Editing Toothache (section)

===Antibiotics===
Antibiotics tend to be extensively used for emergency dental problems.<ref name="Poveda Roda2007">{{cite journal|author=Poveda Roda R, Bagan JV, Sanchis Bielsa JM, Carbonell Pastor, E|title=Antibiotic use in dental practice. A review.|journal=Medicina Oral, Patologia Oral y Cirugia Bucal|date=May 1, 2007|volume=12|issue=3|pages=E186–92|pmid=17468711|url=http://www.medicinaoral.com/pubmed/medoralv12_i3_p186.pdf}}</ref><ref name=Palmer2003>{{cite journal|author=Palmer NA|title=Revisiting the role of dentists in prescribing antibiotics.|journal=Dental Update|date=December 2003|volume=30|issue=10|pages=570–4|pmid=14710570|doi=10.12968/denu.2003.30.10.570}}</ref> As samples for microbiologic [[culture and sensitivity]] are hardly ever carried out in general dental practice, [[broad-spectrum antibiotic]]s such as [[amoxicillin]] are typically used for a short course of about three to seven days.<ref name="Poveda Roda2007" /> Antibiotics are seen as a "quick fix" by both dentists, who generally only have a very short time to manage dental emergencies, and by patients, who tend to want to avoid treatments (such as tooth extraction) which are perceived negatively. However, antibiotics typically only temporarily suppress an infection, and the need for definitive treatment is only postponed for an unpredictable length of time. An estimated 10% of all antibiotic prescriptions are made by dentists, a major factor in [[antibiotic resistance]].<ref name="Poveda Roda2007" /><ref name=Palmer2003 /> They are often used inappropriately,<ref name=Palmer2003 /> in conditions for which they are ineffective, or their risks outweigh the benefits, such as irreversible pulpitis,<ref name=Fedorowicz2013>{{cite journal|vauthors=Fedorowicz Z, van Zuuren EJ, Farman AG, Agnihotry A, Al-Langawi JH |title=Antibiotic use for irreversible pulpitis|journal=The Cochrane Database of Systematic Reviews|date=December 19, 2013|volume=12|issue=12 |pages=CD004969|pmid=24353116|doi=10.1002/14651858.CD004969.pub3|editor1-last=Fedorowicz|editor1-first=Zbys}}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/26886473|date = July 2018}} apical abscess,<ref name="Hupp 2008" />{{rp|303}} dry socket,<ref name="Hupp 2008" />{{rp|303}} or mild pericoronitis.<ref name="Hupp 2008" />{{rp|303}} However, the reality is that antibiotics are rarely needed,<ref name=Odell2010>{{cite book|author=Odell EW|title=Clinical problem solving in dentistry|year=2010|publisher=Churchill Livingstone|location=Edinburgh|isbn=978-0-443-06784-6|edition=3rd}}</ref>{{rp|230}} and they should be used restrictively in dentistry.<ref name=Koch2009>{{cite book|vauthors=Koch G, Poulsen S |title=Pediatric dentistry a clinical approach|year=2009|publisher=Wiley-Blackwell|location=Chichester, UK|isbn=978-1-118-68719-2|url=https://books.google.com/books?id=7Xdh8wb6zFsC&q=antibiotics+dentistry&pg=PA164|edition=2nd}}</ref>{{rp|164}} Local measures such as incision and drainage, and removal of the cause of the infection (such as a necrotic tooth pulp) have a greater therapeutic benefit and are much more important.<ref name=Odell2010 />{{rp|230}} If abscess drainage has been achieved, antibiotics are not usually necessary.<ref name="Hupp 2008" />{{rp|303}}

Antibiotics tend to be used when local measures cannot be carried out immediately.<ref name="Hupp 2008" />{{rp|303}} In this role, antibiotics suppress the infection until local measures can be carried out.  Severe trismus may occur in when the [[muscles of mastication]] are involved in an odontogenic infection, making any surgical treatment impossible. [[Immunocompromised]] individuals are less able to fight off infections, and antibiotics are usually given.<ref name=Odell2010 />{{rp|232}} Evidence of systemic involvement (such as a fever higher than 38.5&nbsp;°C, cervical lymphadenopathy, or [[malaise]]) also indicates antibiotic therapy, as do rapidly spreading infections, [[cellulitis]], or severe pericoronitis.<ref name="Hupp 2008" />{{rp|303}}<ref name=Odell2010 />{{rp|232}} [[Drooling]] and [[dysphagia|difficulty swallowing]] are signs that the airway may be threatened, and may precede [[dyspnoea|difficulty in breathing]]. [[Ludwig's angina]] and [[cavernous sinus thrombosis]] are rare but serious complications of odontogenic infections. Severe infections tend to be managed in hospital.{{citation needed|date=April 2014}}