Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling

Abstract

Background. An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults. Types of Studies Reviewed. The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework. Results. The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high. Conclusion and Practical Implications. Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.

Modifications of emergency dental clinic protocols to combat COVID‐19 transmission

“…In many cases, this process alleviated the need for in‐office visits by recommending over‐the‐counter pain management regiments and in select cases antibiotic prescriptions. Antibiotics were prescribed based on the antibiotic stewardship guidelines from the ADA 31 . Urgent but not emergent patients would only be scheduled on days that emergency patients as defined above were scheduled.…”

Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess

“…We conducted this review in collaboration with an expert panel during the development of an associated clinical practice guideline. 12 For Cochrane Reviews licensed under the standard Cochrane license for publication, the Cochrane Collaboration grants each user a nonexclusive, nontransferable, perpetual, royalty-free, worldwide license for noncommercial use of the data. Users may extract, download, and make copies of the information contained in the data and may share that information with third parties.…”

“…Its content informed the development of a clinical practice guideline on the appropriate use of antibiotics for the urgent management of pulpal-and periapical-related pain and intraoral swelling published in The Journal of the American Dental Association. 12…”

Plain language summary for “Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: systematic review and meta-analysis—a report of the American Dental Association”

“…3 This systematic review was used to collect and synthesize evidence to inform the first comprehensive guideline on appropriate antibiotic prescribing for pulpal-and periapical-related dental pain and associated intraoral swelling for general dentists in the United States. 1 This information is important for dentists who prescribe antibiotics for these conditions, as well as for patients who seek care in settings in which DCDT, such as pulpectomy, pulpotomy, nonsurgical root canal therapy, and incision and drainage of abscess may not always be available (for example, hospital emergency departments). However, this information is also important for practitioners and patients in settings in which DCDT, with or without the additional use of antibiotics, can be delivered.…”

“…The guideline presents recommendations on the use of antibiotics for the urgent management of dental pain and intraoral swelling in adults who have the ability to fight a bacterial infection. 1 This systematic review and meta-analysis presents the evidence informing the effect (benefits and harms) of antibiotic use on this patient population and the certainty (quality) of this evidence. 2…”