Expert: Steven C. Scherr, D.D.S. - 6/25/2007

Question
My husband has an abcsess, finally went to the dentist Thursday who gave him PCN and Lortab.  Even taking those, his pain was even worse yesterday, so I called the dentist who doubled the doseage of PCN.  Yesterday swelling began which is even worse today (very noticeably swollen now).  My questions are : would the antibiotic working be causing the swelling, or is this a sign that the antibiotic is NOT effective on his bacteria?  Should he have felt some relief by now?  I know these infections can go systemic- having had such an experience I would like to avoid it in his case. Thanks for any advice

Answer
Leslie,

Dental abscesses are not very successfully treated with antibiotics alone.  Antibiotics are an important part of treatment, it is just that they don't do well unless combined with a treatment that addresses the source of infection.

The reason for this is that there is no blood supply to the center of a dental infection.  The blood supply surrounds the abscess, and can affect only the periphery.  Even if temporarily effective, the abscess will reactivate after the antibiotic is discontinued.

If the swelling continues to enlarge, it may be a sign the infection is not susceptible to penicillin, or it may be that the abscess has too large a core for the Penicillin to be effective against.  Depending on the source of the infection (gum disease, pulpal infection, or both), the abscess may need to be drained surgically or root canal therapy may be needed.

Your husband needs to be seen.  If your dentist won't see him, find another dentist.

Best wishes,

Steve