The use of broad-spectrum antibiotics in dentistry is common, on the rise, and problematic. Prescriptions are written too often when not indicated (for example, for symptomatic irreversible pulpitis, necrotic pulps, and localized acute apical abscesses), said the authors of an article who sought to recommend more judicious applications of antibiotics in endodontics.
In an article published January 16 in International Endodontic Journal, the European authors examined the current literature regarding the indications and use of antibiotics in dentistry with the aim of providing guidance to endodontists. The authors declared that dentists generally prescribe about 10% of antibiotics dispensed in primary care and “it is important not to underestimate the potential contribution of the dental profession to the development of antibiotic-resistant bacteria … .”
The authors examined antibiotic prophylaxis as an adjunct to endodontic therapies (irreversible pulpitis, acute apical periodontitis, and progressive infections) and for treatment of traumatic injuries to teeth (luxation injuries and replantation of avulsed tooth). They also examined the use of topical antibiotics in pulp capping, root canal treatments, regenerative endodontic procedures, and replantation of avulsed tooth.
They determined that antibiotics were to be avoided as adjuncts in favor of other approaches, specifically when treating symptomatic irreversible pulpitis, pulp necrosis, acute apical periodontitis, chronic apical abscess, and acute apical abscess with no systemic involvement.
They examined 5 types of traumatic injury. The only 1 for which antibiotic prophylaxis was indicated was replantation of avulsed teeth. In those cases, antibiotics should be prescribed for the shortest, most effective time and not as substitutes for endodontic treatment.
“The key to obtaining a successful result in an endodontic infection is the chemomechanical removal of the infecting agent from the root canal system as well as drainage of pus,” wrote the authors. “The indications for antibiotic administration should be considered very carefully and only as an adjunct to endodontic treatment, which is the major and indispensable procedure for obtaining the optimum outcome in lesions of endodontic origin.”
The authors concluded that endodontists can avoid overprescription of antibiotics by limiting them to instances in which infection is persistent, progressive, or systemic or when the patient is medically compromised in specific ways, including having infective endocarditis, immune system deficiencies, and certain prosthetics. The authors recommended the use of certain antibiotics. “Although penicillin VK, possibly combined with metronidazole to cover anaerobic strains, is still effective in most cases, amoxicillin (alone or together with clavulanic acid) is recommended because of better absorption and lower risk of side effects,” they wrote. “In case of confirmed penicillin allergy, lincosamides, such as clindamycin, are the drug of choice.”
Consulting Editor: Susan Wood, DDS
Diplomate, American Board of Endodontics