What is the strongest antibiotic for mouth infection?

Antibiotics for Tooth Infection: What You Should Know

Laura Dorwart is a health journalist with expertise in disability rights, mental health, and pregnancy-related conditions. She has written for publications like SELF, The New York Times, VICE, and The Guardian.

Published on March 23, 2022

Edmund Khoo, DDS, is board-certified in orthodontics. He teaches full-time as a clinical associate professor at his alma mater, New York University College of Dentistry, is a diplomate of the American Board of Orthodontics, and serves on advisory boards for the American Dental Education Association.

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A tooth infection is a pocket of pus (abscess) caused by the proliferation of bacteria. Usually, an abscess appears in the pulp—the soft, living tissue inside a tooth.

A periapical abscess develops from an infection in the pulp that forms an abscess at the root of a tooth, while a periodontal abscess develops between the tooth and the surrounding gum tissue.

Symptoms of a tooth infection may include a severe toothache, sensitivity to heat and cold, swollen glands, swelling in the gums, foul-smelling breath, and pain while chewing. If the infection spreads to the surrounding bones, it may become life-threatening.

Your dentist may prescribe antibiotics to clear up your tooth infection. Learn more about antibiotics for tooth infections, including why they are used and how fast they work.

When Are Antibiotics Used for a Tooth Infection?

Tooth infections don’t always require antibiotics. In many cases, they may clear up on their own. Rinsing with warm saltwater or taking over-the-counter medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs), may help to reduce tooth pain and swelling.

The American Dental Association (ADA) recommends that dentists avoid prescribing antibiotics for most tooth infections due to potential side effects. Dental treatments, such as drainage, deep cleaning, or a root canal (removing the infected pulp from the tooth), may sometimes be necessary.

However, your dentist may prescribe antibiotics if you are immunocompromised (have a weakened immune system) or if your tooth infection is spreading. Some of the signs that your tooth infection is getting worse may include:

• Fever
• Fatigue
• Malaise (a general “ill feeling”)
• Swelling in the jaw or neck
• Intense pain or swelling that does not go away

If left untreated, a tooth infection may spread to the surrounding bones and tissues. This can lead to serious health complications, including:

• Tooth loss
• Blood infection
• Pneumonia (lung infection)
• Brain infection
• Endocarditis (infection in the heart)

If you have a severe tooth infection, your dentist may prescribe a course of antibiotics to prevent it from spreading. Antibiotics may prevent tooth loss and other serious health complications.

When to See a Dentist

It’s important to seek dental treatment right away if you suspect you might have a tooth infection. Make an appointment with your dentist if you have a toothache that doesn’t go away, if your gums are red and inflamed, or if you notice a pimple-like bubble along your gum line.

Taking Antibiotics

Your dentist can diagnose you with a tooth infection with a thorough physical examination. Your healthcare provider may tap your teeth or ask you to bite down to assess your level of pain. They may also perform imaging tests, such as dental X-rays.

If your tooth infection is severe or persistent, your dentist may prescribe antibiotics. The goals of taking antibiotics for a tooth infection are to prevent tooth loss and other serious health complications.

According to the ADA, the first-line antibiotics for a tooth infection include:

• Oral amoxicillin
• Oral penicillin V potassium

Amoxicillin and penicillin V potassium are both in a class of antibiotics known as penicillin-type drugs. They work to fight infections by killing bacteria or stopping its growth. Penicillin-type drugs won’t work to treat viral infections.

If you are allergic to penicillin-type drugs, your dentist may prescribe one of the following antibiotics instead:

• Oral azithromycin
• Oral clindamycin
• Oral cephalexin

Azithromycin, clindamycin, and cephalexin are all commonly used to treat bacterial infections.

Dosage

The current ADA recommendations for antibiotic dosage for tooth infections are as follows:

• Oral amoxicillin: 500 milligrams (mg), three times per day
• Oral penicillin V potassium: 500 milligrams, four times per day
• Oral azithromycin: 500 milligrams on the first day, followed by 250 milligrams for four days
• Oral clindamycin: 300 milligrams, four times per day
• Oral cephalexin: 500 milligrams, four times per day

Duration

These are the current ADA recommendations for the duration of a course of antibiotics for a tooth infection:

• Oral amoxicillin: Three to seven days
• Oral penicillin V potassium: Three to seven days
• Oral azithromycin: Five days
• Oral clindamycin: Three to seven days
• Oral cephalexin: Three to seven days

Some of your tooth infection symptoms should begin to clear up after two to three days. However, it’s important to take the full course of antibiotics as your dentist prescribes.

