If I had a dollar for every time someone asked me if they would need antibiotics after a tooth extraction, I could probably retire from practicing! With all jokes aside, it is one of the most commonly asked questions for the procedure.

If everyone is going to keep asking, we might as well answer. This will be your guide to knowing everything about antibiotics after having a tooth extracted.

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Commonly prescribed antibiotics for an extraction

Amoxicillin is the most commonly prescribed antibiotic by dentists for most dental procedures including extractions. It is more than adequate in fighting off infections for most conditions. However there are situations which may require a different one so it would be helpful to know what all of them are.

List of antibiotics used for oral conditions:

Amoxicillin. Most commonly given prescription after a tooth removal. It covers the majority of the bacterial spectrum that may cause a post-operative infection.
Augmentin. Given when there is a sinus exposure, perforation, or involvement.
Azithromycin. Allergic to penicillin or amoxicillin.
Cephalexin. It can be used for those allergic to penicillin, studies have shown there is about a 10% cross allergenicity with it. This is the prescription for facial lacerations.
Clindamycin. Allergic to penicillin or amoxicillin.
Doxycycline. Often prescribed for acute periodontal abscesses.
Erythromycin. Allergic to penicillin or amoxicillin.
Metronidazole. For gum infections, infected sockets, and osteomyelitis which involves anaerobic bacteria.
Penicillin. The classic and the original but has mostly been replaced by amoxicillin.

How to take them

The dosing schedule differs significantly from one medication to the next so be sure to read the instructions on the label carefully. Not all of them are taken every 8 hours like amoxicillin.

Tips:

Drink a full glass of water with each dose.
Make sure you have a meal or at least eat something while you take it. This helps to prevent upset stomachs.
Finish the entire course. Do not stop short of finishing the entire prescribed course. It is only effective when taken for said amount of time.

The exception to finishing the antibiotics is if you develop an allergic reaction or you have uncontrollable diarrhea. In both cases you should contact your dentist immediately to figure out an alternative solution.

How soon should I take it?

As soon as you pick up the prescription or when you get home, you should try your best to get the first dose in. Getting the medication into your system as soon as possible will decrease the risk of you getting an infection.sinus exposure

If you delay taking the antibiotic you will expose yourself to a greater chance of catching an infection. The extraction was probably traumatic enough as it is and we’re sure you don’t want to return to the dentist so soon.

Do I need to take antibiotics after tooth removal?

Believe it or not but antibiotics aren’t always necessary after a tooth extraction. Our immune system is much more robust than what you may have thought. Although there are instances were it could use some assistance from a prescription. The key is understanding when you need it and when you don’t need it.

When antibiotics are needed

Diffuse swelling. Facial or intraoral swelling within the mouth that cannot be pinpointed. If your dentist can’t identify the precise source of the infection, the only option they would have is to give you a systemic antibiotic.
Surgical extractions. Routine dental extractions do not require antibiotics but sometimes routine procedures turn into surgical ones. Prime example would be a severely decayed tooth that breaks down to the gum line during the middle of the procedure. There is no more tooth structure to grab with the forceps so your dentist is forced to start drilling away bone in order to remove the tooth. It has now turned into a surgical procedure.
Severe infections. Extensive dental abscesses will require it with no exceptions.
Impacted wisdom teeth. The third molars which are partially or completely impacted within the bone will require a surgical extraction. The jaw bone must be drilled away in order to expose the molar enough for it to be removed.
Sinus exposure. The roots of some upper molars or premolars can be close to the floor of the sinus. That increases the chances of a sinus perforation as a complication.

When antibiotics are not needed

Sometimes you may be wondering why your dentist didn’t give you antibiotics after an extraction. Well, here are the reasons why.

Localized swelling. Facial swelling or swelling in the mouth that can be identified and localized to a specific location do not require antibiotics. Your dentist can perform an incision and drainage to get rid of the abscess directly. Establishing a path for drainage is actually more important and effective than taking a couple of pills.
Routine extractions. Fully erupted teeth can be removed without much trouble. If your dentist doesn’t need to do any drilling nor peel the gums back, there is absolutely no need for antibiotics.

What about antibiotics before an extraction?

There are certain medical conditions which require antibiotics to be taken prior to beginning the procedure. The recommendation is to take it 1 hour before your extraction in order to prevent risk of infection.

These medical conditions which require it are a part of the ADA prophylactic guidelines:

Prosthetic Joint Infections. While it used to be recommended if you had a knee or hip replacement, the guidelines have now changed. According to a 2014 panel, prophylactically taking antibiotics prior to dental procedures to prevent prosthetic joint infections are not recommended.
Prevention of infective endocarditis. Antibiotics are still recommended for this condition. There are quite a few which fall under this category.

Patient selection for infective endocarditis:

Prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts
Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
A history of infective endocarditis
A cardiac transplant with valve regurgitation due to a structurally abnormal valve
Congenital (present from birth) heart disease:
- unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device

Doesn’t antibiotics decrease the risk for infection?

While it may be true that even conditions which do not require antibiotics can still get infected, it doesn’t mean that you should take it. Your doctor makes the decision by weighing your risks to benefits for taking it.

The chances of developing an infection are quite low for the conditions which don’t need it. The vast majority of the time, the prescription will just upset your stomach instead.
The risk for taking too many antibiotics is the potential for developing super bugs. These are bacteria which gain resistance and immunity to antibiotics from taking an excessive amount of it. That is a serious problem if you get an infection by these super bugs because you will need to be hospitalized to treat it.

Takeaway

Despite the common misconception that antibiotics are necessary after an extraction, the reality turns out to be quite different. While there are many situations which do require it, there are also some which do not.

Yes, you may have a gaping hole where the tooth socket is but your immune system is robust enough to ward off bacteria, infection, and invaders. You need to have faith in your ability to recover and repair.

Our last piece of advice is that if your dentist gives you a prescription for it, it would serve you well to take it and finish it. They wouldn’t have given it to you if they didn’t think you needed it!

Antibiotics After Tooth Extraction – Guide