Metronidazole is a widely used antibiotic in dentistry due to its high efficacy against anaerobic bacteria — microorganisms frequently involved in oral infections.
From periapical infections to severe periodontitis, metronidazole has proven to be a valuable tool for modern dental practice.
What is Metronidazole?
Metronidazole is a bactericidal antimicrobial agent that works by disrupting bacterial DNA, leading to cell death.
It is particularly effective against strict anaerobic bacteria and some protozoa.
In dentistry, its primary use is in the treatment of anaerobic-origin infections.
Main Dental Indications
Metronidazole is commonly used in the following dental conditions:
✔ Severe periodontal infections: such as aggressive and chronic periodontitis.
✔ Dental abscesses: especially those predominantly caused by anaerobic bacteria.
✔ Endodontic infections: as part of the management of acute periapical infections.
✔ Pericoronitis: infection and inflammation of the tissue surrounding a partially erupted tooth, like a third molar.
✔ Osteomyelitis of the jaws: as an adjunctive therapy along with broader-spectrum antibiotics.
✔ Prevention of postoperative infections: particularly in high-risk surgical procedures.
► Read also: Doxycycline in Periodontal Therapy: Clinical Applications, Mechanisms, and Recent Evidence
How is Metronidazole Used in Dentistry?
Metronidazole is rarely used alone. It is most often combined with other antibiotics, such as:
✔ Amoxicillin or Amoxicillin-clavulanic acid, to cover both aerobic and anaerobic bacteria.
✔ In penicillin-allergic patients, it can be combined with alternatives like azithromycin or clindamycin, although each case should be evaluated individually.
Common dental dosage
✔ 250–500 mg every 8 hours for 7 to 10 days, depending on the severity of the infection.
Important: Metronidazole should always be prescribed and monitored by a healthcare professional to avoid bacterial resistance and adverse effects.
Clinical Considerations
✔ Alcohol consumption: Strictly contraindicated during therapy and up to 48 hours after the last dose, due to the risk of a disulfiram-like reaction (nausea, vomiting, tachycardia).
✔ Side effects: Metallic taste, nausea, gastrointestinal discomfort, and in prolonged treatments, risk of peripheral neuropathy.
✔ Drug interactions: Metronidazole may enhance the effect of anticoagulants like warfarin, requiring careful monitoring.
✔ Pregnancy and lactation: Contraindicated during the first trimester; cautious use is advised during the second and third trimesters based on medical evaluation.
Advantages of Metronidazole in Dentistry
✔ Highly effective against anaerobic pathogens involved in deep dental infections.
✔ Rapid oral absorption.
✔ Good penetration into inflamed and infected tissues.
Conclusion
Metronidazole remains a cornerstone in the dental management of severe oral infections.
Its rational use, based on scientific evidence and professional guidance, greatly contributes to treatment success and helps prevent complications.
References
- Herrera D, Alonso B, León R, Roldán S, Sanz M. Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. J Clin Periodontol. 2008;35(8 Suppl):45-66. doi:10.1111/j.1600-051X.2008.01267.x
- Feres M, Figueiredo LC, Soares GM, Faveri M. Systemic antibiotics in the treatment of periodontitis. Periodontol 2000. 2015;67(1):131-186. doi:10.1111/prd.12075
