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Antibiotic Use for the Urgent Management of Dental Pain and Intra-oral Swelling Clinical Practice Guideline (2019)

Pills in a bottleAs part of the ADA's pledged commitment to the U.S. government's Antimicrobial Resistance Challenge, the ADA Center for Evidence-Based Dentistry presents a clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling. The guideline is endorsed by the American College of Emergency Physicians.

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Key Points 

  • The guideline recommends against using antibiotics for most pulpal and periapical conditions and instead recommends only the use of dental treatment and, if needed, over-the-counter pain relievers such as acetaminophen and ibuprofen.
  • Instead of prescribing antibiotics, dentists should prioritize dental treatments such as pulpotomy, pulpectomy, nonsurgical root canal treatment, or incision and drainage for symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess in adult patients who are not severely immunocompromised. 
  • If a patient’s condition progresses to systemic involvement, showing signs of fever or malaise, then dentists should prescribe antibiotics.

Additional Resources

Additional resources promoting the responsible prescription of antibiotics are available via the tabs below, including: 

  • ADA chairside guides
  • Oral Health Topics pages
  • ADA CE Online
  • MouthHealthy pages
  • For the Patient page explaining how to use antibiotics wisely
  • Video explaining why antibiotics aren't always necessary

Get Your Personalized Clinical Recommendation

To find the guideline recommendation that's best for your patient, select the appropriate parameters below and press the "Next" button.


Content on this page is for informational purposes only. It is based on the “Evidence-Based Clinical Practice Guideline on Antibiotic Use for the Urgent Management of Pulpal- and Periapical-Related Dental Pain and Intraoral Swelling,” published in the November 2019 issue of the Journal of the American Dental Association. Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this website.

Clinical practice guidelines include recommendation statements intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.

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