TOOTH ABSCESS
A cavity that is not filled grows bigger and deeper until it touches the nerve. Germs travel inside the tooth's root and start an infection called an abscess.
Pus forms at the end of the root, inside the bone. As the pus increases, it causes grc jt pressure. This is why an abscess causes severe pain.
SIGNS:
- pain all the time, even when trying to sleep
- tooth often feels longer, and even a bit loose
- tooth hurts when it is tapped
- a sore on the gums near where the root ends (gum bubble)
- swelling of the gums around the tooth, or swelling of the face on the same side as the bad tooth
TREATMENT:
If there is no swelling, take out the tooth immediately (unless you are able to give root canal treatment). This allows the pus to escape and relieves the pain.
If there is swelling, treat the swelling first. Take out the tooth only after the swelling goes down. This is necessary because an anesthetic will not work if there is swelling. If the anesthetic works, then it is safe to take out the tooth.
To treat the swelling, give an antibiotic. Penicillin by mouth is best.
Use an injection only when the person is in immediate danger. For example, inject penicillin when the person has a fever or if the swelling is pressing against the throat. But remember you can treat most serious infections with simple penicillin by mouth. For the doses for serious infections, look below the box on the next page. If you still think an injection is necessary, look at the section on 'aqueous procaine penicillin'
Adults and children over 25 kg. (60 pounds) of weight should take the same amount of oral penicillin.
Children under 25 kg. should take 1/2 as much.
For most infections, penicillin by mouth is taken 13 times: a very large first dose and 12 smaller doses every 6 hours for 3 days. The person should take all of the penicillin, even if the pain or swelling goes down.
For the correct doses, see below.
THE BEST CHOICE |
SECOND CHOICE (for those allergic to penicillin) |
Penicillin G or V: 1 tablet = 250 mg. Give enough tablets for 3 days First Dosa (take all at once) Adults 8 tablets and children over 25 kg. (2000 mg.) Children under 25 kg. 4 tablets (1000 mg.) Then every 6 hours for 3 days (12 doses) Adults 2 tablets and children over 25 kg. (500 mg.) Children under 25 kg. 1 tablet (250 mg.) IMPORTANT: to allow it to best fight infection, take penicillin before eating. |
Erythromycin: 1 tablet (or capsule) = 250 mg. Give enough tablets for 3 days First Dose (take all at once) Adults 4 tablets and children over 25 kg. (1000 mg.) Children under 25 kg. 2 tablets (500 mg,) Then every 6 hours for 3 days (12 doses) Adults 2 tablets and children over 25 kg. (500 mg.) Children under 25 kg. 1 tablet (250 mg.) IMPORTANT: to avoid upset stomach, take erythromycin with meals. |
For serious infections, it may be necessary to take the antibiotics for a longer time. Take the same first dose as above, then take 1/2 the first dose every 6 hours until the condition begins to improve. Then take the second, smaller dose every 6 hours until the end of five days, or seven days if it is very serious.
* Usually you can take out the tooth 1 or 2 days before the end of the antibiotic treatment, but the person must continue to take all of the tablets, even after you have taken out the tooth.
If the swelling is 'pointing', open it with a sharp sterile knife to release the pus. Cover the wound with a sterile dressing to keep it clean. If you are not able to do that, explain how to reduce the swelling with heat. As often as possible until the swelling goes away:
- soak a cloth in warm water and hold it against the face.
- hold warm water inside the mouth near the swelling. It is not necessary to add salt to the water.
Finally, give the person medicine for pain. A two-day supply will be enough, because the penicillin* and the heat will reduce the pressure and that will reduce the pain. The best medicines for pain are aspirin, which comes in 300 mg. tablets, and acetaminophen (paracetamol), which comes in 500 mg. tablets.
Aspirin is usually cheaper, but acetaminophen does not cause stomach pain and it is safer than aspirin for children. (To avoid stomach pain, take aspirin with food, milk, or water.)
Take aspirin or acetaminophen 4 times a day.
Every 6 hours;
- adults can take 2 tablets,
- children 8 to 12 years take 1 tablet, and
- children 3 to 7 take 1/2 tablet.
Children 1 to 2 years should only take acetaminophen, 1/4 tablet 4 times a day.
*lf the infection does not heal, penicillin may not be the best antibiotic. Take some pus from the infection and have it tested, to see which antibiotic is best.
