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Tooth Abscess Still Swollen After Antibiotics

A tooth abscess that is still swollen after taking antibiotics is not a complication until 3 days have passed because it does take time to work. However, there are a few exceptions and rules that you must follow in order to make an accurate determination.


swollen abscess on face
swollen abscess on face


Table of Contents:


 

When antibiotics start working

Depending on which antibiotic you've taken, it may take 1-2 hours before it starts working. It takes that long because two things need to happen.

  • After ingesting the pill, it needs to get absorbed by your digestive system.

  • Then it needs to be transported to the site of the abscess and that takes time.


Antibiotic

Tmax (Time to reach peak concentration)

Amoxicillin

Augmentin

Clindamycin

Azithromycin


Ultimately, it takes time before the medications start working. Also just because it has started working, it doesn't mean you'll feel the effects immediately. What you will feel are incremental improvements that happen slowly over time. In other words it will not go away immediately but it should trend towards the positive direction.


The four most commonly prescribed antibiotics for dental abscesses:

  • Amoxicillin. The most commonly prescribed antibiotic for dental infections is amoxicillin. It is the first choice unless there is an allergy or the infection is too severe.

  • Amoxicillin and Clavulanate (Augmentin). This is stronger than amoxicillin due to the addition of clavulanate. It can be used to treat sinus involvements and also dog bites.

  • Clindamycin. Was previously the first choice if the patient had a penicillin allergy.

  • Azithromycin. Recently azithromycin has become the first choice for those who are allergic to penicillin. It appears to be safer and has less side effects.


amoxicillin capsules
amoxicillin capsules

How long after starting antibiotics will tooth pain go away?

It will take about 1-2 hours after you've taken the antibiotics before you feel an improvement in tooth pain. It will not go away all at once but you should gradually feel better with each passing day. Your condition should trend towards the positive direction.


Factors affecting how fast antibiotics work:

  • Taking it on an empty stomach. It may work faster if you take the antibiotic without eating because there won't be food getting processed ahead of it. This means that your body can process it right away. The downside is that when taken on an empty stomach, you may have stomach pains.

  • Taking it on a full stomach. You may delay the pain relief a little bit longer but at least you won't get any stomach pains from taking it. Our doctors and all the other doctors in the world will tell you to take it with a meal because the pain from having it on an empty stomach is pretty miserable!


Our dentists in Long Island City recommend taking all prescription medication with a meal.


How long does it take for antibiotics to reduce swelling from a tooth infection?

The antibiotics will start working 1-2 hours after ingestion but you most likely won't notice a reduction in swelling until 24-48 hours later. However you should start feeling better on the day of starting the prescription.


swollen abscess around crowns
swollen abscess around crowns

The facial swelling should improve with each day. Although it won't go away completely until after you finish the entire course of the antibiotic. Even if you've noticed that the swelling has mostly gone away by the 5th day, you should still finish the course of the medication.


There could be traces of the abscess that is left which you can't see! You don't want it to swell back up again because you didn't finish taking it as directed.


 

Signs antibiotics are NOT working

If the infection is very severe the swelling from the tooth abscess will not go away with antibiotics alone. Here are some signs to look out for so you know when to seek professional help.


Signs antibiotics aren't working:

  • Still swollen after 3 days of antibiotics.

  • Abscess is getting bigger after taking antibiotics.

  • Tooth pain is worsening while on antibiotics.


Tooth abscess still swollen after 3 days of antibiotics

If you're still swollen with no improvement after 3 days of antibiotics, it means that you have a complication. It is quite normal and not unusual for you to still be swollen after the first day because everyone's immune system works at a different pace.


However to still have no signs of recovery after the third day, something is definitely wrong. The normal course of recovery should be gradual improvements with each passing day. The three day mark is the limit as to how long you should ever wait. You need to contact your dentist now.


Other signs that antibiotics are not working:

  • Tooth abscess still swollen after 5 days of antibiotics.

  • Tooth abscess still swollen after 7 days of antibiotics.

  • Essentially any residual swelling after the 3rd day is a bad sign.


