How Did Amoxicillin Become A Treatment For Dental Abscesses?

In an age of greater awareness and responsibility surrounding antibiotics such as amoxicillin, they are typically prescribed and provided to people when it is either the best course of treatment or the only option.

This is the case with dental abscesses, which in most cases are treated with a mix of drainage and cleaning of the swelling and a short course of antibiotics, although in some cases antibiotics are provided whilst waiting for a dental appointment.

Understanding why this is the case involves an exploration into the development of amoxicillin itself, how germ theory and antibiotics transformed dental health and the rise of the Antibiotic Era that changed the world as we know it.

Why Do Dental Abscesses Form?

People have been treating dental abscesses for tens of thousands of years, as whilst the precise cause of bacterial infection and decay of dental pulp is a more recent development, the sharp pain, swelling and pus caused by an abscess was a clear signifier of a dental issue.

Early treatments involved drilling and filling to relieve pressure as a tooth-specific form of trepanation, but this treatment was more common in certain parts of the world compared to others.

Traces of the antibiotic tetracycline were found in a skeleton found in Sudanese Nubia dating almost 1700 years ago, and other apothecary and herbalist traditions have used ingredients that contain antibiotic materials which may have helped reduce the onset of dental swelling.

However, the ways in which antibiotics functioned were not understood at the time, and until that was the case, dental infections were treated with a methodology of using what works but without knowing how it could be refined. At the time, dental extractions were far more common in the case of infection.

This would start to change in the 18th and 19th centuries.

The Rise Of Modern Dentistry And Gum Health

Modern dentistry is typically agreed to have begun with Pierre Fauchard, “The Surgical Dentist” who catalogued, developed and published the first books on dentistry.

He was one of the first to promote preventative care and posit the view that both dental caries and abscesses were caused by infection exacerbated by sugars and acids, denouncing the concept of a “tooth worm” that had been common in early dentistry.

His work was deeply influential, and whilst his work was still missing some fundamental details due to the limitations of medical knowledge and technology at the time, his book on dentistry had a lot of advice that is still provided in modern dental health.

In fact, the root cause of both dental decay and dental abscesses would not be determined until nearly a century after his death.

The Rise Of Germ Theory In Dentistry

Dental infections were known about, and many of their causes had been discovered, but a missing piece that stopped the development of effective medical solutions was the reason why. 

This was discovered thanks to a water pump in London.

In both dentistry and surgery more broadly, a major concern was the risk of infection, and something that did not help was a lack of understanding of the organisms that caused infection.

Up until the 19th century, the primary belief was based around miasma theory, an ancient idea that diseases were caused by an emanating bad air or smell.

Whilst completely false, it did overlap with certain hygiene practices, such as the desire to clean up areas to avoid noxious smells, such as those caused by foul water and rotting food.

This began to change in the 1850s, particularly thanks to John Snow and his investigation of a cholera outbreak on Broad Street in London in 1854.

Cholera, itself a bacterial infection, was one of the deadliest diseases of the 19th century, but Mr Snow found that the vast majority of deaths were located close to one particular pump, which turned out to have been infected by a leaking cesspit.

This discovery would soon form the germ theory of disease, as proven by Louis Pasteur and applied by Joseph Lister, both of which revolutionised surgery, emphasised the importance of hygiene and would have a huge influence on dentistry even before antibiotic medicines became available.

The London-based dentist Ashley Barrett was believed to be the first to treat dental abscesses through disinfection via the use of carbolic acid (phenol), which prevented further decay and infection.

Arsphenamine, Penicillin And The Dawn Of Antibiotics

The discovery of germ theory began a search for a “magic bullet” that could kill bacteria without harming healthy tissue, and German scientist Dr Paul Ehrlich was the first to find one.

Inspired by the composition of staining dyes, which affected cells in different ways. The logic, therefore, was that certain medications could also be modified to destroy harmful bacteria.

By 1907, arsphenamine had been discovered, and by 1909 it became the leading treatment for syphilis compared to mercury because of its antibacterial properties that did not cause harm to people.

However, the most important antibiotic ever made was famously discovered by accident in 1928 by Alexander Fleming, when a culture plate became contaminated by a fungus that killed the bacteria.

This was the first antibiotic, but it needed to be synthesised and developed before it could be used to save lives, something attempted by Sir Alexander but ultimately accomplished by Howard Florey and Ernst Chain, all three of which share the Nobel Prize for its discovery.

The Antibiotic Era And Amoxicillin

Following the beginning of mass production of penicillin in 1943, the primary goals were to expand the number of treatable diseases and to increase the amount that could be produced in order to lower the cost per dose. 

Natural penicillins break down due to stomach acid, meaning that they needed to be injected and thus were limited in the diseases they could treat.

Both of these elements were aided significantly by the discovery of 6-aminopenicillanic acid (6-APA), which is at the root of penicillin and could create more effective derivative medications that make it more effective and allow it to be taken in liquid or tablet form.

The second of these after ampicillin is amoxicillin, which was first produced in 1972 by The Beecham Group, and has since become a widely prescribed antibiotic that has proven to be highly effective for treating dental abscesses in combination with other dental interventions.