Top 5 Dental Analgesics and Their Indications

Acute dental pain is commonly associated with pulpal inflammation, periapical disease, periodontal procedures, tooth extraction, endodontic treatment, and oral surgery.

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Pharmacological management should be based on the underlying diagnosis, expected pain intensity, patient-specific risk factors, and the anticipated duration of symptoms.

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Current evidence-based guidelines recommend nonopioid analgesics as first-line therapy for acute dental pain, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) alone or combined with acetaminophen. NSAIDs are particularly relevant because inflammatory mediators contribute substantially to postoperative and odontogenic pain.
The following five agents represent commonly encountered options in dental practice: ibuprofen, naproxen, acetaminophen, diclofenac, and ketorolac. Their pharmacological profiles and safety considerations differ considerably.

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1. Ibuprofen
Ibuprofen is one of the most frequently used NSAIDs for acute dental pain. It inhibits cyclooxygenase (COX) enzymes and reduces prostaglandin synthesis, thereby providing both analgesic and anti-inflammatory effects.
For adolescents and adults, the 2024 ADA guideline identifies ibuprofen 400 mg as an appropriate first-line option after tooth extraction. Depending on clinical circumstances, higher therapeutic doses may be used under professional supervision.

Main indications
▪️ Postoperative dental pain
▪️ Simple or surgical tooth extraction
▪️ Endodontic pain
▪️ Acute inflammatory dental pain
▪️ Mild-to-moderate odontogenic pain
Ibuprofen can also be combined with acetaminophen, providing analgesia through complementary mechanisms. Evidence indicates that this combination can provide substantial pain relief without the adverse-effect profile associated with routine opioid use.
Important precautions: NSAIDs should be used cautiously or avoided in patients with significant gastrointestinal disease, renal impairment, certain cardiovascular conditions, NSAID hypersensitivity, or other contraindications.

2. Naproxen
Naproxen, particularly naproxen sodium, is another NSAID used for acute dental pain. Its relatively long duration of action can be clinically useful when sustained analgesia is desirable.
The ADA guideline specifically identifies naproxen sodium 440 mg as a first-line option for acute postoperative dental pain. The guideline lists a maximum daily dose of 1,100 mg of naproxen sodium for the relevant adult/adolescent recommendations.
Clinical trials involving postoperative third-molar pain have demonstrated significant analgesic efficacy with naproxen, with some evidence suggesting a longer duration of pain relief than ibuprofen at commonly used doses.

Main indications
▪️ Moderate acute dental pain
▪️ Post-extraction pain
▪️ Oral surgical procedures
▪️ Inflammatory dental pain
▪️ Situations in which longer analgesic duration is desirable
As with other NSAIDs, gastrointestinal, renal, cardiovascular, bleeding, and hypersensitivity risks should be considered before prescribing.

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3. Acetaminophen (Paracetamol)
Acetaminophen, also known as paracetamol, is an analgesic and antipyretic but has substantially weaker peripheral anti-inflammatory activity than NSAIDs.
Its clinical importance in dentistry is particularly related to its use when NSAIDs are contraindicated and as part of a combination regimen with an NSAID. The ADA guideline recommends acetaminophen alone when NSAIDs cannot be used.

Main indications
▪️ Mild-to-moderate acute dental pain
▪️ Patients with contraindications to NSAIDs
▪️ Combination therapy with ibuprofen or naproxen
▪️ Postoperative dental pain
The 2024 ADA guideline uses acetaminophen 500 mg as an example when combined with an NSAID and identifies 1,000 mg as a full therapeutic dose when acetaminophen is used alone in the relevant clinical context.
The principal safety concern is dose-dependent hepatotoxicity, particularly with excessive cumulative dosing or concurrent use of multiple acetaminophen-containing products. Patients with significant hepatic disease or substantial alcohol exposure require individualized assessment.

4. Diclofenac
Diclofenac is an NSAID with analgesic and anti-inflammatory activity. It has been investigated extensively for postoperative dental pain and may be used in some countries as an alternative to ibuprofen or naproxen.
Clinical research has demonstrated analgesic efficacy of diclofenac following third-molar extraction, including efficacy comparable with acetaminophen in some dosing regimens.

Main indications
▪️ Postoperative dental pain
▪️ Oral surgical procedures
▪️ Acute inflammatory odontogenic pain
▪️ Moderate dental pain when an NSAID is clinically appropriate
Because diclofenac is an NSAID, the same major considerations concerning gastrointestinal, renal, cardiovascular, bleeding, and hypersensitivity risks apply. It should be prescribed at the lowest effective dose for the shortest appropriate duration.

5. Ketorolac
Ketorolac is a potent NSAID generally reserved for short-term management of moderately severe acute pain. Evidence from dental studies supports its analgesic efficacy after third-molar surgery and following endodontic treatment. Recent systematic reviews have also reported beneficial effects in post-endodontic pain.
However, ketorolac has a more restrictive safety profile than commonly used NSAIDs. In the United States, the oral formulation is indicated only as continuation therapy following IV or IM ketorolac and the total duration of ketorolac therapy must not exceed 5 days.

Main indications
▪️ Short-term management of moderately severe acute pain
▪️ Selected postoperative oral surgical pain
▪️ Selected post-endodontic pain
Ketorolac should not be considered a routine first-line analgesic for uncomplicated dental pain. Its gastrointestinal and renal risks require careful patient selection, and it is contraindicated in several high-risk clinical situations.

✅ Comparison of the Top 5 Dental Analgesics

Analgesic	Class	Common Dental Indications	Key Clinical Consideration
Ibuprofen	NSAID	Acute inflammatory and postoperative dental pain	Common first-line option; can be combined with acetaminophen
Naproxen	NSAID	Moderate postoperative and inflammatory dental pain	Longer duration of action than ibuprofen in some clinical studies
Acetaminophen	Non-NSAID analgesic	Mild-to-moderate pain; NSAID contraindications	Monitor cumulative dose and hepatic risk
Diclofenac	NSAID	Postoperative and inflammatory dental pain	Consider gastrointestinal, renal, cardiovascular, and bleeding risks
Ketorolac	NSAID	Selected short-term moderate-to-severe acute pain	Restricted duration and greater safety concerns; not routine first-line therapy

✅ How Should the Analgesic Be Selected?
Analgesic selection should not depend exclusively on pain intensity. The clinician should consider the inflammatory component of the pain, expected duration, medical history, concomitant medications, renal and hepatic function, gastrointestinal risk, cardiovascular status, and previous adverse reactions.
For most adolescents and adults with acute dental pain, an NSAID such as ibuprofen or naproxen is an appropriate starting point when no contraindication exists. Combining an NSAID with acetaminophen can provide complementary analgesia and is supported by the current evidence base.
Importantly, analgesics should serve as an adjunct to definitive dental treatment, rather than replacing treatment of the underlying cause. For pulpal and periapical disease, definitive procedures such as pulpectomy, root canal treatment, drainage, or extraction may be necessary depending on the diagnosis.