Taking Antibiotics

It’s important to take antibiotics exactly as prescribed, even if you start feeling better quickly. If you stop taking antibiotics too early, your infection may linger. You could also raise your risk of developing a bacterial infection that is resistant to antibiotics.

Common Antibiotics Used for a Tooth Infection

Penicillin-type drugs, such as amoxicillin and penicillin V potassium, are typically the first-line antibiotics that dentists prescribe to treat a tooth infection.

However, allergic reactions to penicillins are common. If you have a history of allergy symptoms (such as hives, swelling, or low blood pressure) after taking penicillin-type drugs, let your dentist know. They may prescribe a macrolide antibiotic, such as clindamycin, to clear up your infection.

In some cases, your dentist may prescribe another type of antibiotic, such as:

• Augmentin (amoxicillin with clavulanate)
• Flagyl (metronidazole)

These drugs are typically prescribed if other antibiotics don’t work to treat your symptoms or if your tooth infection begins to spread.

Side Effects

Some of the most common side effects of antibiotics may include:

• Nausea
• Headache
• Diarrhea
• Yeast infection
• Changes in taste

Seek immediate medical help if you experience any serious side effects while taking antibiotics, such as:

• Rash
• Difficulty breathing
• Wheezing
• Hives
• Peeling skin or blisters
• Swelling in the face, eyes, or mouth
• Stomach cramps
• Joint pain
• Worsening signs of a tooth infection
• Fever

Prevention

A tooth abscess may sometimes be caused by a cracked or chipped tooth, an injury, or failed dental work. However, in most cases, tooth infections are caused by tooth decay.

The best way to prevent a tooth infection is to practice good oral hygiene. Here are some ways to protect your teeth from cavities and gum disease:

• Brush your teeth at least twice a day with fluoride toothpaste.
• Floss or use interdental brushes regularly to remove hard-to-reach plaque from between your teeth.
• Limit your sugar intake, especially between meals.
• Visit your dentist regularly for cleanings and check-ups.

Summary

A tooth infection is a pocket of pus that develops inside a tooth’s pulp due to the multiplication of bacteria. Tooth infections are usually caused by tooth decay, failed dental work, broken or chipped teeth, or injury.

Not all tooth infections require treatment with antibiotics. However, a dentist may sometimes prescribe antibiotics to save the tooth and prevent the infection from spreading.

The most common antibiotics used to treat tooth infections are penicillin-type drugs (such as amoxicillin and penicillin V potassium). Clindamycin, azithromycin, and cephalexin are options for people who have a history of allergies to penicillin. If first-line drugs don’t work, metronidazole may be prescribed.

Possible side effects of antibiotics for tooth infections may include nausea, diarrhea, yeast infection, changes in taste, and headache. More serious side effects, such as rash, hives, swelling, joint pain, and fever, require immediate medical attention.

Frequently Asked Questions

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

In many cases, you’ll start feeling better about two to three days after you start taking antibiotics for a tooth infection. However, you should take the full round of prescribed antibiotics. Usually, your dentist will prescribe an antibiotic for three to seven days for a tooth infection.

How can I tell if the antibiotics are working for tooth infection?

If your antibiotics are working, the symptoms of your tooth infection will begin to subside. Your fever, fatigue, pain, and/or swelling will decrease. If your symptoms persist or get worse, contact your dentist right away.

Are there any natural antibiotics for a tooth infection?

The most popular natural treatment for a tooth infection is a warm saltwater rinse. Other home remedies for a tooth infection may include baking soda, garlic, hydrogen peroxide, aloe vera gel, herbal tea, or essential oils (such as oil of oregano or tea tree oil). However, if you have a tooth infection, you should still make an appointment with your dentist.

