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Antibiotics for Dental Problems: When They Help and When They Do Not

Most toothache and dental infections are treated by a dentist, not by antibiotics. Here is when antibiotics are used, why they are not given more often, and how to take them safely if you need them.

Updated September 2026·By the OHA editorial team·8 min read·How we write
Key takeaways
  • Antibiotics do not cure most toothache. The cause needs dental treatment, such as a filling, root canal treatment or taking the tooth out, with painkillers if needed.
  • A dental abscess needs the pus drained and the cause treated. Antibiotics alone do not remove the infection.
  • Antibiotics are used alongside dental treatment when an infection is spreading (for example facial swelling or fever) or when someone is at high risk of complications, such as having a weakened immune system.
  • If you are prescribed antibiotics, take them exactly as you are told. Do not stop early on your own, and never share them.
  • In the UK, a GP cannot give dental treatment. Contact a dentist, or NHS 111 if you do not have one.

The NHS says taking antibiotics when you do not need them can mean they will not work for you in future. For toothache, the American Dental Association (ADA) says an antibiotic prescription should be avoided unless absolutely necessary.

Why antibiotics do not cure most toothache

The Scottish Dental Clinical Effectiveness Programme (SDCEP), part of NHS Education for Scotland, lists tooth decay, broken teeth, gum disease, abscesses and jaw problems among the causes of toothache. Its patient leaflet says a dentist needs to find and treat the cause, and that antibiotics on their own do not remove the infection or stop the pain.

SDCEP's guidance for dentists, updated in May 2026, says pain from irreversible pulpitis (an inflamed tooth nerve that cannot recover) or dry socket is due mainly to inflammation, and should be managed with painkillers and local treatment, not antibiotics. Our dry socket article notes that some other sources say a dentist may give antibiotics for dry socket.

The other bodies agree:

  • Australia: healthdirect says antibiotics are usually not used for toothache unless there is a clear infection. A 2020 Australian Prescriber review says there is a lack of evidence that antibiotics ease the pain of irreversible pulpitis, and advises prompt dental treatment.
  • US: the ADA's 2019 guideline recommends against antibiotics for most conditions affecting the nerve and root tip of a tooth. It recommends dental treatment and, if needed, over-the-counter painkillers such as paracetamol (acetaminophen in the US) and ibuprofen.
  • Evidence: a Cochrane review (a systematic review of trials, searched to 2019) found only one small trial. Penicillin did not appear to significantly reduce the toothache of irreversible pulpitis, but the evidence was low certainty.

For pain relief while you wait, see toothache.

Abscesses need draining

A dental abscess is a build-up of pus from a bacterial infection. The NHS says a dentist will drain the pus, and you may be given antibiotics after treatment. NHS inform (Scotland) says antibiotics are not routinely prescribed for dental abscesses, but may be used if the infection spreads or is particularly severe.

SDCEP says the first step is to drain the pus, by removing the tooth, through the root canals or through a small cut. It says evidence suggests adding antibiotics makes very little or no difference for most people with acute dental problems. See fillings and root canal treatment and having a tooth out.

When are antibiotics needed?

Guidance in all three countries keeps antibiotics for infections that are spreading or making you unwell. SDCEP and Australian Prescriber both say they are given alongside dental treatment, not instead of it.

  • UK: SDCEP says antibiotics are only appropriate for spreading infection (cellulitis, a spreading soft-tissue infection, swollen lymph glands or swelling), signs the whole body is affected (fever, feeling unwell), or a high risk of complications, such as a weakened immune system or uncontrolled diabetes. It also lists necrotising gum infections and pericoronitis (infected gum around a partly erupted tooth) with whole-body signs or swelling that persists after local treatment.
  • Australia: the Australian Prescriber review says antibiotics are only an addition to dental treatment when there is fever, feeling unwell, swollen lymph glands or difficulty opening the mouth, rapidly spreading infection, or a weakened immune system.
  • US: the ADA says dentists should prescribe antibiotics if the condition spreads to affect the whole body, with fever or feeling unwell.

SDCEP says antibiotics should not be prescribed to prevent infection after routine dental surgery, such as removing impacted wisdom teeth. The Australian Prescriber review lists phenoxymethylpenicillin or amoxicillin, sometimes with metronidazole, among the options for dental infections; SDCEP prefers phenoxymethylpenicillin in the UK because it acts on a narrower range of bacteria.

Why not take antibiotics just in case?

  • Resistance. healthdirect says the main cause of antibiotic resistance is antibiotic use. The NHS says overuse has led to "superbugs" that resist many antibiotics. SDCEP says indiscriminate use also raises the risk of Clostridioides difficile (C. diff) disease.
  • Side effects. The NHS lists being sick, feeling sick, bloating, indigestion and diarrhoea as common, and healthdirect adds thrush in the mouth or vagina.

If you are prescribed antibiotics

  • Follow the instructions on the packet or leaflet, or from your prescriber or pharmacist (NHS). SDCEP advises spacing doses evenly through the day.
  • Missed dose: the NHS says take it when you remember, unless the next dose is nearly due. Never take a double dose.
  • Only your own. Never share antibiotics (NHS, healthdirect), and return unused tablets to a pharmacy (healthdirect).
  • Alcohol: the NHS says to avoid it completely while taking metronidazole, which is sometimes used for dental infections, and for 48 hours afterwards, as the combination can cause very unpleasant side effects.
  • Other medicines: the NHS says some antibiotics do not mix well with other medicines, including warfarin, so tell your dentist about everything you take.
Finishing the course: the advice is changing

healthdirect says to take antibiotics for as long as you are told, even if you feel better, and lists not finishing the course as one way resistance can develop. SDCEP's 2026 guidance says dentists should review patients, ideally after about 3 days, and can advise stopping once signs of whole-body infection have gone, to keep the course as short as works. Either way, follow your dentist's instructions and do not stop on your own.