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🎯 Clinical Recommendations
This section is more appropriate than Clinical Pearls because the topic is fundamentally pharmacological and requires direct clinical application of current evidence.
▪️ Use NSAIDs as first-line pharmacological therapy for most acute dental pain when no contraindication exists.
▪️ Consider ibuprofen or naproxen, alone or with acetaminophen, according to the expected pain level and patient-specific risk profile.
▪️ Use acetaminophen alone when NSAIDs are contraindicated, while carefully assessing hepatic risk and total daily exposure.
▪️ Reserve ketorolac for selected short-term situations because of its more restrictive safety profile and duration limitations.
▪️ Do not prescribe multiple NSAIDs concurrently; combining agents from the same NSAID class increases toxicity without providing an established therapeutic advantage.
▪️ Reassess persistent or worsening pain rather than simply escalating analgesic therapy, particularly when symptoms persist after extraction or when definitive treatment has not been completed.

💬 Discussion
The current evidence has shifted dental pain management toward nonopioid analgesia, particularly NSAIDs with or without acetaminophen. The 2024 ADA-endorsed guideline concluded that nonopioid medications provide a more favorable balance of benefits and harms than opioids for acute dental pain.
Among the agents discussed, ibuprofen and naproxen have particularly strong clinical relevance for routine acute dental pain, while acetaminophen provides an important alternative when NSAIDs cannot be used and an effective component of combination therapy. Diclofenac remains a useful NSAID in appropriate settings, whereas ketorolac requires more restrictive patient selection because of its adverse-effect profile and regulatory limitations.
Analgesic therapy should therefore be individualized rather than based on a fixed hierarchy of medications. The lowest effective dose for the shortest clinically appropriate duration remains a central principle of safe pharmacological management.

✍️ Conclusion
Dental analgesics are an important component of managing acute odontogenic and postoperative pain, but their selection should be guided by diagnosis, expected pain severity, contraindications, and patient-specific risk factors.
Current evidence supports NSAIDs as first-line therapy, with ibuprofen and naproxen representing common options. Acetaminophen is particularly useful when NSAIDs are contraindicated and as part of combination therapy. Diclofenac may be considered in selected patients, whereas ketorolac should be restricted to appropriate short-term indications.
Effective pain control ultimately depends on combining rational pharmacotherapy with timely definitive dental treatment, rather than relying on analgesics alone.

📚 References

✔ American Dental Association. (2024). Oral analgesics for acute dental pain. American Dental Association.
✔ Carrasco-Labra, A., Polk, D. E., Urquhart, O., Aghaloo, T., Claytor, J. W., Jr., Dhar, V., Dionne, R. A., Espinoza, L., Gordon, S. M., Hersh, E. V., Law, A. S., Li, B. S.-K., Schwartz, P. J., Suda, K. J., Turturro, M. A., Wright, M. L., Dawson, T., Miroshnychenko, A., Pahlke, S., ... Moore, P. A. (2024). Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults. The Journal of the American Dental Association, 155(2), 102–117.e9. https://doi.org/10.1016/j.adaj.2023.10.009
✔ Moore, P. A., & Hersh, E. V. (2013). Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: Translating clinical research to dental practice. The Journal of the American Dental Association, 144(8), 898–908. https://doi.org/10.14219/jada.archive.2013.0207
✔ Kiersch, T. A., Halladay, S. C., & Koschik, M. (1993). A double-blind, randomized study of naproxen sodium, ibuprofen, and placebo in postoperative dental pain. Clinical Therapeutics, 15(5), 845–854.
✔ Cooper, S. A., Desjardins, P., Brain, P., Paredes-Diaz, A., Troullos, E., Centofanti, R., & An, B. (2019). Longer analgesic effect with naproxen sodium than ibuprofen in post-surgical dental pain: A randomized, double-blind, placebo-controlled, single-dose trial. Current Medical Research and Opinion, 35(12), 2149–2158. https://doi.org/10.1080/03007995.2019.1655257
✔ Kiersch, T. A., Halladay, S. C., & Hormel, P. C. (1994). A single-dose, double-blind comparison of naproxen sodium, acetaminophen, and placebo in postoperative dental pain. Clinical Therapeutics, 16(3), 394–404.
✔ Green, V. G., Polk, D. E., Turturro, M. A., Moore, P. A., & Carrasco-Labra, A. (2025). Evidence-based clinical practice guidelines for the management of acute dental pain. American Journal of Emergency Medicine, 89, 247–253. https://doi.org/10.1016/j.ajem.2024.12.054
✔ Ping, R., Kang, X., Fang, R., Wang, H., & Wu, L.-A. (2026). The effectiveness of ketorolac in relieving pain associated with root canal therapy: A systematic review and meta-analysis. Clinical and Experimental Dental Research, 12(2), e70295. https://doi.org/10.1002/cre2.70295
✔ U.S. National Library of Medicine. (2026). Ketorolac tromethamine tablets, USP: Prescribing information. DailyMed.

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Acute vs Chronic Odontogenic Infections in Children

Odontogenic infections in children most commonly originate from dental caries, pulpal necrosis, trauma, or periodontal disease. Their clinical behavior ranges from a localized process with minimal systemic involvement to rapidly progressive facial cellulitis or deep-space infection.

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For the pediatric dentist, distinguishing an acute odontogenic infection from a chronic odontogenic infection is clinically important because the presentation, urgency, risk of dissemination, and treatment strategy may differ.

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Importantly, the apparent absence of pain does not necessarily indicate resolution: chronic infections may drain through a sinus tract and remain associated with a necrotic tooth.
Current pediatric guidance emphasizes that treatment should primarily address the source of infection, while systemic antibiotics are reserved for appropriately selected cases rather than used routinely for localized dental disease.

