Pericoronitis

Antibiotics are rarely indicated in Pericoronitis unless there is pyrexia, spreading infection and/or trismus.

Local Measures

  • Irrigate and debride the stagnation area
  • Relieve occlusion by filing down the opposing tooth or extracting as appropriate

Comments

  • Treat pericoronitis in the first instance using local measures to achieve debridement and irrigation of stagnation areas. Antibiotics are only required in the case of spreading infection (cellulitis, lymph node involvement, trismus) or systemic involvement (fever and malaise) 11
  • Pericoronitis is usually caused by gram negative organisms. Metronidazole or amoxicillin are usually effective in treating such infections. The duration of treatment depends on the severity of the infection and the clinical response but drugs are usually given for 3 days 3 .
  • For severe infections consideration should be give to using both amoxicillin and metronidazole in combination. Severe infections include those cases where there is extra-oral swelling, cellulitis or trismus, but it’s a matter of clinical judgement.
  • Where there is significant trismus, floor of the mouth swelling or difficulty breathing, transfer patient to hospital as an emergency.
  • If patient does not respond to the prescribed antibiotic check the diagnosis and consider referral to a specialist.
  • For recurrent pericoronitis consider extraction of the impacted tooth  3 .

Treatment

First line Metronidazole**  Recommended duration 3 days

Age Normal Dose Duration
1-3 years 50 mg Susp TDS 3 Days
3 - 7 years 100 mg Susp BD 3 Days
7-10 years 100 mg susp TDS 3 Days
10-18 years 200-250 mg TDS 3 Days
Adult 400 mg TDS 3 Days

See guidance on dosing in children for quick reference dosage/weight guide.


**Advise patients to avoid alcohol. The anticoagulant effect of Warfarin might be enhanced by Metronidazole3.

Products available: Metronidazole oral suspension 200mg/5ml, 200mg and 400 mg tablets


Alternative Amoxicillin*   Recommended duration 3 days

Amoxicillin is as effective at treating dental infections as phenoxymethylpenicillin (Penicillin V) but is better absorbed.

See guidance on dosing in children for quick reference dosage/weight guide.

Age

 Normal Dose

Maximum Dose

Maximum dose check
(average weight for age)

1-11 months

125mg TDS

30mg/kg per dose
to be given 3 times daily

1 month (4.3kg): 125mg 3 times daily
11 months (8kg): 250mg 3 times daily

1-4 years

250mg TDS

30mg/kg per dose
to be given 3 times daily

1 yr (9kg): 250mg 3 times daily
4 yrs (16kg): 500mg 3 times daily

5-11 years

500mg TDS

30mg/kg per dose
to be given 3 times daily

5 yrs (18kg) : 500mg 3 times daily
11 yrs (35kg): 1g 3 times daily

12-17 years

500mg TDS

1g 3 times daily

1g 3 times daily

Adult

500mg TDS

1g 3 times daily

1g 3 times daily

Please note: various strengths of Amoxicillin powder for suspension available:

  • 125mg/ 1.25ml
  • 125mg/5ml
  • 250mg /5ml

* Amoxicillin and phenoxymethyl penicillin, like other penicillins can cause hypersensitivity reactions including rashes and anyphalaxis and can cause diarrhoea. Do not prescribe to patients with a history of anaphylaxis, urticaria, rash immediately after penicillin administration as these patients are at risk of immediate hypersensitivity³.


Severe Infection

Consider Amoxicillin* plus Metronidazole**

Amoxicillin*

See guidance on dosing in children for quick reference dosage/weight guide.

Age

Amoxicillin Dose for severe infection

Maximum dose check
(average weight for age)

1-4 years

30mg/kg per dose
to be given 3 times daily

1 yr (9kg): 250mg 3 times daily
4 yrs (16kg): 500mg 3 times daily

5-11 years

30mg/kg per dose
to be given 3 times daily

5 yrs (18kg) : 500mg 3 times daily
11 yrs (35kg): 1g 3 times daily

12-17 years

1g 3 times daily

1g 3 times daily

Adult

1g 3 times daily

1g 3 times daily

* Amoxicillin and phenoxymethyl penicillin, like other penicillins can cause hypersensitivity reactions including rashes and anyphalaxis and can cause diarrhoea. Do not prescribe to patients with a history of anaphylaxis, urticaria, rash immediately after penicillin administration as these patients are at risk of immediate hypersensitivity³.

Metronidazole**

Age Normal Dose
Duration
1-3 years 50 mg Susp TDS 5 Days
3-7 years 100 mg Susp BD 5 Days
7-10 years 100 mg Susp TDS 5 Days
10-18 years 200-250 mg TDS 5 Days
Adult 400 mg TDS 5 Days

**Advise patients to avoid alcohol. The anticoagulant effect of Warfarin might be enhanced by Metronidazole3Check for drug interactions before prescribing.


Patient Information

Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)


Reviewed June 2016

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