What do antibiotics do for toothache


This review by the Cochrane Oral Health Group was conducted to assess the effects of antibiotics on pain and swelling in two clinical pictures that are often responsible for causing toothache with or without dental treatment (e.g. pulling teeth, draining a Swelling or root canal treatment).


Toothache is a common problem and can arise when the nerve within a tooth dies from progressive decay or serious injury. The tissue at the end of the root becomes inflamed and this can lead to acute pain that worsens when you bite into it. Without treatment, bacteria can infect the dead tooth and cause a dental abscess, causing swelling and spreading of the infection, which can become potentially life-threatening.

The recommended treatment for this form of toothache is to get rid of the dead nerves and the bacteria that are associated with them. This is usually done by pulling the tooth or doing root canal treatments. Antibiotics should only be prescribed if there is a severe infection that has spread from the tooth. However, some dentists still routinely prescribe oral antibiotics for people with acute dental conditions who show no evidence of the spread of the infection.

Minimizing inappropriate antibiotic prescriptions plays a key role in limiting the development of antibiotic-resistant bacteria. Since dentists prescribe approximately 8% to 10% of basic medical antibiotics in developed countries, this can contribute to antibiotic resistance. Hence, it is important that antibiotics should only be used when they are clinically beneficial to the person.

Study characteristics

The evidence from this review is current as of October 1, 2013. We searched scientific databases and found two studies with 62 participants that were included in the analysis. Both studies, conducted at university dental schools in the United States, evaluate the use of oral antibiotics to reduce pain and swelling in adults who reported the same after the first stage of root canal treatment under local anesthesia. The antibiotic in both studies was penicillin VK, and all participants also received pain medication.

Main results

The two included studies said that participants did not report significant differences in pain or swelling when given oral antibiotics compared to placebo (dummy treatment), provided that this was in conjunction with first-stage root canal treatment and pain reliever prescriptions. The studies were small, however, and we cannot rule out potentially important differences between the groups. No study examined the effects of antibiotics that were prescribed without simultaneous dental treatment.

One study reported side effects in the participants: one person who received the placebo drug suffered from diarrhea and one person who received antibiotics complained of tiredness and fatigue after the operation.

Quality of the evidence

We rate the quality of the evidence as very low. There is currently insufficient evidence to be able to assess the effect of antibiotics in these clinical pictures.