Antibiotics and dental pain: addressing the gap between symptom management and definitive care

Dear Editor,

Prescribing decisions are usually guided by a clear diagnosis and linked to a definitive treatment plan. When it comes to dental pain, however, antibiotics are often prescribed without a confirmed diagnosis or clear pathway to definitive care.¹ Limited access to dental services may contribute to this, with many patients presenting to medical general practitioners (GPs) for management of dental pain. This raises concerns that antibiotics may sometimes be used in place of definitive dental treatment and highlights the need to consider how this issue can be better managed.

Within oral health services, a recurring pattern is observed whereby patients present to dental clinics weeks or months after initially seeking care from a GP for dental pain. Many report having received one or more courses of antibiotics, often with only temporary symptomatic relief. In some cases, patients may not recognise the pain as being dental in origin, instead describing symptoms such as ear pain, sinus discomfort, facial pain or headache. After medical causes have been excluded, they may be advised that the pain could be dental in origin and prescribed antibiotics. When the symptoms settle, patients may feel that no further treatment is required and may not seek dental care. However, without definitive dental intervention, the underlying pathology remains and can continue to progress silently. Patients may later present with more advanced disease, including abscess formation, spreading infection or tooth loss, often resulting in further courses of antibiotics being sought during recurrent flare ups. Many of these outcomes may have been preventable with timely dental treatment.

Most dental pain is odontogenic in origin, commonly arising from conditions such as irreversible pulpitis or apical periodontitis. These are localised inflammatory or infective processes confined to the tooth and surrounding structures, and they cannot be resolved with systemic antibiotics alone. Definitive management instead requires elimination of the source of infection through procedures such as caries removal and restoration, root canal therapy, or extraction. Although antibiotics may provide temporary suppression of bacterial activity, they do not address the underlying cause and may delay appropriate treatment, potentially allowing disease progression.^2–4

Contemporary clinical guidelines are unequivocal on this issue. Antibiotics should be reserved for cases where there is clear evidence of systemic involvement or spreading infection. Examples include cellulitis, diffuse swelling, trismus, lymphadenopathy, fever or malaise. In the absence of these features, prescribing antibiotics for dental pain alone is not indicated.^5,6 Despite this, inappropriate prescribing remains common in primary medical care settings, often driven by diagnostic uncertainty, perceived patient expectations, or barriers to accessing urgent dental services.

The implications of this practice extend beyond individual patient outcomes. Inappropriate antibiotic use contributes directly to the growing global burden of antimicrobial resistance (AMR), which the World Health Organization has identified as one of the leading threats to global health.⁷ Recent reports highlight that the misuse of antibiotics in outpatient settings, including for dental indications, remains a significant contributor in AMR.^7,8 Although dentistry has made substantial progress in antimicrobial stewardship, antibiotic prescribing for odontogenic conditions within primary medical care remains an under-recognised area of concern.

We acknowledge that GPs are often the first point of contact for patients experiencing dental pain, particularly in regions where access to dental care is limited or cost prohibitive. In such contexts, clinicians may feel pressured to provide immediate relief. However, empirical antibiotic prescribing in the absence of systemic involvement does not address the underlying cause and may inadvertently contribute to patient harm. The most appropriate management in these situations is prompt referral to a dental practitioner, alongside supportive measures such as analgesia and clear patient education regarding the need for definitive treatment.

This issue also highlights the importance of effective interdisciplinary collaboration in the management of patients with dental pain. Medical and dental practitioners each contribute distinct expertise, and optimal patient outcomes are best achieved when care is delivered through timely communication and appropriate referral pathways. Medical practitioners play an important role in initial assessment, analgesia and management of associated medical concerns; however, definitive treatment of odontogenic conditions ultimately requires dental assessment and intervention. Ensuring that patients can access dental care promptly, while maintaining close collaboration between medical and dental professionals, is likely to reduce unnecessary antibiotic use and improve patient outcomes.

Addressing this challenge requires a multifaceted approach. First, continued education of non-dental clinicians regarding the appropriate indications for antibiotic use for dental conditions is essential. Second, improving access to urgent and affordable dental services is critical to reducing reliance on medical practitioners for dental pain and infection. Finally, strengthening antimicrobial stewardship frameworks across both medical and dental settings will help ensure that antibiotics are used judiciously and effectively.

Ultimately, antibiotics should not be a surrogate for definitive dental treatment. Management of the source of infection, rather than temporary suppression of symptoms, is fundamental to appropriate patient care. Failure to address the underlying pathology compromises both individual patient outcomes and contributes to the broader public health challenge of antimicrobial resistance, an issue that requires urgent and sustained attention.^7,8