents have developed since, but bacterial resistance using diverse mechanisms, have increased concomitantly. Since
antimicrobial agents are frequently needed in dentistry, their judicious use is of prime importance. Dental
infections can be divided to two main groups according to the origin of the
infection. First, odontogenic
infections (acute dento-alveolar
abscess) originating from the dental pulp are most commonly caused by gram-positive anaerobic or facultative bacteria. Systemic
antibiotic should be given concomitantly with drainage of the dento-alveolar
abscess, debridment of the root canal of the infected tooth, and placement of inta-canal antimicrobial medication such as
calcium hydroxide.
Penicillin G,
penicillin V (Rafapen) or
amoxycillin (moxypen) are the first line systemic
antimicrobial agents. In case of no improvement within 2-3 days, second line regimens such as
amoxycillin-
clavulanate (
augmentin),
cefuroxime (
zinnat) or
penicillin and
metronidazole are recommended. In patients allergic to
penicillin, clindamycinn (dalacin) is preferred over
macrolides. The second group of
infections originates from the periodontal apparatus, and is caused usually by gram-negative anaerobes bacilli, sometimes with Actinobacillus actinomycetemcomitance (Aa). Systemic
antibiotics are only infrequently indicated in this situation, and always accompanied by
scaling, root planning and
curettage of the infected root and gingiva. In regenerative or post surgical
periodontitis,
augmentin,
metronidazole or
metronidazole in combination with
penicillin or
amoxycillin augmentin are recommended. In
aggressive periodontitis the most common pathogen is Aa and therefore
tetracycline,
augmentin, or
metronidazole and
amoxicillin are recommended. In
necrotizing ulcerative gingivitis, which is caused usually by fusiform bacilli and spirochetes,
metronidazole or
augmentin are appropriate. In patients with
periodontal disease who are allergic to
penicillin can be treated with a
macrolides.