October 29, 2019
1 min read

Most toothaches do not require antibiotics, new ADA guideline says

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Antibiotics are not needed for most toothaches, the American Dental Association, or ADA, instructed in a newly published guideline, saying that antibiotics may do more harm than good in these cases.

Previous research has shown that dentists prescribe around 10% of all antibiotics, and that most are unnecessary. Such overprescribing can contribute to antimicrobial resistance, according to experts.

Inappropriate prescribing in dentistry may be overlooked in antimicrobial stewardship efforts, but researchers recently showed how the implementation of a multimodal stewardship intervention at a large academic dental practice resulted in a 73% decline in antibiotic prescribing.

According to a news release, the new ADA guidance is aligned with the group’s “longstanding” efforts in antimicrobial stewardship, as well as its pledged commitment to the U.S. government’s Antimicrobial Resistance Challenge, a year-long campaign to stimulate the fight against resistance.

“Antibiotics are, of course, tremendously important medications," Peter Lockhart, DDS, chair of the ADA guideline expert panel and research professor at Atrium Health’s Carolinas Medical Center, said in the release. "However, it's vital that we use them wisely so that they continue to be effective when absolutely needed."

It is common for patients with toothaches to be prescribed antibiotics, according to the ADA. The new guideline suggested that dental treatment and over-the-counter pain medications (ibuprofen and acetaminophen) are better methods for infection prevention and the management of symptoms associated with toothaches.

Antibiotics should be prescribed if dental treatment is not immediately available, or if a patient presents with a fever, swollen lymph nodes or extreme tiredness, according to the release.

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


ADA. Antibiotic use for the urgent management of dental pain and intra-oral swelling clinical practice guideline (2019). https://ebd.ada.org/en/evidence/guidelines/antibiotics-for-dental-pain-and-swelling?utm_source=adaorg&utm_medium=VanityURL. Accessed October 28, 2019.

CDC. Antibiotic / Antimicrobial Resistance (AR / AMR). https://www.cdc.gov/drugresistance/intl-activities/amr-challenge.html. Accessed October 28, 2019.

Disclosure: Lockhart helped to draft the ADA guideline.