Dental Drug Guide,
evidence-based prescribing.

Quick-reference prescribing for referring dentists — antibiotics, analgesics, premedication, steroids, anxiolytics, and a pediatric antibiotic dose calculator. Built on current AAE, ADA, and AHA guidance.

AAE — Systemic Antibiotics Guidance ADA 2024 — Acute Dental Pain Guideline AHA 2021 — IE Prophylaxis

Curated by Dr. Sean Lawson, DDS, MSD — Diplomate, American Board of Endodontics · Lawson Endodontics, Roanoke VA

When to prescribe (AAE guidance): antibiotics are not indicated for symptomatic irreversible pulpitis or a localized abscess without systemic involvement — definitive endodontic treatment (debridement, drainage) is the cure. Reserve systemic antibiotics for fever, malaise, lymphadenopathy, trismus, progressive or spreading swelling / cellulitis, or immunocompromised patients. Reassess within 48–72 hours; use the shortest effective course.
AmoxicillinFirst line
Amoxil, Trimox
Dose
500 mg tabs
Disp
21 tablets
SigTake 1 tablet by mouth every 8 hours for up to 7 days (reassess at 48–72 h; stop when resolving).
  • Optional loading dose: 1,000 mg first dose.
  • Severe infection alternative: 875 mg every 12 hours.
  • Preferred over broader agents — narrow spectrum, well tolerated.
Do not prescribe with penicillin allergy — see cephalexin (non-anaphylactic) or azithromycin (true allergy).
Penicillin VKFirst line
Pen-Vee K, Veetids
Dose
500 mg tabs
Disp
28 tablets
SigTake 1 tablet by mouth every 6 hours for up to 7 days (reassess at 48–72 h).
  • Narrowest-spectrum option for odontogenic infections.
  • QID dosing may reduce compliance vs amoxicillin.
Contraindicated with penicillin allergy.
Amoxicillin / ClavulanateEscalation
Augmentin
Dose
500/125 mg
Disp
21 tablets
SigTake 1 tablet by mouth every 8 hours for 7 days (or 875/125 mg every 12 hours).
  • For persistent or spreading infection when first-line therapy fails.
  • Take with food to reduce GI upset.
Contraindicated with penicillin allergy. Higher rate of GI side effects.
MetronidazoleAdjunct
Flagyl
Dose
500 mg tabs
Disp
21 tablets
SigTake 1 tablet by mouth every 8 hours for 7 days — in addition to amoxicillin or penicillin VK.
  • Add-on when no improvement after 48–72 h of first-line therapy (anaerobic coverage).
  • Never used alone for odontogenic infections.
No alcohol during and 72 h after course (disulfiram-like reaction). Avoid with warfarin where possible.
CephalexinPen allergy — non-anaphylactic
Keflex
Dose
500 mg caps
Disp
28 capsules
SigTake 1 capsule by mouth every 6 hours for up to 7 days.
  • Appropriate when the penicillin reaction was not anaphylaxis, angioedema, or hives.
  • Ask what the "allergy" actually was — most reported penicillin allergies are not true allergies.
Avoid if history of anaphylaxis, angioedema, or hives with any penicillin.
AzithromycinTrue pen allergy
Zithromax, Z-Pak
Dose
250 mg tabs
Disp
6 tablets
SigTake 2 tablets (500 mg) on day 1, then 1 tablet (250 mg) daily on days 2–5.
  • Primary alternative for true penicillin allergy (anaphylaxis / angioedema / hives).