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✅ Acute vs Chronic Odontogenic Infections
An acute infection generally develops over a relatively short period and may produce pain, swelling, tenderness, fever, malaise, or rapidly progressive facial inflammation. A chronic infection may persist for weeks or longer and can present with intermittent symptoms, a draining sinus tract, localized swelling, or radiographic evidence of periapical or furcation pathology.

Feature	Acute Odontogenic Infection	Chronic Odontogenic Infection
Onset	Rapid	Gradual or prolonged
Pain	Frequently present	May be absent or intermittent
Swelling	Often prominent	Usually localized or intermittent
Drainage	May be absent initially	Sinus tract or spontaneous drainage may occur
Systemic signs	Possible fever, malaise, or lymphadenopathy	Usually absent unless acute exacerbation occurs
Typical dental source	Acute pulpal or periapical infection	Persistent necrotic pulp or chronic periapical/furcation infection
Primary concern	Rapid local or systemic spread	Persistent infection and possible acute exacerbation
Main treatment principle	Prompt source control ± antibiotics when indicated	Definitive elimination of the dental source

The distinction should not be based solely on symptom duration. Clinical examination, dental history, radiographic findings, and assessment of systemic involvement are required to establish the diagnosis.

✅ Clinical Assessment
The evaluation should establish both the odontogenic source and the severity of infection.

Important findings include:
▪️ Pain: spontaneous versus provoked, intensity, duration, and progression.
▪️ Soft-tissue swelling: localized versus diffuse.
▪️ Sinus tract: particularly important in chronic infection.
▪️ Tooth mobility: excessive mobility unrelated to normal exfoliation or trauma may indicate pulpal necrosis or infection.
▪️ Percussion and palpation: useful when clinically obtainable.
▪️ Lymphadenopathy: may indicate regional inflammatory involvement.
▪️ Fever and malaise: suggest systemic involvement.
▪️ Trismus, dysphagia, or respiratory difficulty: potential indicators of extension into deeper spaces and require urgent escalation.
▪️ Radiographic findings: furcation/periapical radiolucency, pathologic root resorption, or other evidence of infection.
In primary and immature permanent teeth, conventional thermal and electric pulp tests can be unreliable; diagnosis therefore requires integration of history, clinical findings, and radiographic assessment.

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✅ Acute Odontogenic Infections: Clinical Approach
Acute infections may range from a localized abscess to facial cellulitis.
When infection is localized and there are no systemic signs or evidence of spreading infection, definitive dental treatment is the central intervention. Depending on the tooth and prognosis, this may include appropriate pulp therapy or extraction.
AAPD guidance identifies acute facial swelling of dental origin as a condition requiring particular attention because infection can progress beyond the local tissues.

When Antibiotics May Be Appropriate
Systemic antibiotics should generally be considered when there is evidence of:

▪️ Facial cellulitis or progressive diffuse swelling
▪️ Fever or other systemic manifestations
▪️ Regional lymphadenopathy associated with spreading infection
▪️ Significant extraoral involvement
▪️ Deep-space infection or risk of rapid progression
▪️ Situations in which definitive source control cannot immediately be achieved and systemic involvement is present
Antibiotics are adjunctive therapy, not a substitute for treatment of the infected tooth. Contemporary pediatric recommendations emphasize antimicrobial stewardship and avoidance of routine antibiotics for localized dental conditions without systemic involvement.

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✅ Chronic Odontogenic Infections in Children
Chronic infection may be clinically subtle. A sinus tract, recurrent localized swelling, or an asymptomatic radiolucency may represent an ongoing odontogenic infection.
A draining sinus tract should not be interpreted as resolution. Instead, it frequently represents a pathway through which purulent material is being decompressed while the underlying dental source persists. Chronic odontogenic sinus tracts in children have been associated with prolonged infection from caries or trauma and may occasionally present extraorally.
For a primary tooth with irreversible pulpitis or necrotic pulp, current AAPD guidance supports nonvital pulp treatment when the tooth is restorable and clinically appropriate. Pulpectomy and lesion sterilization/tissue repair are among the available approaches, with treatment selection influenced by root resorption, restorability, prognosis, and the child's developmental needs.
When the infectious process cannot be predictably controlled, the tooth is unrestorable, or there is extensive pathological root resorption, extraction should be considered.

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✅ Antibiotics: What the Pediatric Dentist Should Remember
One of the most important distinctions is between infection requiring dental treatment and infection requiring systemic antimicrobial therapy.
A systematic review specifically evaluating antibiotics for odontogenic abscesses in children with primary teeth found insufficient clinical evidence to establish benefit in localized abscesses without systemic involvement.
The current AAPD recommendations similarly emphasize that antibiotics should be prescribed selectively and that antimicrobial stewardship is essential because unnecessary exposure contributes to adverse effects and antimicrobial resistance.

Therefore:
Localized dental infection → prioritize definitive dental treatment.
Spreading/systemic infection → definitive dental treatment + appropriately selected systemic antibiotic therapy when indicated.

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✅ Red Flags Requiring Urgent Escalation
The following findings should prompt urgent referral or hospital-based assessment, depending on severity:

▪️ Rapidly progressive facial or cervical swelling
▪️ Difficulty breathing
▪️ Dysphagia or inability to swallow secretions
▪️ Significant trismus
▪️ Floor-of-mouth elevation
▪️ Toxic appearance or marked systemic illness
▪️ Orbital involvement
▪️ Suspected deep neck-space infection
▪️ Failure to respond to appropriate initial management
Pediatric odontogenic facial cellulitis can rarely become life-threatening. Recent multidisciplinary literature emphasizes source control, appropriate antimicrobial therapy, and hospital management for severe or complicated cases.
Imaging is particularly useful when there is concern for deep-space involvement, abscess formation, or complications that cannot be adequately evaluated clinically.

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💬 Discussion
The distinction between acute and chronic odontogenic infection is clinically useful, but these categories should not be regarded as completely separate disease entities. A chronic infection may undergo an acute exacerbation, producing sudden pain and swelling in a previously asymptomatic tooth.
The principal clinical issue is therefore not simply the duration of symptoms but the relationship between pulpal status, local tissue involvement, systemic response, and potential anatomical spread.
The evidence consistently supports source control as the foundation of treatment. Antibiotics cannot reliably eradicate a persistent odontogenic focus when the infected tooth remains untreated. This principle is particularly relevant in children, in whom inappropriate antibiotic prescribing can expose patients to adverse effects without addressing the underlying dental pathology.
Another important consideration is that the evidence base specifically addressing antibiotic treatment of odontogenic abscesses in children remains limited. Consequently, antibiotic decisions should be based on the clinical severity of infection, systemic involvement, patient-specific factors, and contemporary pediatric antimicrobial guidance rather than on the mere presence of pus or a dental abscess.

