The overuse of antibiotics and the emergence of antibiotic resistant bacterial strains is a global concern. As dentists prescribe approximately 10% of antibiotics dispensed in primary care, it is important not to underestimate the potential contribution of the dental profession to the development of antibiotic resistant bacteria.
A review published in the “International Endodontic Journal” analyzed the current literature on the indications and use of antibiotics and made recommendations for their prescription in endodontic patients.
WHICH ANTIBIOTICS ARE USED IN ENDODONTICS?
In dentistry, antibiotic prescription is empirical because the dentist does not know what microorganisms are responsible for the infection, as samples from the root canal or periapical region are not commonly taken and analysed. The most widely used antibiotic in the endodontics is amoxicillin, due to its sufficiently wide spectrum, greater antibacteria effectiveness, low incidence of resistance, pharmacokinetic profile, tolerance and dosage. The other antibiotics used in case of odontogenic infections are shown in table 1, with the corresponding dosage.
SYSTEMATIC USE OF ANTIBIOTICS IN ENDODONTIC INFECTIONS
As shown in table 2, antibiotics are unnecessary in case of: irreversible pulpitis, necrotic pulps and localized acute apical abscesses, because of abscence of blood circulation, antibiotics can’t reach the area.
Instead, they are necessary in case of: acute apical abscess, progressive and persistent infection. In particular, in case of abscess with systemic involvement, first of all it’s necessary an incision for drainage and than the sub-ministration of antibiotics to avoid the spread of transudate and exudate via interstitial and tissue spaces.
SYSTEMIC ANTIBIOTIC USE IN THE TREATMENT OF TRAUMATIC INJURIES OF THE TEETH
As shown in table 3, the use of antibiotics is indicated only in the case of replantation of avulsed teeth, because positive effects have been shown in periodontal and pulpal healing in experimental studies, specifically using topical application.
In other cases there is no scientific evidence of benefits from these.
TOPICAL ANTIBIOTICS USE IN ENDO
The use of topical antibiotics has been proposed for several endodontic treatments, such as: pulp cupping, root canal treatment, regenerative endodontic procedures, tooth avulsion.
For all these reasons, the use of systemic and topical antibiotics should be limited to these specific cases.
For additional information:
Antibiotics in Endodontics: a review. Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. Int Endod J. 2017 Dec;50(12):1169-1184. doi: 10.1111/iej.12741. Epub 2017 Jan 16.
Endodontics 23 March 2021
Endodontics 04 February 2021
Authors:Barbara G. Nunez Torrijos, Gianluca Plotino, Simone Staffoli, Eugenio Pedullà, Maurizio Bossù, Gianluca Gambarini, Antonella Polimeni
Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth, but they still present some drawbacks. With both...
Endodontics 12 January 2021
Oral pathology 04 August 2021
Authors: Marco Campana, Mariani Umberto, Valeria Martini, Riccardo Bonacina, Sonzogni Aurelio
The Objectives of this work are to propose a literature review from 2008 up to 2018 about oral manifestations of sarcoidosis and scar-sarcoidosis and to introduce a rare case of a primary intraoral...
News 04 August 2021
Oral pathology 02 August 2021
Authors: Emanuela Serritella, Paola Di Giacomo, Chiara Vompi, Gianni Falisi, Carlo Di Paolo
Aim: This study aims to compare the epidemiological data of three cohorts of dysfunctional patients attending to the Clinical Gnathology Service of “Policlinico Umberto I University Hospital...