# Acute dental abscess (odontogenic infection) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · SDCEP Dental Prescribing 2020 - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 - SDCEP Dental Prescribing 2020 - Acute dental abscess (odontogenic infection) - disease-level clinical article (dental-abscess-clinical.txt) ## Treatment metadata - Amoxicillin + Clavulanic acid — 1000 mg — oral.solid - Referral & safety-netting (no drug therapy) - Metronidazole — 500 mg — oral.solid - Clindamycin — 300 mg — oral.solid ## Complete treatment card ```text ACUTE DENTAL ABSCESS (ODONTOGENIC INFECTION) Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · SDCEP Dental Prescribing 2020 Review status: REVIEWED against Egyptian National Drug Formulary - Antimicrobial 2023, SDCEP Dental Prescribing 2020, Acute dental abscess (odontogenic infection) - disease-level clinical article (dental-abscess-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Swelling inside the mouth, sometimes painless, is what patients most often report first - Pain worsened by biting, with the tooth feeling loose from loss of periodontal support - A sense that the tooth is sitting higher than usual is a common complaint - Pus discharges mainly with pressure or probing, and patients notice a bad taste from it [pus] - A history of recent periodontal debridement or antimicrobial use is relevant to how the abscess formed [abscess] - Known or unrecognized diabetes raises the risk of this type of abscess and should be asked about directly [abscess] - An acute abscess brings pain, tenderness, and visible pus, while a chronic one shows a sinus tract with little or no pain [abscess · pus] SIGNS - what you find (4) - Deep probing depths over 6 mm, suppuration, loose teeth, and furcation involvement are typical periodontal signs [pus] - Tenderness is elicited on palpation and on tapping the tooth from the side - An oval swelling of the gum over the side of the root may be visible, though deeper abscesses are easy to miss - Pulp testing with electric or heat and cold stimulation still comes back normal, pointing away from a nerve-origin cause TESTS (5) - A periapical x-ray typically shows widened ligament space and horizontal or vertical bone loss - A dark area at the root tip on x-ray points instead to an abscess of nerve origin, alone or combined with the periodontal one - Tracing a gutta-percha point along the draining tract and x-raying where it stops helps locate the source of infection - Darkfield microscopy of the pus can help rule out a nerve-origin abscess based on the different microbial mix - PET scanning is highly accurate at picking up periodontal and other anaerobic abscesses in the mouth IF NOT THIS - what else fits (7) - A periapical (nerve-origin) abscess is suggested by trauma, worn or fractured teeth, deep decay, or a deep filling, with a negative or unclear pulp vitality test - In a combined perio-endo lesion, a positive pulp test points to a periodontal origin while a non-response points to a nerve origin - A pericoronal abscess around a partly erupted tooth can mimic this, but neighboring teeth stay vital with no extra pocketing - A partial root fracture shows increased mobility and tenderness, best confirmed with x-rays taken from several angles - A gingival squamous cell carcinoma can mimic a recurring periodontal abscess and should be considered in resistant cases - Self-inflicted gum injury from habits like nail-biting or poking with a pen or pin can look similar and is excluded by a full history - Less common look-alikes include a lateral periapical cyst, postoperative infection, odontogenic tumors, metastatic carcinoma, lymphoma, pyogenic granuloma, and osteomyelitis Source StatPearls "Periodontal Abscess" - disease-level clinical article Status traced to the source above 1. AMOXICILLIN + CLAVULANIC ACID [1st line] Adult 1 g (875/125 mg) orally twice daily x 5 days Peds 25-45 mg/kg/day [child max 1750 mg] (Dosed as amoxicillin component in 2 divided doses daily) 3kg -> 75-135 mg/day 4kg -> 100-180 mg/day 5kg -> 125-225 mg/day 6kg -> 150-270 mg/day 7kg -> 175-315 mg/day 8kg -> 200-360 mg/day 9kg -> 225-405 mg/day 10kg -> 250-450 mg/day 11kg -> 275-495 mg/day 12kg -> 300-540 mg/day 13kg -> 325-585 mg/day 14kg -> 350-630 mg/day 15kg -> 375-675 mg/day 16kg -> 400-720 mg/day 17kg -> 425-765 mg/day 18kg -> 450-810 mg/day 19kg -> 475-855 mg/day 20kg -> 500-900 mg/day 21kg -> 525-945 mg/day 22kg -> 550-990 mg/day 23kg -> 575-1035 mg/day 24kg -> 600-1080 mg/day 25kg -> 625-1125 mg/day 26kg -> 650-1170 mg/day 27kg -> 675-1215 mg/day 28kg -> 700-1260 mg/day 29kg -> 725-1305 mg/day 30kg -> 750-1350 mg/day 31kg -> 775-1395 mg/day 32kg -> 800-1440 mg/day 33kg -> 825-1485 mg/day 34kg -> 850-1530 mg/day 35kg -> 875-1575 mg/day 36kg -> 900-1620 mg/day 37kg -> 925-1665 mg/day 38kg -> 950-1710 mg/day 39kg -> 975-1750 mg/day (upper capped) 40kg -> 1000-1750 mg/day (upper capped) 41kg -> 1025-1750 mg/day (upper capped) 42kg -> 1050-1750 mg/day (upper capped) 43kg -> 1075-1750 mg/day (upper capped) 44kg -> 1100-1750 mg/day (upper capped) 45kg -> 1125-1750 mg/day (upper capped) 46kg -> 1150-1750 mg/day (upper capped) 47kg -> 1175-1750 mg/day (upper capped) 48kg -> 1200-1750 mg/day (upper capped) 49kg -> 1225-1750 mg/day (upper capped) 50kg -> 1250-1750 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Beta-lactam combined with a beta-lactamase inhibitor for odontogenic infection, covering the mixed oral aerobic and anaerobic flora typically responsible; used alongside urgent dental drainage or extraction, since antibiotics alone do not resolve a dental abscess and are not a substitute for source control. Caution Antibiotics are adjuncts to dental intervention (drainage/extraction); refer urgently to dentist. Contraindicated in penicillin hypersensitivity. Take with meals to reduce GI adverse effects. Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) JULMENTIN 2X 1GM 15 TAB. JULPHAR 57.50 EGP (3.83/unit) DEXICLAVE 1 GM 10 F.C. TABS. RAMEDA > NOVE... 38.50 EGP (3.85/unit) MACLAVEX 1 GM 14 F.C.TABS. MASH PREMIERE 105.00 EGP (7.50/unit) CLAVIMOX 1 GM 12 F.C.TABS. PHARCO 130.00 EGP (10.83/unit) MEGAMOX 1 GM 14 F.C. TABS. AL JAZEERA PH... 178.00 EGP (12.71/unit) CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Acute dental abscess (odontogenic infection) - disease-level clinical article (dental- abscess-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Systemic spread of infection can progress to extra-oral head/neck swellings, lymphadenopathy, or sepsis. 3. METRONIDAZOLE [2nd line] Adult 500 mg orally three times daily x 5 days Peds 22.5 mg/kg/day [child max 1500 mg] (7.5 mg/kg per dose 3 times daily (22.5 mg/kg/day)) 3kg -> 67.5 mg/day 4kg -> 90 mg/day 5kg -> 112.5 mg/day 6kg -> 135 mg/day 7kg -> 157.5 mg/day 8kg -> 180 mg/day 9kg -> 202.5 mg/day 10kg -> 225 mg/day 11kg -> 247.5 mg/day 12kg -> 270 mg/day 13kg -> 292.5 mg/day 14kg -> 315 mg/day 15kg -> 337.5 mg/day 16kg -> 360 mg/day 17kg -> 382.5 mg/day 18kg -> 405 mg/day 19kg -> 427.5 mg/day 20kg -> 450 mg/day 21kg -> 472.5 mg/day 22kg -> 495 mg/day 23kg -> 517.5 mg/day 24kg -> 540 mg/day 25kg -> 562.5 mg/day 26kg -> 585 mg/day 27kg -> 607.5 mg/day 28kg -> 630 mg/day 29kg -> 652.5 mg/day 30kg -> 675 mg/day 31kg -> 697.5 mg/day 32kg -> 720 mg/day 33kg -> 742.5 mg/day 34kg -> 765 mg/day 35kg -> 787.5 mg/day 36kg -> 810 mg/day 37kg -> 832.5 mg/day 38kg -> 855 mg/day 39kg -> 877.5 mg/day 40kg -> 900 mg/day 41kg -> 922.5 mg/day 42kg -> 945 mg/day 43kg -> 967.5 mg/day 44kg -> 990 mg/day 45kg -> 1012.5 mg/day 46kg -> 1035 mg/day 47kg -> 1057.5 mg/day 48kg -> 1080 mg/day 49kg -> 1102.5 mg/day 50kg -> 1125 mg/day Choice Alternatives, both for the penicillin-allergic patient. Metronidazole is stated as a first-line option in penicillin allergy, attributed to SDCEP Dental Prescribing 2020; clindamycin is the alternative when metronidazole is unsuitable, and it carries a higher Clostridioides difficile risk. Source SDCEP Dental Prescribing 2020 Why Antibiotic targeting the anaerobic bacteria implicated in odontogenic infection; used first-line for patients with penicillin allergy in acute dental abscess. Caution May cause metallic taste and nausea. Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023. Metronidazole is a first-line option for patients with penicillin allergy. Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 9.00 EGP (0.45/unit) NITROFECTAZOLE 500 MG 20 F.C. TABS. GYPTO PHARMA 10.50 EGP (0.53/unit) FLAGICURE FORTE 500 MG 20 F.C. TAB KAHIRA 23.00 EGP (1.15/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) FLAGELLAT FORTE 500MG 20 F.C.TABS. MUP 30.00 EGP (1.50/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid 4. CLINDAMYCIN [2nd line] Adult 300 mg orally every 6 hours x 5 days Peds 8-20 mg/kg/day (8 to 20 mg/kg/day divided every 6 to 8 hours.) 3kg -> 24-60 mg/day 4kg -> 32-80 mg/day 5kg -> 40-100 mg/day 6kg -> 48-120 mg/day 7kg -> 56-140 mg/day 8kg -> 64-160 mg/day 9kg -> 72-180 mg/day 10kg -> 80-200 mg/day 11kg -> 88-220 mg/day 12kg -> 96-240 mg/day 13kg -> 104-260 mg/day 14kg -> 112-280 mg/day 15kg -> 120-300 mg/day 16kg -> 128-320 mg/day 17kg -> 136-340 mg/day 18kg -> 144-360 mg/day 19kg -> 152-380 mg/day 20kg -> 160-400 mg/day 21kg -> 168-420 mg/day 22kg -> 176-440 mg/day 23kg -> 184-460 mg/day 24kg -> 192-480 mg/day 25kg -> 200-500 mg/day 26kg -> 208-520 mg/day 27kg -> 216-540 mg/day 28kg -> 224-560 mg/day 29kg -> 232-580 mg/day 30kg -> 240-600 mg/day 31kg -> 248-620 mg/day 32kg -> 256-640 mg/day 33kg -> 264-660 mg/day 34kg -> 272-680 mg/day 35kg -> 280-700 mg/day 36kg -> 288-720 mg/day 37kg -> 296-740 mg/day 38kg -> 304-760 mg/day 39kg -> 312-780 mg/day 40kg -> 320-800 mg/day 41kg -> 328-820 mg/day 42kg -> 336-840 mg/day 43kg -> 344-860 mg/day 44kg -> 352-880 mg/day 45kg -> 360-900 mg/day 46kg -> 368-920 mg/day 47kg -> 376-940 mg/day 48kg -> 384-960 mg/day 49kg -> 392-980 mg/day 50kg -> 400-1000 mg/day Source Periodontal Abscess - StatPearls - NCBI Bookshelf (NBK560625) for the indication - verbatim: "Clindamycin is recommended as an alternative for patients with penicillin allergies." Dose from Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287) - verbatim: "Oral: 150–300 mg every 6 hours." Paediatric dose from the same monograph, the oral capsule line - verbatim: "Oral: Infants, Children, and Adolescents: Hydrochloride salt (capsule): 8 to 20 mg/kg/day divided every 6 to 8 hours." Neither source states a course length for odontogenic infection; 5 days matches the co-amoxiclav and metronidazole courses already sourced for acute dental abscess. Why The alternative when penicillin is not an option. It penetrates bone and covers the oral anaerobes that drive odontogenic infection. Caution Antibiotics are an adjunct, not the treatment. The abscess still needs drainage or dental treatment; a course of clindamycin alone will not resolve it. Warn about diarrhoea. Clindamycin carries the highest Clostridioides difficile risk of the oral antibiotics here - stop it and reassess if diarrhoea develops during or after the course. Take with a full glass of water to avoid oesophageal irritation. Egypt ADCOCLINDACE 300 MG 16 CAPS. ARAB DRUG COM... 24.00 EGP (1.50/unit) CLINACYN 300MG 16 CAPS. SIGMA > EGYPT... 31.50 EGP (1.97/unit) CLINDAM 300 MG 16 CAPS. SIGMA > OCTOB... 75.00 EGP (4.69/unit) MEPACLIND 300MG 8 CAPS. MEPACO 38.00 EGP (4.75/unit) CLINDACINE ART 300 MG 12 CAPS. RAMEDA > ART ... 76.00 EGP (6.33/unit) ALFACLINDAMYCIN 300 MG 10 CAPS. ATCO PHARMA >... 69.00 EGP (6.90/unit) DALACIN C 300MG 10 CAPS. PFIZER 114.00 EGP (11.40/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)