✍️ Conclusion
Acute and chronic odontogenic infections in children require different levels of clinical vigilance, but both demand identification and elimination of the dental source.
Acute infections require careful assessment for rapid progression, facial cellulitis, and systemic involvement, whereas chronic infections may be deceptively asymptomatic and frequently present through sinus drainage or radiographic changes.
For both presentations, definitive dental treatment remains the cornerstone of management. Systemic antibiotics should be reserved for cases in which clinical findings indicate systemic involvement, spreading infection, or other appropriate indications. Early recognition of red flags and timely escalation are essential to prevent severe complications.

🎯 Clinical Recommendations
1. Determine the pulpal and periapical diagnosis before prescribing antibiotics.
2. Treat the dental source as soon as clinically feasible rather than relying on antimicrobial therapy alone.
3. Consider systemic antibiotics primarily when infection is spreading or systemic signs are present.
4. Do not interpret a draining sinus tract as resolution of the underlying infection.
5. Assess restorability, root resorption, tooth value, and developmental considerations when selecting pulp therapy versus extraction.
6. Escalate urgently when airway compromise, dysphagia, significant trismus, rapidly progressive swelling, or deep-space involvement is suspected.
7. Document clinical findings, diagnosis, treatment, antibiotic indication when applicable, and follow-up.
These recommendations are consistent with current AAPD guidance emphasizing individualized diagnosis, definitive source control, and antimicrobial stewardship.

📚 References

✔ American Academy of Pediatric Dentistry. (2026). Use of antibiotic therapy for pediatric dental patients. In The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry.
✔ American Academy of Pediatric Dentistry. (2026). Pulp therapy for primary and immature permanent teeth: Indications and objectives. In The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry.
✔ American Academy of Pediatric Dentistry. (2020). Use of non-vital pulp therapies in primary teeth. Pediatric Dentistry, 42(5), 337–349.
✔ Clarke, R. (2023). Pediatric odontogenic and paranasal sinus infections. Neuroimaging Clinics of North America, 33(4), 673–684. https://doi.org/10.1016/j.nic.2023.05.014
✔ Coll, J. A., Dhar, V., Chen, C.-Y., et al. (2024). Use of vital pulp therapies in primary teeth 2024. Pediatric Dentistry, 46(1), 13–26.
✔ Welti, R., et al. (2025). Pediatric odontogenic facial cellulitis: A comprehensive review for multidisciplinary management. Journal of the Pediatric Infectious Diseases Society. https://doi.org/10.1093/jpids/piaf108
✔ Wong, A., et al. (2021). Are systemic antibiotics indicated in children presenting with an odontogenic abscess in the primary dentition? A systematic review of the literature. International Journal of Paediatric Dentistry.

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Dental Antibiotics: First-Line vs Alternative Options

The appropriate selection of dental antibiotics requires more than identifying a familiar antimicrobial agent. Current evidence emphasizes antibiotic stewardship, source control, accurate diagnosis, and the use of the narrowest effective antibiotic when systemic therapy is indicated.

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For most localized pulpal and periapical conditions in immunocompetent adults, definitive dental treatment remains the primary intervention. Antibiotics should generally be reserved for infections with systemic involvement, spreading infection, or selected situations in which immediate definitive treatment is not feasible.

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When antibiotics are indicated, first-line agents should generally be preferred over broader-spectrum alternatives. The choice of an alternative depends on treatment response, allergy history, infection severity, drug interactions, and local prescribing recommendations.

✅ When Are Dental Antibiotics Indicated?
Antibiotics are not routinely indicated for conditions such as symptomatic irreversible pulpitis or symptomatic apical periodontitis without evidence of spreading infection or systemic involvement. Appropriate treatment should instead focus on pulpotomy, pulpectomy, root canal treatment, drainage, or extraction when indicated.

Systemic antibiotic therapy may be considered when there is:
▪️ Fever or malaise
▪️ Spreading infection or cellulitis
▪️ Progressive swelling
▪️ Systemic involvement associated with an odontogenic infection
▪️ A significant risk of progression in a patient for whom definitive dental treatment is temporarily unavailable
Antibiotics should not substitute for source control. Definitive dental treatment should be arranged as soon as possible.

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✅ First-Line Dental Antibiotics
For an adult patient in whom systemic antibiotic therapy is clinically indicated, amoxicillin is a commonly preferred first-line option. The ADA guideline also identifies penicillin V potassium as a first-line agent, while noting advantages of amoxicillin related to spectrum and gastrointestinal tolerability.

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✅ Common First-Line Options

Antibiotic	Typical Adult Regimen*	Clinical Role
Amoxicillin	500 mg every 8 hours	Preferred first-line option when a penicillin antibiotic is appropriate
Penicillin V	500 mg every 6 hours	Narrow-spectrum first-line alternative to amoxicillin

*Regimens shown are examples from the ADA guideline for immunocompetent adults in specific urgent pulpal/periapical scenarios. Patient-specific prescribing must consider current local guidelines, renal function, allergies, interactions, pregnancy, infection severity, and clinical diagnosis. The ADA guideline recommends reassessment within approximately 3 days and discontinuation 24 hours after symptom resolution.

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✅ Alternative Dental Antibiotics
Alternative antibiotics should not automatically be interpreted as stronger antibiotics. They are generally selected because of penicillin allergy, inadequate clinical response, or specific microbiological considerations.

1. Cephalexin
Cephalexin may be considered in selected patients reporting penicillin allergy when there is no history of immediate severe hypersensitivity such as anaphylaxis, angioedema, or urticaria. The ADA guideline lists cephalexin as an alternative in this clinical context.
Cephalosporins should be avoided or carefully evaluated in patients with a history of severe immediate reactions to penicillins.

2. Azithromycin
Azithromycin is an alternative for patients with a history of severe immediate penicillin hypersensitivity when an appropriate systemic antibiotic is required. The ADA guideline includes a loading dose of 500 mg followed by 250 mg daily for four additional days.
Its use should remain selective because antimicrobial resistance patterns and patient-specific factors must be considered.