Where can I buy antibiotics for a tooth infection?

The most common antibiotics for a tooth infection include amoxicillin, penicillin, azithromycin, clindamycin, cephalexin, and metronidazole. Antibiotics have to be prescribed by a healthcare provider, such as a dentist. You may be able to get a prescription more quickly via a telehealth visit.

12 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. American Dental Association. Abscess tooth.
2. Scholes Family Dental. What is the difference between a periapical and periodontal abscess?
3. MedlinePlus. Tooth abscess.
4. American Dental Association. Antibiotics for dental pain and swelling guideline.
5. Ahmadi H, Ebrahimi A, Ahmadi F. Antibiotic therapy in dentistry. Int J Dent. 2021;2021:6667624. doi:10.1155/2021/6667624
6. Lockhart PB, Tampi MP, Abt E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American Dental Association. J Am Dent Assoc. 2019;150(11):906-921.e12. doi:10.1016/j.adaj.2019.08.020
7. MedlinePlus. Amoxicillin.
8. Exceptional Dentistry & Sedation Center. What happens if antibiotics don’t work?
9. University of Michigan Health. Penicillin V potassium (oral).
10. MedlinePlus. Penicillin V potassium.
11. Oral Health Foundation. Preventing tooth decay.
12. Channel Islands Family Dental Office. 7 natural antibiotics to ward off any dental infection.

By Laura Dorwart
Laura Dorwart is a health journalist with particular interests in mental health, pregnancy-related conditions, and disability rights. She has published work in VICE, SELF, The New York Times, The Guardian, The Week, HuffPost, BuzzFeed Reader, Catapult, Pacific Standard, Health.com, Insider, Forbes.com, TalkPoverty, and many other outlets.

Amoxicillin — Brand name: Respillin

Amoxicillin is a penicillin antibiotic. It is used to treat bacterial infections, such as chest infections (including pneumonia) and dental abscesses. It can also be used together with other antibiotics and medicines to treat stomach ulcers.

It’s often prescribed for children, to treat ear infections and chest infections.

Amoxicillin is only available on prescription. It comes as capsules or as a liquid that you swallow. It’s also given by injection, but this is usually only done in hospital.

2. Key facts

• For most infections, you’ll start to feel better in a few days.
• The most common side effects of amoxicillin are feeling sick (nausea) and diarrhoea.
• Liquid amoxicillin can stain your teeth. This does not last and is removed by brushing.
• You can drink alcohol while taking amoxicillin.
• Sometimes, taking amoxicillin can cause thrush.

3. Who can and cannot take amoxicillin

Amoxicillin can be taken by most adults and children.

Find out more about giving amoxicillin to children on the Medicines for Children website.

Amoxicillin is not suitable for everyone. To make sure amoxicillin is safe for you, tell your doctor if you:

• have ever had an allergic reaction to amoxicillin or penicillin or any other medicine
• have liver or kidney problems
• have recently had, or are due to have, any vaccinations

4. How and when to take amoxicillin

Dosage

The usual dose of amoxicillin capsules is 250mg to 500mg, taken 3 times a day. The dose may be lower for children.

Amoxicillin liquid is available in 125mg and 250mg doses.

Important

Carry on taking this medicine until you’ve completed the course, even if you feel better. If you stop your treatment early, the infection could come back.

How to take it

Try to space the doses evenly throughout the day. If you take it 3 times a day, this could be first thing in the morning, mid-afternoon and at bedtime.

You can take amoxicillin before or after food.

Swallow amoxicillin capsules whole with a drink of water. Do not chew or break them.

Amoxicillin is available as a liquid for children and people who find it difficult to swallow capsules.

If you or your child are taking liquid amoxicillin, it will usually be made up for you by your pharmacist. The medicine will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

If you forget to take it

If you forget to take a dose, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicines.

If you take too much

Taking an extra dose of amoxicillin is unlikely to harm you or your child, but speak to your pharmacist or doctor if you’re worried.

Urgent advice: Contact 111 for advice now if:

You have taken more than your prescribed dose of amoxicillin and have symptoms including:

• stomach pain or you’re being sick
• blood in your pee
• difficulty peeing or producing less pee than usual

5. Side effects

Like all medicines, amoxicillin can cause side effects, although not everyone gets them.

