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Endodontics Supporting Your Practice

What is the effect of antibiotics in the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess?

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This is a summary of the article: "Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess. Systematic review and meta-analysisda report of the American Dental Association" in the December 2019 edition of the Journal of the American Dental Association.

 

Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immuno-competent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use.

Clinical Implications

Evidence for antibiotics, either alone or as adjuncts to definitive, conservative dental treatment, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.

Evidence also suggests large potential harms associated with antibiotic use for any condition for the outcomes of community-associated Clostridioides difficile infection (CDI), mortality due to community-associated Clostridioides difficile infection (CDI), antibiotic-resistant infections, and mortality due to antibiotic-resistant infections.

Clinical decision making should include this summary of benefits and harms along with other pertinent considerations, including the patient’s values and preferences, acceptability, and feasibility.

I hope you you find the  information helpful. We always look forward to hearing your thoughts and receiving your questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
Chiraz Guessaier, CDA Oasis Manager

Select pulpal and periapical conditions and their clinical signs and symptoms

Symptomatic Irreversible Pulpitis A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Additional descriptors: lingering thermal pain, spontaneous pain, referred pain.
Symptomatic Apical Periodontitis Inflammation usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation. It might or might not be associated with an apical radiolucent area.
Pulp Necrosis and Symptomatic Apical Periodontitis A clinical diagnostic category indicating death of the dental pulp. The pulp is usually
non-responsive to pulp testing.

Inflammation usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation. It might or might not be associated with an apical radiolucent area.

Pulp Necrosis and Localized Acute Apical Abscess A clinical diagnostic category indicating death of the dental pulp. The pulp is usually
non-responsive to pulp testing.

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.

Source: American Association of Endodontists. Glossary of endodontic terms. Available at: http://www.nxtbook.com/nxtbooks/aae/endodonticglossary2016/index.php Accessed December 2019. 

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