3. Metronidazole
Metronidazole provides strong activity against anaerobic bacteria and may be used as an adjunct to a penicillin when the initial response is inadequate or when additional anaerobic coverage is clinically appropriate.
It can also be used as an alternative in certain penicillin-allergic patients according to UK dental prescribing guidance. However, prescribing recommendations vary by jurisdiction.

4. Amoxicillin-Clavulanate
Amoxicillin-clavulanate is generally not required as the initial antibiotic for routine odontogenic infections. It may be considered when appropriate first-line therapy fails and the clinical diagnosis, adherence, and source control have been reassessed.
The ADA chairside guideline identifies amoxicillin-clavulanate as an option after failure of first-line therapy rather than as the routine initial choice.

5. Clindamycin: Why Its Role Has Changed
Although older dental guidelines included clindamycin as an alternative for patients with severe penicillin allergy, contemporary stewardship recommendations have moved away from routine use.
Clindamycin has a comparatively high risk of Clostridioides difficile infection and other serious adverse effects. A 2024 Therapeutics Letter specifically recommends avoiding clindamycin for initial treatment and prophylaxis of dental infections when safer alternatives are available.
The 2026 ADA stewardship statement further reinforces the need to minimize unnecessary antibiotic exposure and select agents according to evidence-based indications.

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✅ First-Line vs Alternative Antibiotics: Practical Comparison

Clinical Situation	Preferred Approach	Potential Alternative
Antibiotic indicated; no penicillin allergy	Amoxicillin	Penicillin V
Reported penicillin allergy without severe immediate reaction	Evaluate allergy history carefully	Cephalexin may be appropriate in selected patients
Severe immediate penicillin allergy	Avoid penicillin-class therapy	Azithromycin or another guideline-supported alternative
Inadequate response to first-line therapy	Reassess diagnosis, adherence, and source control	Metronidazole adjunct or amoxicillin-clavulanate when indicated
Routine initial treatment	Use the narrowest appropriate agent	Avoid routine clindamycin

✅ How Should Treatment Failure Be Managed?
Failure to improve should not automatically lead to a broader antibiotic. The clinician should first reassess:

1. The diagnosis
2. Adequacy of drainage or other source control
3. Patient adherence
4. Allergy history and drug interactions
5. Development of spreading or systemic infection
6. The need for endodontic, periodontal, surgical, or hospital-based management
The ADA recommends reassessment at approximately 3 days when antibiotics are prescribed for the relevant urgent dental conditions. If the condition worsens or there is concern for a deep-space infection or threat to life, urgent medical evaluation is required.

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Dental Article 🔽 Antibiotics in Pediatric Dentistry: When They Are Needed and When They Are Not ... This guide reviews indications, contraindications, dosing considerations, and clinical decision-making for antibiotics in pediatric patients, with updated evidence-based recommendations.

✅ Antibiotic Stewardship in Dentistry
The 2026 ADA clinical practice statement emphasizes that appropriate prescribing means using antibiotics only when clinically indicated, selecting an appropriate agent, dose, and duration, and integrating antimicrobial stewardship into routine dental practice.
A broad-spectrum antibiotic should not be selected simply because it appears more powerful. Unnecessary exposure increases the risk of adverse drug reactions, microbiome disruption, Clostridioides difficile infection, and antimicrobial resistance.

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💬 Discussion
The distinction between first-line and alternative dental antibiotics is increasingly important because contemporary dental antibiotic prescribing is moving toward a more conservative, evidence-based approach.
Amoxicillin remains a major first-line option when systemic therapy is genuinely indicated, while penicillin V remains a narrow-spectrum alternative. Alternative agents should be selected according to specific clinical circumstances rather than prescribed routinely.
Importantly, antibiotic selection cannot compensate for inadequate source control. Drainage and definitive dental treatment remain fundamental components of managing odontogenic infection. The increasing concern regarding clindamycin-associated adverse events also demonstrates why older prescribing habits should be periodically reassessed against current safety evidence.
The most appropriate antibiotic is therefore not necessarily the broadest-spectrum agent, but the narrowest effective treatment for the correct clinical indication.

✍️ Conclusion
Dental antibiotics should be prescribed selectively and strategically. For patients who genuinely require systemic therapy, amoxicillin or penicillin V are established first-line options in relevant odontogenic infections. Cephalexin, azithromycin, metronidazole, or amoxicillin-clavulanate may have specific roles depending on allergy status, treatment response, and clinical circumstances.
The contemporary approach prioritizes definitive dental treatment, appropriate antibiotic selection, short effective therapy, reassessment, and antimicrobial stewardship. Routine use of broad-spectrum agents or clindamycin should be avoided when safer, evidence-supported alternatives are available.

🎯 Clinical Recommendations
▪️ Confirm that an antibiotic is actually indicated before prescribing.
▪️ Prioritize source control and definitive dental treatment rather than antibiotic therapy alone.
▪️ Use amoxicillin or penicillin V as first-line options when systemic therapy is indicated and there is no relevant penicillin allergy.
▪️ Obtain a precise history of the type and severity of antibiotic allergy before selecting an alternative.
▪️ Reserve broader-spectrum therapy for specific clinical circumstances, particularly after reassessment of treatment failure.
▪️ Avoid routine clindamycin use because of its unfavorable safety profile.
▪️ Reassess patients receiving antibiotics and modify therapy when the diagnosis, response, or source-control strategy warrants it.
▪️ Follow current local and national prescribing guidelines for dose, duration, contraindications, interactions, pregnancy, pediatric patients, and medically complex patients.

📚 References

✔ American Dental Association Council on Scientific Affairs. (2026). Antibiotic stewardship: Balancing patient care and public health: American Dental Association Council on Scientific Affairs clinical practice statement. Journal of the American Dental Association. Advance online publication. https://doi.org/10.1016/j.adaj.2026.07.013
✔ Lockhart, P. B., Tampi, M. P., Abt, E., Aminoshariae, A., Durkin, M. J., Fouad, A. F., Gopal, P., Hatten, B. W., Kennedy, E., Lang, M. S., Patton, L. L., Paumier, T., Suda, K. J., Pilcher, L., Urquhart, O., O'Brien, K. K., & Carrasco-Labra, A. (2019). Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. Journal of the American Dental Association, 150(11), 906–921.e12. https://doi.org/10.1016/j.adaj.2019.08.020
✔ Perry, T. (2024). Rethink clindamycin for dental patient safety. Therapeutics Initiative, University of British Columbia. https://www.ncbi.nlm.nih.gov/books/NBK608182/
✔ Tampi, M. P., Pilcher, L., Urquhart, O., Kennedy, E., O'Brien, K. K., Lockhart, P. B., Abt, E., Aminoshariae, A., Durkin, M. J., Fouad, A. F., Gopal, P., Hatten, B. W., Lang, M. S., Patton, L. L., & Paumier, T. (2019). Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: Systematic review and meta-analysis—A report of the American Dental Association. Journal of the American Dental Association, 150(12), e179–e216. https://doi.org/10.1016/j.adaj.2019.09.011
✔ Thornhill, M. H., Dayer, M. J., Durkin, M. J., Lockhart, P. B., & Baddour, L. M. (2019). Risk of adverse reactions to oral antibiotics prescribed by dentists. Journal of Dental Research, 98(10), 1081–1087. https://doi.org/10.1177/0022034519863645

