Antibiotics for Dental Pain and Swelling Guideline (2019)

This guideline addresses antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling. The guideline is endorsed by the American College of Emergency Physicians.

Key Points

  • The guideline recommends against using antibiotics for most pulpal and periapical conditions and instead recommends only the use of dental treatment and, if needed, over-the-counter pain relievers such as acetaminophen and ibuprofen.
  • Instead of prescribing antibiotics, dentists should prioritize dental treatments such as pulpotomy, pulpectomy, nonsurgical root canal treatment, or incision and drainage for symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess in adult patients who are not severely immunocompromised. 
  • If a patient’s condition progresses to systemic involvement, showing signs of fever or malaise, then dentists should prescribe antibiotics.

Find clinician and patient resources below that promote the responsible use of antibiotics in dental care, including detailed guides, videos, CE courses, and more.

For Clinicians

Resources for the Guideline on Antibiotics for Dental Pain and Swelling

Related Antibiotic Resources

For Patients

Resources for the Guideline on Antibiotics for Dental Pain and Swelling

Related Antibiotic Resources


Content on this page is for informational purposes only. It is based on the “Evidence-Based Clinical Practice Guideline on Antibiotic Use for the Urgent Management of Pulpal- and Periapical-Related Dental Pain and Intraoral Swelling,” published in the November 2019 issue of the Journal of the American Dental Association. Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this website.

Clinical practice guidelines include recommendation statements intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.