2. Infection that needs a drug — and infection that does not

Source control first

Most acute dental pain is inflammatory (irreversible pulpitis, symptomatic apical periodontitis without spreading infection). The effective treatments are local: pulp extirpation, extraction, incision and drainage, irrigation. Antibiotics do not remove the pulp, and they do not replace a drainage visit you could have provided today.

When antimicrobials are more likely to help

Spreading infection: spreading swelling, cellulitis, extra-oral swelling, floor-of-mouth involvement, trismus that is worsening, systemic upset (fever, malaise), or infection in a severely immunocompromised person where your current guidance supports adjunctive drugs. Even then, arrange drainage or definitive treatment as soon as you can — do not use a prescription as the entire plan.

Review the patient

If you cannot drain today, give clear worsening advice (module 2 and the Sepsis series) and a timed review. “Take these and ring if you remember” is not a plan.

Periodontal and surgical use

Routine scaling, simple extractions in healthy people, and implant placement are not automatic antibiotic indications. Follow current specialty and national guidance for the few situations (for example some medically complex patients) where prophylaxis is considered. Do not copy a hospital protocol you have not read.

Children and pregnancy

Drug choice, dose and who can prescribe are not “half an adult tablet”. Check the BNF and your scope of practice. If you are not the prescriber, do not improvise from the emergency cupboard without the dentist’s instruction and a record.