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Dexamethasone Use in Periodontal Surgery: Pros & Cons

Dexamethasone use in periodontal surgery has been investigated as a perioperative strategy to reduce the inflammatory response associated with surgical manipulation of periodontal tissues.

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Because postoperative pain and edema can affect comfort, mastication, and recovery, corticosteroids may provide an adjunctive benefit when appropriately selected.

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Current evidence suggests that perioperative dexamethasone can reduce postoperative pain and swelling, particularly during the first several days after periodontal flap surgery.
However, its benefits should be balanced against patient-specific contraindications, potential adverse effects, and the limited number of high-quality periodontal studies.

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✅ How Dexamethasone Works in Periodontal Surgery
Dexamethasone is a potent glucocorticoid with anti-inflammatory activity. It suppresses multiple inflammatory pathways, including the production of prostaglandins and other mediators involved in vascular permeability, tissue edema, and postoperative pain.
In periodontal surgery, this mechanism may attenuate the acute inflammatory response produced by flap elevation, tissue manipulation, and surgical trauma.
Importantly, dexamethasone is an adjunct to surgical and analgesic management, not a substitute for atraumatic surgical technique or appropriate postoperative analgesia.

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✅ Benefits of Dexamethasone in Periodontal Surgery

1. Reduction of postoperative pain
Randomized clinical trials have demonstrated a reduction in postoperative pain following periodontal flap surgery when dexamethasone is administered perioperatively.
A randomized trial involving 60 patients undergoing open-flap debridement found that an 8-mg preoperative dose of dexamethasone provided greater pain control and reduced the need for rescue acetaminophen compared with placebo.
More recently, a randomized crossover trial found that 8 mg of intravenous dexamethasone administered before periodontal flap surgery significantly reduced pain during the first 72 hours compared with placebo.

2. Reduction of postoperative swelling
The anti-inflammatory effect of dexamethasone may also reduce postoperative edema.
In the 2022 randomized trial, intravenous dexamethasone was associated with significantly less swelling during several postoperative assessment periods, including the early postoperative phase.
A 2024 randomized clinical study also reported less swelling on the first postoperative day after submucosal administration of 8 mg dexamethasone during periodontal flap surgery.

3. Potential improvement in early postoperative function
Reduction of inflammatory edema may facilitate early oral function. The 2024 submucosal study reported improved chewing efficiency and less reduction in mouth opening during the early postoperative period. However, these findings should be interpreted cautiously because the study included only 25 patients.

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✅ Routes and Timing of Administration
Dexamethasone has been studied through several administration routes, including oral, intravenous, and submucosal administration.

Approach	Evidence in Periodontal Surgery	Main Consideration
Preoperative oral	Evidence of reduced postoperative pain	Convenient; evidence remains limited
Intravenous	Reduced pain and swelling in randomized clinical trials	Useful when IV access is already established
Submucosal	Recent evidence suggests reduced pain and swelling	Avoids the need for IV access
Repeated postoperative dosing	Less consistently studied	Greater exposure is not necessarily associated with greater benefit

Factor	Clinical implication
Timing	Preoperative or perioperative administration is the approach most consistently investigated.
Dose	Studies have commonly evaluated single doses of 4–8 mg, but no universally established periodontal surgery regimen exists.
Route	IV and submucosal administration have demonstrated clinical effects; the optimal route remains uncertain.

The evidence should therefore not be interpreted as establishing 8 mg as a universal standard dose. The 8-mg regimen has been studied in clinical trials, but patient characteristics, surgical extent, route of administration, and local prescribing regulations must be considered.

✅ Limitations and Safety Considerations

1. Evidence remains limited
A 2024 systematic review identified only six randomized clinical trials involving 250 participants evaluating preemptive steroidal and nonsteroidal analgesia in periodontal surgery. The authors noted substantial methodological limitations, including risk of bias and heterogeneity in drugs and doses.
Consequently, dexamethasone should be regarded as a selective adjunct rather than routine therapy for every periodontal surgical procedure.

2. Hyperglycemia
Systemic corticosteroids can transiently increase blood glucose concentrations. This is particularly relevant in patients with diabetes or impaired glucose regulation.
Patient-specific risk assessment is therefore important before administration, especially when systemic corticosteroids are being considered.

3. Infection considerations
Corticosteroids suppress immune responses and can potentially exacerbate or mask infection. Current prescribing information warns that corticosteroids may reduce resistance to infection and obscure clinical signs of infection.
This does not mean that a single perioperative dose inevitably causes infection. Indeed, a large Cochrane review of perioperative dexamethasone in surgical patients found no evidence of increased postoperative wound infection with a single perioperative steroid exposure.
Nevertheless, dexamethasone should not be used to mask an inadequately controlled infection or as a substitute for appropriate antimicrobial or surgical management.

4. Not a replacement for conventional analgesia
Dexamethasone primarily modifies the inflammatory component of postoperative morbidity. It should not automatically replace evidence-based analgesic therapy.
Current dental pain guidelines support NSAIDs, alone or combined with acetaminophen, as first-line pharmacologic therapy for acute dental pain when not contraindicated.

5. Limited evidence regarding long-term periodontal outcomes
Most studies evaluate short-term outcomes such as pain, swelling, trismus, and analgesic consumption. There is insufficient evidence to conclude that perioperative dexamethasone improves long-term periodontal healing, attachment gain, or regenerative outcomes.