Dental abscess getting bigger with antibiotics

If your tooth abscess is getting bigger despite taking the antibiotics, it means the antibiotic is not working. The medication should be decreasing the swelling and NOT increasing it.


This is indicative that you're trending towards a negative outcome. The most important sign to look for while recovering from an abscess is a trend in the positive direction.


Therefore, if you notice the abscess getting bigger after 24 hours, we would immediately seek medical help. Our recommendation is to not even wait for the 3rd day in this situation. Call your dentist right away if it is getting bigger.


Worsening tooth pain

The tooth pain won't dissipate immediately after taking the antibiotic but it should improve gradually. It should feel a little bit better after each day. However if you notice the tooth pain getting worse, it is an indication that a complication has occurred.


 

Reasons antibiotics are NOT working

There are a few potential causes for the antibiotics to not work on a dental abscess.

  • Taking the antibiotics too late.

  • It was the wrong type of antibiotic for your infection.

  • You've an antibiotic resistant infection.


Took the antibiotics too late

Antibiotics are effective for reducing swelling from dental abscesses if they were taken within 48 hours of it starting. If you take it after 48 hours, it may be too late and it won't be effective enough to treat the swelling.


Essentially, oral antibiotics are effective but only for the early stages of the infection. You have a time window for catching it and acting quickly. If you miss this window of opportunity you will need to move onto the next step.


Incision and drainage of a dental abscess

If the dental abscess is still swollen after 3 days of antibiotics, it means it is not working and it needs to be drained instead. This emergency surgical dental procedure is called an incision and drainage. It will definitely reduced the facial swelling.


Incision/Drainage: What to expect

  1. Administer local anesthesia. You need to be numb for this procedure.

  2. Make an incision. A cut is made into the swelling.

  3. Drain the abscess. The abscess will need to be popped and drained.

  4. Irrigate the wound. Flush out all of the pus and infection.

  5. Place a drain as necessary. A rubber drain may be kept inside the wound to prevent it from closing and to encourage continual drainage.



The swelling should have come down a lot after this treatment but you still need to finish the rest of the antibiotics.


Wrong type of antibiotic

Each antibiotic is effective against a certain spectrum of bacteria. If you happen to have a strain that is not covered by the commonly prescribed amoxicillin, the swelling may not go down.


That is an impossible situation to predict because it is not common place for dentists to do bacterial cultures. Maybe if you were at a hospital they might do a culture but usually the amoxicillin does the trick most of the time. Typically when it doesn't, it means something very interesting is going on but that isn't something you want to experience!


The solution for this situation would be to try a different antibiotic. If the abscess decreases in size from the change in medication then it means it is the right one.


List of antibiotics used for a tooth infection:

  • Amoxicillin

  • Amoxicillin Clavulanate

  • Clindamycin

  • Erythromycin

  • Azithromycin

  • Doxycycline

  • Metronidazole

  • Cephalexin


Antibiotic-resistant Superbugs

In rare situations, you can have an antibiotic resistant strain of bacteria which are referred to as superbugs. These bacteria have developed resistance or even immunity to our commonly prescribed antibiotics due to overuse of them. If you've taken too many antibiotics over the years, there is a chance it may not be working today when you need it to.


One example of a superbug would be MRSA (methicillin-resistant Staphylococcus aureus). If you happen to have this, you may need to go to a hospital to get treated. Dental offices are not equipped for this level of infection.


This is why it is important to practice jurisprudence in prescribing antibiotics only when it is absolutely needed.


Takeaway

The antibiotics take time for it to start working because it needs to get absorbed into the system and transported to the site of infection. It may take 1-2 hours before it even starts working but you probably won't notice any relief until the next day.


You can expect the tooth pain and swelling to slowly decrease and improve with each passing day. However if you notice it getting worse or if the swelling is still persistent after 3 days, you need to seek help. Don't wait and contact your dentist immediately.


What you want to look for is a trend of increasing improvements. If you're headed in the opposite direction of it worsening then a complication has occurred.


Author: This article was written by Dr David Chen, an emergency dentist in long island city.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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