Are antibiotics absolutely essential for treating an abscess prior to a root canal?

[Karenw]

I have an abscess beneath my lower right #7 crowned tooth. It has probably been there, flaring up occasionally over the last 6 years from the time when the tooth was crowned - an x-ray at the time showed a shadow present under tooth root, and tooth wouldn't numb for the crown. This time there has been no toothache but just a sensitivity to pressure whereas in previous years I've had throbbing toothache and nerve pain, mistakenly diagnosed as probable trigeminal neuralgia.

I've only rarely been prescribed antibiotics and almost always had reactions to them, even on a half-dose - skin flaking, rashes, tongue swelling etc so the dentist was limited in what he could prescribe and I opted for cephalexin which I'd had once before on a low dose for 3 days.

At the dental appointment, I didn't have any pain other than the sensitivity to pressure and the dentist said my immune system was probably dealing with it.

However, this is making me feel quite ill, I can barely stay awake, am dizzy, confused and am managing only half of the 250mg 4x daily 7-day course. I feel thoroughly drained, run-down, weak and wobbly, barely eating, losing weight and am already underweight (8 stone, 5'9") so something like this really knocks me. How critical is the dosage? Would a half-dose be okay bearing in mind my low body weight?

I spoke generally to a GP 'on behalf of a friend' who said antibiotics should not be routinely prescribed for a dental abscess unless it has spread. Is this true?

 

[MountainMama]

My dentist gave me antibiotics for my abscess, but told me that she didn't generally prescribe them for abscesses. Mine was quite large and she wanted to try to get it somewhat contained before the root canal. I also have difficulty getting numb, and she said that some people have more difficulty with numbing with an abscess, as the acidity of the abscess can make the local anesthetic ineffective. However, that is not true for all people, and she did say I could go without.

I chose to take them because of my fear of not getting numb and I didn't want to take a chance.

 

[Karenw]

Thank you.

The thought they might not be essential is reassuring.

I'm really struggling to take even a half or quarter dose and right now, taking this stuff has become more of a worry than the root canal itself...

 

[MountainMama]

My husband had a terrible abscess that he did not take antibiotics with. He had the root canal and had no issues at all with numbing.

 

[Gordon]

I agree with your GP.

Taking a smaller amount than the prescribed dose is a very bad idea, either take them as prescribed or don't take them.

 

[SallyUK]

@Karenw I can empathise with some of your reactions to the antibiotics. I would suggest you contact your dentist or GP or pharmacist and explain your side effects. This is what I did and was better able to decide if I wanted to stop them or keep going. With regard to necessity. Like mountain mama I have not always taken antibiotics for infections, in fact not for anything in 20 years until recently but my dentist wanted to reduce the infection before treatment as it was large on the X-ray.

 

[Karenw]

Thank you @MountainMama, @Gordon and @SallyUK for your replies.

I really couldn't face any more of the cephalexin - I'm really not good with meds. Historically I've had very, very few and only ever half/children's doses of antibiotics. I realise prescribing rules are much tighter now.

On advice from a friend in the NHS, I rang NHS111 and went through two standard questionnaire assessments but was then referred back to the GP surgery where the nurse assessor said that some people simply do not get on with antibiotics and if I was not in severe pain (I'm not - the tooth is just sensitive) then it would be better to stop. However, I must monitor for any further signs of infection including an increase in pain, swelling, redness or a rise in my body temperature.

I have contacted my dental surgery to keep them updated and asked them to let me know if they feel this is bad advice or I am doing anything 'wrong' or if this could jeopardise the root canal planned for 26/2. I haven't had any response but think the dentist is away at present.

Having looked back at old dental x-rays, it now looks as though I've had the abscess since at least January 2008 with an occasional 'full' feeling in my jaw which I have always assumed to be due to the adjacent impacted wisdom tooth, but I now know otherwise.

I don't think the abscess is large - or at least I hope not.

Again, thank you for your replies. I have felt rather worried regarding this (and the root canal to follow).