Antibiotics in Endodontics: a review

Abstract

The overuse of antibiotics and the emergence of antibiotic‐resistant bacterial strains is a global concern. This concern is also of importance in terms of the oral microbiota and the use of antibiotics to deal with oral and dental infections. The aim of this paper was to review the current literature on the indications and use of antibiotics and to make recommendations for their prescription in endodontic patients. Odontogenic infections, including endodontic infections, are polymicrobial, and in most cases, the prescription of antibiotics is empirical. This has led to the increasing use of broad‐spectrum antibiotics even in cases where antibiotics are not indicated, such as symptomatic irreversible pulpitis, necrotic pulps and localized acute apical abscesses. In case of discrete and localized swelling, the primary aim is to achieve drainage without additional antibiotics. Adjunctive antibiotic treatment may be necessary in the prevention of the spread of infection, in acute apical abscesses with systemic involvement and in progressive and persistent infections. Medically compromised patients are more susceptible to complication arising from odontogenic infections and antimicrobials have a more specific role in their treatment. Therefore, antibiotics should be considered in patients having systemic diseases with compromised immunity or in patients with a localized congenital or acquired altered defence capacity, such as patients with infective endocarditis, prosthetic cardiac valves or recent prosthetic joint replacement. Penicillin VK, possibly combined with metronidazole to cover anaerobic strains, is still effective in most cases. However, amoxicillin (alone or together with clavulanic acid) is recommended because of better absorption and lower risk of side effects. In case of confirmed penicillin allergy, lincosamides such as clindamycin are the drug of choice.

Antibiotic prescribing for endodontic therapies: a comparative survey between general dental practitioners and final year Bachelor of Dental Surgery students in Cardiff, UK

“…, NICE , ESE ), and for specific situations such as: (i) evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling), (ii) systemic involvement (fever, malaise) (SDCEP , AAE , Segura‐Egea et al . , ESE ) and (iii) significant trismus (SDCEP , AAE , Segura‐Egea et al . , ESE ).…”

“…, Segura‐Egea et al . , ESE ). Coordinated and cooperative international efforts are required to implement evidence‐based policies/guidance and to provide clear detailed strategies to solve this crisis (VMD , O'Neill , ESE ).…”

“…Life‐threatening situations, such as floor‐of‐mouth swelling or difficulty in breathing, should be managed in a hospital setting with the administration of intravenous antibiotics (SDCEP , AAE , Segura‐Egea et al . , ESE ).…”

Antibiotic and Analgesic Prescription Patterns among Dentists or Management of Dental Pain and Infection during Endodontic Treatment

“…However, when the patient presents with diffuse facial swelling (cellulitis) resulting from an acute apical abscess or an infection with systemic involvement (fever or malaise), an appropriate regimen of systemic antibiotics (oral or intravenous) with proper endodontic management (removal of the cause) are the treatments of choice [3]. Similarly, the European Society of Endodontology recommends adjunctive systemic antibiotic treatment in conjunction with endodontic therapy in an acute apical abscess with systemic involvement (localized fluctuant swellings, elevated body temperature >38°C, malaise, lymphadenopathy, trismus, and progressive infections (rapid onset of severe infection within 24 h, cellulitis, or a spreading infection and osteomyelitis) [5]. …”

Rationale for using a double-wavelength (940 nm + 2780 nm) laser in endodontics: literature overview and proof-of-concept

“…Antibiotics are currently overprescribed for the management of endodontic infections such as symptomatic irreversible pulpitis, necrotic pulps and localized acute apical abscesses. However, it is highly recommended that the primary aim while treating teeth with AP and localized swelling or pain is to achieve drainage and disinfection without additional use of antibiotics [121,122]. Despite being limited to two clinical cases, laser-assisted endodontic treatments may support and corroborate this position statement.…”