Common side effects

These common side effects happen in around 1 in 10 people. Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or do not go away:

• feeling sick (nausea)
• diarrhoea

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Call a doctor or contact 111 straight away if you get:

• diarrhoea (possibly with stomach cramps) that contains blood or mucus or severe diarrhoea that lasts for more than 4 days
• pale poo and dark pee, and the whites of your eyes or your skin turn yellow (although this may be less obvious on brown or black skin) – these can be signs of liver or gallbladder problems
• bruising or changes in your skin colour
• joint or muscle pain that comes on after 2 days of taking the medicine
• a skin rash with circular red patches (this may be less obvious on brown or black skin)

Some of these serious side effects can happen up to 2 months after finishing the amoxicillin.

Serious allergic reaction

Around 1 in 15 people have an allergic reaction to amoxicillin.

In most cases, the allergic reaction is mild and can take the form of a skin rash.

Mild skin rashes can usually be treated by taking antihistamines.

In rare cases, amoxicillin can cause a serious allergic reaction (anaphylaxis).

Immediate action required: Call 999 or go to A&E now if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you’re wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of amoxicillin. For a full list, see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

6. How to cope with side effects of amoxicillin

What to do about:

• feeling sick – stick to simple meals and do not eat rich or spicy food. It might help to take your amoxicillin after a meal or snack.
• diarrhoea – drink plenty of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. If you take contraception and you have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.

7. Pregnancy and breastfeeding

Amoxicillin and pregnancy

It is safe to take amoxicillin during pregnancy.

Amoxicillin and breastfeeding

It is OK to take amoxicillin while breastfeeding. Information shows that only tiny amounts of amoxicillin get into breast milk. Such levels would not be expected to cause side effects in your baby.

Talk to your doctor, pharmacist, health visitor or midwife if:

• your baby is not feeding as well as usual
• they have sickness or diarrhoea
• your baby has oral thrush, or a skin rash
• you have any other concerns about your baby

For more information about how amoxicillin can affect you and your baby during pregnancy, visit the Best Use of Medicines in Pregnancy (BUMPS) website.

8. Cautions with other medicines

There are some medicines that do not mix well with amoxicillin.

Tell your doctor if you’re taking any of these medicines before you start taking amoxicillin:

• methotrexate, used to treat arthritis and psoriasis
• warfarin, a medicine to prevent blood clots
• gout medicines called probenecid or allopurinol
• other antibiotics

Tell your doctor if you’ve recently had, or are due to have, an oral typhoid vaccine. Amoxicillin can make it less effective.

Mixing amoxicillin with herbal remedies and supplements

There is little information about taking herbal remedies and supplements alongside amoxicillin.

Important: Medicine safety

Tell your doctor or pharmacist if you’re taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about amoxicillin

How does amoxicillin work?

Amoxicillin is a penicillin antibiotic. It works by killing the bacteria that cause the infection.

When will I feel better?

For most infections, you should feel better within a few days.

It’s very important that you keep taking amoxicillin until your course is finished. Do this even if you feel better. It will help stop the infection coming back.

What if I do not get better?

Tell your doctor if you do not start feeling better after taking amoxicillin for 3 days. Also tell them if, at any time, you start to feel worse.

Will it give me thrush?

Some people get a fungal infection called thrush after taking a course of antibiotics like amoxicillin. If you think you have thrush, speak to your pharmacist or ask your doctor for advice.

How does amoxicillin compare with other antibiotics?

Amoxicillin and other penicillins, like phenoxymethylpenicillin, are antibiotics that are widely used to treat a variety of infections, including skin, dental, throat and chest infections.

Not all antibiotics are suitable for every infection. Your doctor will choose an antibiotic that’s suitable for the type of infection you have. Speak to your pharmacist or doctor if you have any questions.

Will it affect my contraception?

Amoxicillin does not stop contraceptive pills working, including the combined pill or emergency contraception.

However, if amoxicillin makes you sick (vomit) or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.

Will it affect my fertility?

There’s no evidence to suggest that taking amoxicillin reduces fertility in either men or women.