QT-prolongation risk — caution with antiarrhythmics and other QT-prolonging drugs.
ClindamycinLast resort
Cleocin
Dose
300 mg caps
Disp
28 capsules
SigTake 1 capsule by mouth every 6 hours for up to 7 days.
  • Only when the patient cannot take azithromycin or cephalexin.
  • No longer a routine penicillin-allergy alternative.
FDA boxed warning: Clostridioides difficile colitis — can occur after a single dose. Counsel patients to stop and call if significant diarrhea develops.
ADA 2024 acute dental pain guideline: NSAIDs alone or with acetaminophen are first line for adolescents (12+) and adults — more effective than opioid combinations for dental pain. Reserve opioids for when first-line therapy is insufficient or contraindicated; avoid "just-in-case" prescribing; limit to ≤ 3 days.
IbuprofenFirst line
Motrin, Advil
Dose
400–600 mg
Max/day
3,200 mg (Rx)
SigTake 400–600 mg by mouth every 6 hours as needed for pain, with food.
  • Analgesic ceiling ~400 mg; higher doses add anti-inflammatory effect.
Avoid with GI ulcer/bleeding history, significant renal disease, anticoagulants, aspirin-sensitive asthma, and in 3rd-trimester pregnancy.
Ibuprofen + AcetaminophenModerate–severe
combination regimen
Dose
400–600 / 500–1000 mg
Max/day
3,200 / 3,000 mg
SigTake ibuprofen 400–600 mg + acetaminophen 500–1,000 mg together every 6 hours as needed for pain.
  • The evidence-based workhorse for post-endodontic pain — outperforms opioid combinations.
  • Can also alternate the two q3h for steadier coverage.
Count acetaminophen from ALL sources (combination products, OTC). Hepatic disease: reduce or avoid APAP.
Naproxen
Aleve, Naprosyn
Dose
440–550 mg
Max/day
1,100 mg (OTC)
SigTake 1 tablet by mouth every 12 hours as needed for pain, with food.
  • Longer duration — convenient q12h dosing for overnight coverage.
Same NSAID precautions as ibuprofen. Do not combine two NSAIDs.
Acetaminophen (alone)NSAID contraindicated
Tylenol
Dose
650–1,000 mg
Max/day
3,000–4,000 mg
SigTake 650–1,000 mg by mouth every 6 hours as needed for pain.
  • First choice when NSAIDs are contraindicated (GI, renal, anticoagulation, pregnancy).
Hepatotoxicity — 3,000 mg/day ceiling advisable in older adults, hepatic disease, or regular alcohol use.
Opioid escalationRescue only
hydrocodone/APAP 7.5/325 · oxycodone 5 mg
Dose
1 tab
Limit
≤ 3 days
SigContinue the NSAID; add acetaminophen 325 mg + one combination tablet (e.g., hydrocodone 7.5 mg / APAP 325 mg) every 6 hours as needed for severe breakthrough pain.
  • Only when NSAID ± APAP is insufficient or contraindicated (ADA 2024).
  • Smallest quantity, shortest duration; no routine "just-in-case" scripts.
Extreme caution in adolescents and young adults. No driving; no alcohol or benzodiazepines. Check your state PDMP.
Who needs it (AHA 2021): prosthetic cardiac valve or prosthetic material used for valve repair · previous infective endocarditis · specific congenital heart disease (unrepaired cyanotic CHD; repaired CHD with residual defects or during first 6 months after repair with prosthetic material) · cardiac transplant with valvulopathy.