Antibiotic allergies

The NHS says allergic reactions are most common with penicillins and cephalosporins, and very rarely cause anaphylaxis, a medical emergency. healthdirect says being sick is a side effect, not an allergy, and that in most people antibiotic allergies disappear after a few years. Tell your dentist about any allergy (ADA).

Antibiotics before dental treatment

Some people with heart conditions used to take antibiotics before dental work to prevent infective endocarditis, a rare but serious heart infection. In the UK, NICE does not recommend this routinely. In the US, the ADA follows American Heart Association guidelines that limit it to a small group at highest risk, such as people with an artificial heart valve or previous endocarditis. In Australia, healthdirect says antibiotics may be recommended for people at risk, and to discuss this with your doctor and dentist. See heart disease and oral health.

For joint replacements, the ADA says antibiotics are generally not recommended before dental treatment, and any rare use should be decided together by you, your dentist and your orthopaedic team.

Why a GP will not usually treat toothache (UK)

The NHS says not to go to a GP with toothache or an abscess, because a GP cannot give dental treatment. The British Medical Association's guidance says GPs are not responsible for treating dental problems. Prescribing guidance from Nottinghamshire explains that only a dentist can treat the cause, and medicines will not remove the source of infection. If you do not have a dentist, NHS 111 can help: see finding a dentist and dental emergencies.

In Australia, the Australian Prescriber review notes that doctors can help manage symptoms until you can see a dentist.

When to see a dentist
  • You have toothache, gum swelling or a possible abscess. In the UK, the NHS says ask for an urgent dentist appointment or contact NHS 111.
  • You were given antibiotics and your symptoms are worse, not improving, or new (SDCEP).
  • You think you are allergic to an antibiotic, or have side effects that do not go away (ADA).
Get help urgently
  • UK (NHS): call 999 or go to A&E if you find it hard to breathe, speak or swallow, have a swollen or painful eye or sudden eyesight problems, have a lot of swelling in your mouth, or find it hard to open your mouth.
  • Australia (healthdirect): get emergency care if toothache or gum swelling causes problems breathing or speaking, or swelling around your eye or neck.
  • US (ADA): if your dentist is closed, go to your local emergency room.
  • Allergic reaction: the NHS says call 999 for a swollen, blistered or peeling rash, wheezing, chest or throat tightness, trouble breathing or talking, or swelling of the mouth, face, lips, tongue or throat. In Australia, call triple zero (000) for a suspected anaphylactic reaction (healthdirect).

Frequently asked questions

Will I get antibiotics for a dental abscess?

Not always. The pus needs draining. NHS inform says antibiotics are not routinely prescribed, but may be used if the infection spreads or is severe.

My dentist would not give me antibiotics. Is that right?

Very likely. Guidance in the UK, Australia and the US keeps antibiotics for spreading infection or people at high risk. If you get worse, contact the practice again.

Should I stop my antibiotics when I feel better?

Only if your dentist or doctor tells you to.

Sources

  1. Antibiotics, NHS, accessed September 2026
  2. Antibiotic resistance, NHS, accessed September 2026
  3. Antibiotics: interactions, NHS, accessed September 2026
  4. Warfarin, NHS, accessed September 2026
  5. Dental abscess, NHS, accessed September 2026
  6. Toothache, NHS, accessed September 2026
  7. Dental abscess, NHS inform (Scotland), accessed September 2026
  8. Bacterial infections, Scottish Dental Clinical Effectiveness Programme, Drug Prescribing for Dentistry (updated May 2026), accessed September 2026
  9. Antibiotics: there are better ways to manage toothache and infection (patient leaflet, PDF), Scottish Dental Clinical Effectiveness Programme, accessed September 2026
  10. Update to Drug Prescribing guidance now available, Scottish Dental Clinical Effectiveness Programme, accessed September 2026
  11. Prophylaxis against infective endocarditis: recommendations (CG64), National Institute for Health and Care Excellence, accessed September 2026
  12. Patients presenting with dental problems, British Medical Association, accessed September 2026
  13. Dental abscess: antimicrobial prescribing guidelines for primary care (PDF), Nottinghamshire Area Prescribing Committee, accessed September 2026
  14. Antibiotics, healthdirect Australia, accessed September 2026
  15. Toothache and gum swelling, healthdirect Australia, accessed September 2026
  16. Endocarditis, healthdirect Australia, accessed September 2026
  17. Management of dental pain in primary care, Australian Prescriber (Timmerman and Parashos, 2020), accessed September 2026
  18. Antibiotics for dental pain and swelling guideline (2019), American Dental Association, accessed September 2026
  19. Antibiotics for pain and swelling, American Dental Association (MouthHealthy), accessed September 2026
  20. Antibiotic prophylaxis prior to dental procedures, American Dental Association, accessed September 2026
  21. Antibiotic prophylaxis for heart patients, American Dental Association (MouthHealthy), accessed September 2026
  22. Dental emergencies, American Dental Association (MouthHealthy), accessed September 2026
  23. Antibiotic use for severe toothache (irreversible pulpitis), Cochrane (2019), accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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