Does it stain teeth?

If you or your child take amoxicillin as a liquid medicine, it can stain your teeth. This does not last and should go after brushing your teeth well.

Amoxicillin capsules do not stain teeth.

Can I drive or ride a bike?

Yes. Amoxicillin should not affect you being able to drive or cycle.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking amoxicillin.

Can I drink alcohol with it?

Yes, you can drink alcohol with amoxicillin.

Patients Reporting Penicillin Allergy Less Likely to Have Successful Dental Implants

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© Getty Images

Dental implants are more than twice as likely to fail in people who report an allergy to penicillin and are given alternative antibiotics, compared to those given amoxicillin, a new study by researchers at NYU College of Dentistry shows. The study, published in Clinical Implant Dentistry and Related Research, is the first to examine the impact of prescribing antibiotics other than amoxicillin for dental implants. Dental implants provide secure, long-term solutions for replacing missing or damaged teeth. A screw-like implant is surgically placed in the jawbone to act as a replacement tooth’s root and anchor the artificial tooth. The bone then fuses to the implant over several months, integrating it into the jaw. While dental implants are largely successful, a small proportion of implants fail when the jawbone does not properly integrate the implant. This can happen for a variety of reasons, including infection, smoking, or injury to the tooth. To reduce the chance of infection, many dental providers prescribe amoxicillin—an antibiotic in the penicillin family—prior to and following implant surgery. If a patient reports an allergy to penicillin, alternative antibiotics can be prescribed. Previous studies have shown that patients with a penicillin allergy experience higher rates of dental implant failure but have not looked at which antibiotics were used. To understand the outcomes of taking different antibiotics, NYU College of Dentistry researchers reviewed the charts of patients who received dental implants, documenting which antibiotics were given and whether their dental implant was successful or failed. The sample included 838 patients—434 who reported having a penicillin allergy, as well as a random sample of 404 patients without the allergy. All patients without a penicillin allergy were given amoxicillin, while those who reported an allergy were given alternative antibiotics: clindamycin, azithromycin, ciprofloxacin, or metronidazole. The researchers found that dental implants failed in 17.1% of patients who reported a penicillin allergy, compared to 8.4% of patients without an allergy. Patients who took certain antibiotics other than amoxicillin were much less likely to have successful dental implants; the failure rate for patients taking clindamycin was 19.9% and was 30.8% for azithromycin. In addition, patients with an allergy to penicillin were more likely to experience earlier failure of their dental implant (less than 6 months) than those without an allergy (more than 12 months). The reason why dental implants failed in patients with a penicillin allergy is unknown, the researchers write. It could be attributed to several factors, including reactions to the material used in implants or inefficacy of the alternative antibiotics. However, research shows that penicillin allergies are overreported—90% of people who say they have penicillin allergies are not truly allergic to penicillin after testing. As a result, health experts recommend testing patients who report a penicillin allergy to confirm whether they are actually allergic. “If a patient’s actual allergy status is determined prior to oral surgery, we may be able to achieve more favorable outcomes by prescribing amoxicillin to those without a true allergy,” said Zahra Bagheri, DDS, clinical assistant professor in the Ashman Department of Periodontology and Implant Dentistry at NYU College of Dentistry and the study’s lead author. «Although a growing body of evidence—at the research level—demonstrates links between oral and systemic conditions, the population still needs to know—at the consumer level—just how connected oral conditions, like the success of dental implants, are to systemic conditions, like allergies,” said Leena Palomo, DDS, chair of the Ashman Department of Periodontology and Implant Dentistry at NYU College of Dentistry. “This study highlights the importance of patients transmitting accurate, updated systemic health details to their dental care teams.» In addition to Bagheri, study authors include Nicholas Barrese, Geoffrey Rubinshtein, Dina Zahedi, Malvin Janal, and Stuart Froum of NYU College of Dentistry. About NYU College of Dentistry
Founded in 1865, New York University College of Dentistry (NYU Dentistry) is the third oldest and the largest dental school in the US, educating nearly 10 percent of the nation’s dentists. NYU Dentistry has a significant global reach with a highly diverse student body. Visit dental.nyu.edu for more.