Infection following dentoalveolar surgery
Infection following dentoalveolar surgery (eg tooth extraction, implant placement and associated procedures) is uncommon, and its incidence is not reduced by surgical antibiotic prophylaxis. Before diagnosing postoperative dental infection, exclude postsurgical inflammation and alveolar osteitis (dry socket). Signs and symptoms of postoperative dental infection include:
- cellulitis adjacent to the surgical site
- fluctuant surgical site
- purulent discharge from the surgical site
- pain and swelling that is worsening or is not improving 48 hours after surgery.
If postoperative dental infection is associated with severe symptoms (eg significant facial swelling and pain, trismus, swelling of the neck, difficulty swallowing, difficulty breathing), follow the management advice here.
Management of postoperative dental infection not associated with severe symptoms requires:
- draining pus
- addressing the source of infection, including removing residual root or tooth fragments if demonstrated on X-ray
- analgesia and rehydration therapy.
Most postoperative dental infections can be managed by dental treatment alone. However, if the patient is immunocompromised or has systemic features of infection (eg pallor, sweating, tachycardia, axillary temperature above 38°C1), consider using antibiotic therapy in addition to dental treatment. If antibiotic therapy is indicated, use:
1 metronidazole 400 mg (child: 10 mg/kg up to 400 mg) orally, 12-hourly for 5 days odontogenic infection, postoperative metronidazole
PLUS EITHER
1 phenoxymethylpenicillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days odontogenic infection, postoperative phenoxymethylpenicillin
OR
2 amoxicillin 500 mg (child: 15 mg/kg up to 500 mg) orally, 8-hourly for 5 days odontogenic infection, postoperative amoxicillin
OR (as a single preparation)
2 amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly for 5 days. odontogenic infection, postoperative amoxicillin + clavulanate
For patients with hypersensitivity to penicillins, use:
clindamycin 300 mg (child: 7.5 mg/kg up to 300 mg) orally, 8-hourly for 5 days2. odontogenic infection, postoperative clindamycin
Review the patient 48 to 72 hours after starting treatment to check response. Advise the patient to seek prompt dental review if their condition deteriorates or if the infection has not resolved within 5 days.