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💬 Discussion
The current evidence supports a potential role for perioperative dexamethasone as an adjunct in periodontal surgery, particularly when postoperative inflammation is expected to be clinically significant.
The strongest periodontal evidence concerns reduction of early postoperative pain and swelling. Both intravenous and submucosal administration have demonstrated beneficial effects in randomized trials, while a recent systematic review supports the potential effectiveness of preemptive dexamethasone for postoperative pain.
However, the evidence base remains relatively small and heterogeneous. The 2024 systematic review specifically highlighted methodological limitations and the need for additional well-designed randomized trials.
Therefore, the clinical decision should be individualized rather than protocol-driven. Dexamethasone may be particularly reasonable when substantial postoperative inflammation is anticipated, while routine administration for uncomplicated periodontal procedures offers less clearly established incremental benefit.

✍️ Conclusion
Dexamethasone can reduce postoperative pain and swelling following periodontal surgery, with evidence supporting both systemic and local administration. Its anti-inflammatory effect makes it a potentially useful perioperative adjunct, particularly for procedures associated with greater tissue trauma.
Nevertheless, dexamethasone is not universally indicated. The relatively limited periodontal evidence, potential systemic effects, glucose elevation, infection-related considerations, and absence of demonstrated long-term periodontal benefits support a selective, patient-centered approach.
The most appropriate use is therefore as an adjunct to atraumatic surgical technique and evidence-based analgesia, rather than as routine medication for all periodontal surgical patients.

🎯 Clinical Recommendations
▪️ Consider perioperative dexamethasone selectively when postoperative pain or edema is expected to be clinically significant.
▪️ Do not interpret the commonly studied 8-mg dose as a universal periodontal protocol; dosing should be individualized according to the clinical situation and route of administration.
▪️ Consider submucosal administration when an IV route is unnecessary; current evidence suggests it can provide postoperative benefits without clear superiority of IV administration for pain or analgesic consumption.
▪️ Evaluate diabetes, infection, immunosuppression, corticosteroid exposure, and other relevant medical conditions before prescribing.
▪️ Maintain conventional evidence-based analgesia; dexamethasone should generally be considered an adjunct rather than a replacement for NSAID-based analgesic strategies when these are appropriate.
▪️ Avoid routine corticosteroid use when the expected inflammatory burden is low and the potential benefit is unlikely to justify systemic exposure.
▪️ Explain to patients that the principal expected benefit is short-term reduction of postoperative inflammatory symptoms, not improvement of long-term periodontal healing.

📚 References

✔ Altindal, D., Alsafadi, A., Alshujaa, B., Talmac, A. C., Ege, B., Calisir, M., & Alpaslan, N. Z. (2024). Effect of submucosal dexamethasone on postoperative pain, swelling and trismus after periodontal surgery: A randomized clinical study. Clinical Oral Investigations, 28(12), 681. https://doi.org/10.1007/s00784-024-06076-5
✔ Carrasco-Labra, A., Polk, D. E., Urquhart, O., Aghaloo, T., Claytor, J. W., Jr., Dhar, V., Dionne, R. A., Espinoza, L., Gordon, S. M., Hersh, E. V., Law, A. S., Li, B. S.-K., Schwartz, P. J., Suda, K. J., Turturro, M. A., Wright, M. L., Dawson, T., Miroshnychenko, A., Pahlke, S., Pilcher, L., Shirey, M., Tampi, M., & Moore, P. A. (2024). Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults. Journal of the American Dental Association, 155(2), 102–117.e9. https://doi.org/10.1016/j.adaj.2023.10.009
✔ Lages, L. P. de D., Bergamaschi, C. de C., Lopes, L. C., da Frota, E. G., Silva, M. T., Monte, T. L., & Motta, R. H. L. (2024). Preemptive oral analgesia with steroidal and nonsteroidal anti-inflammatory drugs in periodontal surgery: A systematic review. Frontiers in Pharmacology, 15, 1385401. https://doi.org/10.3389/fphar.2024.1385401
✔ Vieth, M. P., Deas, D. E., Palaiologou, A. A., Diogenes, A., Mader, M. J., & Mealey, B. L. (2022). Effect of intravenous dexamethasone on postoperative pain and swelling following periodontal flap surgery: A randomized controlled trial of patient-centered outcomes. Journal of Periodontology, 93(2), 237–245. https://doi.org/10.1002/JPER.21-0153
✔ Wagner, J. C., Johnson, T. M., & Gilbert, W. A. (2022). Should periodontists prescribe postoperative oral corticosteroids to control pain and swelling? A systematic review. Clinical Advances in Periodontics, 12(2), 134–142. https://doi.org/10.1002/cap.10169
✔ Sauerland, S., Nagelschmidt, M., Mallmann, P., & Neugebauer, E. A. M. (2019). Adverse side-effects of dexamethasone in surgical patients—An abridged Cochrane systematic review. Anaesthesia, 74(8), 1013–1020. https://doi.org/10.1111/anae.14610
✔ Green, V. G., Polk, D. E., Turturro, M. A., Moore, P. A., & Carrasco-Labra, A. (2025). Evidence-based clinical practice guidelines for the management of acute dental pain. American Journal of Emergency Medicine, 89, 247–253. https://doi.org/10.1016/j.ajem.2024.12.054

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Dental Infection: When Can It Become Life-Threatening?

Can a dental infection kill you? In most cases, dental infections can be treated successfully, especially when they are diagnosed early. However, an untreated infection can sometimes spread beyond the tooth and jaw into the face, neck, bloodstream, or other areas of the body.

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Severe odontogenic infections are uncommon, but they can become life-threatening when they cause airway obstruction, sepsis, deep neck infection, or spread toward the chest or brain. Modern diagnosis, dental treatment, antibiotics when indicated, and emergency care have greatly reduced these complications, but they have not eliminated them.

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✅ How Can a Dental Infection Become Dangerous?
A dental infection usually begins around a tooth affected by deep decay, pulp infection, trauma, or periodontal disease. If the infection remains localized, treatment can often control the problem.
The concern arises when bacteria and inflammation spread into surrounding tissues. Depending on the location of the infection, this may involve the spaces beneath the jaw, under the tongue, around the throat, or deeper into the neck.
In severe cases, infection can interfere with breathing or swallowing, enter the bloodstream, or extend toward the chest or other critical structures.

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✅ When Is a Dental Infection an Emergency?
Not every toothache or dental abscess is a medical emergency. However, certain symptoms indicate that the infection may be spreading or threatening vital functions.

