Antibiotics not necessary for most toothaches, according to new ADA guideline

The American Dental Association (ADA) announced today a new guideline indicating that in most cases, antibiotics are not recommended for toothaches. This guidance, published in the November issue of the Journal of the American Dental Association, aligns with the ADA's longstanding antibiotic stewardship efforts and its pledged commitment to the U.S. government's Antimicrobial Resistance Challenge.

Patients with toothaches are often prescribed antibiotics by physicians and dentists to help relieve signs and symptoms and prevent progression to a more serious condition. However, the new guideline and accompanying systematic review find that healthy adults experiencing a toothache are best served not by antibiotics but by dental treatment and, if needed, over-the-counter pain relievers such as acetaminophen and ibuprofen.

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

Studies have shown that antibiotics, which are designed to stop or slow the growth of bacterial infections, don't necessarily help patients experiencing a toothache. In addition, antibiotics can cause serious side effects, and overuse has resulted in bacterial strains that are resistant to antibiotics.

The guideline offers example scenarios when antibiotics may be prescribed for a toothache. "When dental treatment is not immediately available and the patient has signs and symptoms such as fever, swollen lymph nodes, or extreme tiredness, antibiotics may need to be prescribed," said Dr. Lockhart. "But in most cases when adults have a toothache and access to dental treatment, antibiotics may actually do more harm than good."