Who doesn't: routine prophylaxis for prosthetic joints is not recommended — coordinate with the orthopedic surgeon for unusual cases. Clindamycin was removed from the AHA regimens (2021) due to severe adverse-event risk. Give the dose 30–60 minutes before the procedure; if missed, it may be given up to 2 hours after.
AmoxicillinStandard
oral, able to take PO
Adult
2 g PO
Child
50 mg/kg PO
SigSingle dose 30–60 minutes before the procedure.
CephalexinPen allergy — non-anaphylactic
Keflex
Adult
2 g PO
Child
50 mg/kg PO
SigSingle dose 30–60 minutes before the procedure.
Avoid if the penicillin reaction was anaphylaxis, angioedema, or hives.
Azithromycin / ClarithromycinPen allergy
Adult
500 mg PO
Child
15 mg/kg PO
SigSingle dose 30–60 minutes before the procedure.
DoxycyclinePen allergy
Adult
100 mg PO
Child <45 kg
2.2 mg/kg PO
SigSingle dose 30–60 minutes before the procedure.
Unable to take oral meds
IM / IV options
  • Ampicillin 2 g IM/IV (child 50 mg/kg)
  • Cefazolin or Ceftriaxone 1 g IM/IV (child 50 mg/kg)
SigSingle dose within 30–60 minutes before the procedure.
Use case: short-course corticosteroids can reduce severe post-operative inflammatory pain and swelling (e.g., after surgical endodontics or significant flare-ups). Short bursts do not require tapering. Do not prescribe with an active, undrained infection unless antibiotic coverage is on board. Caution: diabetes (glucose elevation), peptic ulcer disease, active infections (TB, herpes, fungal), psychiatric instability.
DexamethasoneCommon endo regimen
Decadron
Dose
4 mg tabs
Disp
4 tablets
SigTake 2 tablets (8 mg) day of procedure, then 1 tablet (4 mg) each morning for 2 days.
  • Potent, long-acting; effective for post-surgical edema and flare-up pain.
Methylprednisolone
Medrol Dosepak (4 mg)
Dose
4 mg tabs
Disp
1 Dosepak (21 tabs)
SigTake as directed on the package — tapering dose over 6 days (24 mg → 4 mg).
  • Convenient pre-packaged taper; patient instructions printed on the pack.
Prednisone
Deltasone
Dose
20 mg tabs
Disp
6–10 tablets
SigTake 2 tablets (40 mg) by mouth each morning with food for 3–5 days.
  • Short burst — no taper needed at ≤ 5 days.
  • Morning dosing reduces insomnia and mimics diurnal cortisol.
Minimal sedation ground rules: confirm your state permit requirements for enteral sedation · adult escort required — no driving or important decisions for 24 h · avoid combining with opioids, alcohol, or other CNS depressants · contraindicated in pregnancy and untreated narrow-angle glaucoma · halve doses in older adults and consider avoiding in severe hepatic disease or sleep apnea. Have flumazenil available when using benzodiazepines.
TriazolamMost used in dentistry
Halcion
Dose
0.25 mg tab
Disp
1–2 tablets
SigTake 1 tablet by mouth 30–60 minutes before the appointment (range 0.125–0.5 mg; sublingual speeds onset).
  • Short half-life — ideal for dental appointment length.
  • Elderly: start at 0.125 mg.
Avoid grapefruit juice and CYP3A4 inhibitors (erythromycin, ketoconazole, some antivirals) — marked potentiation.
Diazepam
Valium
Dose
5–10 mg tab
Disp
1–2 tablets
SigTake 5–10 mg by mouth 1 hour before the appointment (± 5–10 mg at bedtime the night before for sleep).
  • Long half-life with active metabolites — prolonged drowsiness possible.
Lorazepam
Ativan
Dose
1–2 mg tab
Disp
1–2 tablets
SigTake 1–2 mg by mouth 1 hour before the appointment.
  • Intermediate duration — good for longer appointments; no CYP3A4 interaction (glucuronidated).
HydroxyzineNon-benzodiazepine
Vistaril, Atarax
Dose
25–50 mg
Disp
1–2 capsules
SigTake 25–50 mg by mouth 1 hour before the appointment.
  • Mild anxiolysis + antiemetic; useful when benzodiazepines are unsuitable.
  • Antihistamine dry-mouth effect; QT caution at high doses.
Nitrous oxide / oxygen
in-office inhalation
  • Titratable, rapid on/offset, patient drives home — often the simplest option.
  • Can be combined cautiously with a single oral benzodiazepine dose (this becomes moderate-sedation territory in many states — verify permit level).
  • Avoid in first-trimester pregnancy, severe COPD, recent vitreoretinal surgery, B12 deficiency concerns.
Reference tool for licensed clinicians only — not a substitute for clinical judgment. Verify dosing, allergies, interactions, and renal/hepatic adjustments against current AAE, AAPD, ADA, and AHA references and the product label before prescribing. Per-dose amounts are capped at the usual adult maximum. Round suspension volumes to a measurable amount for the dispensed product.
Clinical disclaimer: This guide is a quick reference for licensed dental professionals, based on AAE guidance on systemic antibiotics, the AHA 2021 statement on infective endocarditis prevention, and the ADA 2024 acute dental pain guideline. Verify all doses against current prescribing information and individual patient factors (allergies, renal/hepatic function, pregnancy, interactions). Final prescribing decisions rest with the treating clinician.