Emergency dental treatments
Antibiotics for dental infection: when they help and when they will not
Antibiotics do not cure toothache and rarely cure an abscess. They have a real but narrow role. This page explains what that role is, and what we do instead.
Clinically reviewed by Dr Ibraheem Ijaz, Principal Dentist · GDC 301711 · Last reviewed April 2026
Why we usually will not prescribe antibiotics for toothache
Most toothache comes from an inflamed or dead nerve inside the tooth. The nerve sits in a sealed chamber, and once it dies its blood supply goes with it. Antibiotics travel in the blood. They cannot reach a space that has no blood flowing through it, so they cannot touch the bacteria living in a dead tooth, any more than they could treat an infection inside a stone. The same applies to the centre of an abscess, which is a pocket of pus with no vessels running through it.
This is why national guidance for UK dentists from SDCEP and the FGDP is clear: antibiotics are not a treatment for toothache, for a tooth with a dying nerve, or for a localised abscess in a patient who is otherwise well. The treatment for those is to remove the source, by draining the abscess, removing the nerve or removing the tooth. A course of antibiotics may take the edge off for a few days as the surrounding tissue calms, and then the pain returns, often worse, because the cause is untouched. We see this every week in patients who have been given two or three courses elsewhere and are still in pain.
When antibiotics are appropriate
Antibiotics earn their place when infection has escaped the tooth and is spreading through the tissues, or when the body is struggling to contain it. In practice we prescribe them alongside treatment, not instead of it, when we see:
- Swelling spreading into the face, under the jaw or towards the eye, rather than a contained lump on the gum.
- Signs that the infection is affecting the whole body: a temperature, feeling shivery or unwell, swollen glands in the neck.
- An abscess that cannot be drained at the visit, for example when a hot swelling makes anaesthetic ineffective and treatment must wait two or three days.
- Severe pericoronitis around a wisdom tooth with trismus, meaning you cannot open your mouth properly.
- Patients whose immune system is weakened by illness or medication, where a small infection can become a large one quickly.
Even then the prescription is a bridge to definitive treatment. Antibiotics for a spreading infection without draining or removing the cause is the pattern most likely to end with a hospital admission.
What we do instead of a prescription
The £30 emergency examination finds the source. From there the options are the treatments that actually work: opening the tooth and removing the infected nerve as a pulpectomy, which usually stops the pain that day; draining a swelling by incision and drainage; or, if the tooth cannot be saved, an extraction. For a gum abscess the pocket is cleaned and irrigated; for pericoronitis the flap is washed out. Around eight in ten emergency patients get one of these on the day they call, which is the reason we rarely need to reach for a prescription pad.
Which antibiotics dentists use in the UK
When an antibiotic is justified, the choice is narrow and follows the same national guidance. Amoxicillin is first line: a broad-spectrum penicillin, usually 500mg three times a day for up to five days, taken as the label directs and finished. Phenoxymethylpenicillin is an older alternative. Metronidazole, 400mg three times a day, is used for patients allergic to penicillin, and is sometimes added to amoxicillin in a severe spreading infection because it targets the anaerobic bacteria that live deep in dental abscesses. You must not drink alcohol while taking metronidazole and for 48 hours afterwards; the combination causes flushing, vomiting and a pounding headache.
Short courses are the rule. Guidance has moved from seven days to up to five, and we review you rather than simply extend the prescription. Antibiotics are prescribed privately here, so you pay the pharmacy for the medicine rather than the NHS prescription charge.
Penicillin allergy and other medicines
Tell us if you have ever reacted to penicillin, and what happened. A true allergy, with rash, swelling or breathing difficulty, rules out amoxicillin; we use metronidazole or clarithromycin instead. An upset stomach as a child is not an allergy and does not. Many people carry a penicillin-allergy label they do not need, and it can leave them with less effective antibiotics for life, so it is worth being precise.
Also tell us about warfarin and other blood thinners, which interact with metronidazole and some other antibiotics; the contraceptive pill, which under current UK advice is not affected by these antibiotics unless you have vomiting or diarrhoea; and any kidney or liver problems, which change the dose.
Antibiotic resistance and why it matters in dentistry
Every course of antibiotics kills the susceptible bacteria and leaves behind the ones that can survive it. Repeat that across millions of prescriptions and the survivors become the norm. Dentists write a meaningful share of the country’s antibiotic prescriptions, and studies of dental prescribing consistently find that a large proportion were not needed. Resistant infections are already harder to treat in hospitals across the UK. The practical consequence for you is simple: an antibiotic taken today for a problem it cannot fix is one that may not work when you or your family genuinely need it. Choosing drainage or extraction over a prescription is better for the tooth and better for everyone.
Costs when antibiotics are part of your treatment
There is no separate fee from us for writing a prescription. A full list of emergency treatment fees is on the emergency fees page.
| Item | Fee (from) |
|---|---|
| Emergency examination including X-rays | £30 |
| Private prescription, if one is clinically justified | Written at the appointment; you pay the pharmacy for the medicine |
| Incision and drainage of an abscess | Quoted in writing at the examination |
| Emergency root canal, stage one | from £200 |
| Extraction | £120–£260 |
| Out-of-hours (after 6pm weekdays, weekends) | Additional charge |
When it is more than a dental problem
Spreading infection can move fast. Go to A&E or call 999 if swelling is closing an eye, has spread under the jaw to both sides, is making it hard to swallow, open your mouth or breathe, or if you have a high fever and feel very unwell. These need intravenous antibiotics and surgical drainage in hospital, not tablets. The Northern General Hospital on Herries Road is the nearest A&E with a maxillofacial unit. Outside our 8am to 8pm hours, NHS 111 can advise, and our overnight emergency line is answered by Dr Ijaz personally.
Questions, answered
Common questions
Will antibiotics get rid of my toothache?
No. Toothache from a dying nerve does not respond to antibiotics because they cannot reach inside the tooth. The pain stops when the nerve is removed or the tooth is taken out.
Can I get antibiotics for a tooth abscess without seeing a dentist?
A GP or pharmacist may prescribe them if you have spreading swelling and cannot reach a dentist, but that only delays the treatment you need. We see emergencies seven days a week, without registration, so the abscess can be drained the same day.
Why did my last dentist give me antibiotics and you will not?
Practice has changed. UK guidance now tells dentists to treat the cause rather than prescribe, because antibiotics do not cure dental infections and overuse drives resistance. We prescribe when there is spreading infection or you are unwell, and we treat the tooth.
Which antibiotic is best for a tooth infection?
Amoxicillin is the usual first choice in the UK. Metronidazole is used if you are allergic to penicillin, or added for a severe infection. The right answer is still to remove the source.
How long do antibiotics take to work on a dental abscess?
Spreading swelling usually starts to improve within 48 hours. If it does not, or it gets worse, you need to be seen the same day. Improvement does not mean the abscess has gone, only that the surrounding tissue has calmed.
Can I drink alcohol with dental antibiotics?
Not with metronidazole, during the course and for 48 hours after, because it causes severe nausea and flushing. With amoxicillin, alcohol does not interact with the drug but may slow your recovery.
Do antibiotics affect the contraceptive pill?
Current UK guidance says amoxicillin and metronidazole do not reduce the pill’s effectiveness. Extra precautions are only advised if the antibiotic gives you vomiting or diarrhoea.
What if I finished the antibiotics and the pain came back?
That is the expected outcome when the cause was not treated. Book an emergency examination so the tooth can be root filled or removed. A second course rarely helps and adds to resistance.
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