Warning Sign	Why It Matters
Difficulty breathing	May indicate narrowing or obstruction of the airway.
Difficulty swallowing	Can indicate a deeper infection involving the throat or floor of the mouth.
Rapidly increasing facial or neck swelling	May indicate that the infection is spreading into surrounding tissues.
Swelling under the tongue or jaw	Can be associated with serious infections involving deeper spaces of the mouth and neck.
Drooling or inability to swallow saliva	May signal significant swallowing difficulty or potential airway compromise.
Voice changes	Can occur when swelling affects deeper tissues of the mouth or neck.
High fever or marked weakness	May indicate systemic involvement or a more severe infection.
Confusion, severe weakness, or fainting	Can be signs of serious systemic illness requiring urgent medical assessment.

Difficulty breathing, inability to swallow, rapidly progressing neck or facial swelling, or signs of severe systemic illness require emergency medical evaluation. Deep neck infections can progress rapidly and may require hospital treatment, intravenous antibiotics, airway management, and surgery.

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✅ Can a Tooth Abscess Cause Sepsis?
Yes, although this is uncommon.
A localized dental abscess does not automatically mean that a person has sepsis. However, if bacteria and the inflammatory response spread beyond the original dental infection, systemic infection and sepsis can develop.
A 2026 study of 2,530 patients with odontogenic infections found severe complications in 9.8% of the study population, while mortality was 0.6%. Importantly, this was a clinical population with odontogenic infections and should not be interpreted as the risk of death from an ordinary dental abscess in the general population.

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✅ Who Is at Greater Risk of Severe Complications?
The risk is not the same for everyone. Severe complications are more likely when infection spreads extensively or when the body's ability to control infection is reduced.

Factors associated with more serious disease include:
▪️ Diabetes
▪️ Impaired immune function
▪️ Multiple affected anatomical spaces
▪️ Advanced age
▪️ High fever
▪️ Difficulty breathing
▪️ Deep neck involvement
A 2024 systematic review and meta-analysis found particularly strong associations between life-threatening head and neck infections and dyspnea, multiple-space involvement, systemic disease, diabetes, and advanced age.

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✅ Does Taking Antibiotics Prevent a Dental Infection From Becoming Fatal?
Not necessarily.
Antibiotics are important when a dental infection has systemic involvement or when there is a significant risk of spread. However, antibiotics alone generally do not remove the underlying source of a tooth infection.
Depending on the diagnosis, definitive dental treatment may involve drainage, root canal treatment, or extraction. The American Dental Association recommends prioritizing definitive dental treatment for most localized pulpal and periapical infections rather than routinely prescribing antibiotics. Antibiotics become appropriate when systemic involvement, such as fever or malaise, is present or when the risk of progression is high.
This is why taking leftover antibiotics or delaying dental treatment because the swelling temporarily improves can be dangerous.

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✅ How Are Severe Dental Infections Treated?
Treatment depends on how far the infection has spread.
A localized infection may be managed with appropriate dental drainage, root canal treatment, or extraction, depending on the tooth and clinical diagnosis.

A severe spreading infection may require:
▪️ Hospital admission
▪️ Intravenous antibiotics
▪️ Surgical drainage
▪️ Removal of the source of infection
▪️ Airway monitoring or protection
▪️ Management of sepsis or other systemic complications
For deep neck infections, rapid diagnosis and treatment are critical because infection can spread to structures involved in breathing and, in some cases, toward the chest.

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💬 Discussion
The important message is not that every dental infection is life-threatening. Most dental infections are treatable and do not result in death. The real danger is an infection that is ignored, allowed to spread, or treated without addressing its source.
The distinction between a localized dental infection and a spreading infection is clinically important. Pain and swelling around a tooth may require prompt dental care, but airway symptoms, rapidly progressive swelling, systemic illness, or deep facial and neck involvement change the urgency completely.
Current evidence also supports responsible antibiotic use. Antibiotics should not replace definitive dental treatment when the infection can be treated locally. At the same time, delaying antibiotics or emergency referral in a patient with systemic or deep-space involvement can be inappropriate.

🎯 Clinical Recommendations
1. Do not ignore a dental abscess or progressive facial swelling. Arrange prompt dental evaluation.
2. Screen for red flags such as breathing difficulty, swallowing difficulty, drooling, voice changes, rapidly increasing swelling, or significant systemic illness.
3. Refer immediately for emergency medical evaluation when airway compromise, deep neck infection, or severe systemic infection is suspected.
4. Treat the source of infection, rather than relying on antibiotics alone when definitive dental treatment is indicated.
5. Use antibiotics selectively and appropriately, particularly when systemic involvement or a significant risk of progression is present.
6. Do not reassure patients solely because pain decreases. A dental infection can continue to progress even when symptoms temporarily change.

✍️ Conclusion
Can a dental infection kill you? Yes, but this is uncommon. The risk becomes serious when an untreated infection spreads into deep facial or neck spaces, compromises the airway, or produces systemic infection.
The safest approach is simple: do not delay professional care for a dental infection, and treat difficulty breathing, difficulty swallowing, rapidly increasing facial or neck swelling, or severe systemic symptoms as potential emergencies.

📚 References

✔ Dou, K., Shi, Y., Yang, B., & Zhao, Z. (2024). Risk factors for life-threatening complications of head and neck space infections: A systematic review and meta-analysis. Journal of Stomatology, Oral and Maxillofacial Surgery, 125(4S), 101954. https://doi.org/10.1016/j.jormas.2024.101954
✔ Sheikh, Z., Yu, B., Heywood, E., Quraishi, N., & Quraishi, S. (2023). The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis. Clinical Otolaryngology, 48(4), 540–562. https://doi.org/10.1111/coa.14064
✔ Wu, B. W., Li, W., Rekawek, P., Karlis, V., & Fleisher, K. (2026). Prevalence and risk factors for severe complications of odontogenic infections. Journal of Oral and Maxillofacial Surgery.
✔ Lockhart, P. B., Tampi, M. P., Abt, E., Aminoshariae, A., Durkin, M. J., Fouad, A. F., Gopal, P., Hatten, B. W., Kennedy, E., Lang, M. S., Patton, L. L., Paumier, T. M., & Suda, K. J. (2019). Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. The Journal of the American Dental Association, 150(11), 906–921.e12. https://doi.org/10.1016/j.adaj.2019.08.020
✔ Jevon, P., Abdelrahman, A., & Pigadas, N. (2020). Management of odontogenic infections and sepsis: An update. British Dental Journal, 229, 363–370. https://doi.org/10.1038/s41415-020-2114-5

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