American Dental Association recommends against the use of antibiotics in most toothache cases
CHICAGO, U.S.: To combat the menace of antibiotic overprescription of antibiotics that results in the development of antibiotic-resistant bacteria, the American Dental Association (ADA) has issued a new set of guidelines recommending that antibiotics are not needed in most toothache cases.
Various reports published recently (2017 -2019) suggest that 30- 85% of dental antibiotic prescriptions are either suboptimal or not indicated, raising the cost-related and public health concerns, which has made the appropriate use of antibiotics a critical issue in the health care agenda.
The new guidelines published in the Journal of American Dental Association recommend against the use of antibiotics for most pulpal and periapical conditions. Instead, they recommend, if needed, over-the-counter pain relievers such as acetaminophen and ibuprofen.
Definitive, Conservative Dental Treatment (DCDT) refers to pulpotomy, pulpectomy, nonsurgical root canal treatment, or incision for drainage abscess. Only those clinicians, who are authorized or trained to perform the specified treatment, should do so. The new report has developed an algorithm to identify where and how to prescribe antibiotics as an adjunct to DCDT.
With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability.
A vital pulp with symptomatic irreversible pulpitis or a necrotic pulp with symptomatic apical periodontitis does not warrant antibiotic prescription if there is only pain and no swelling. The report quotes enough evidence that suggests that nonsteroidal anti-inflammatory drugs may be effective in managing dental pain. Dentists should consider antibiotics only in cases of pain with swelling, and that too when an acute apical abscess leads to systemic involvement (fever, swollen lymph nodes etc).
The expert panel recommends both amoxicillin and penicillin as first-line treatments but prefers amoxicillin over penicillin because of two reasons. First, amoxicillin is more effective against a range of gram-negative anaerobes, and second, it is associated with a lower incidence of gastrointestinal adverse effects.
Dentists should reevaluate the clinical condition within 3 days. Also, they should instruct their patients to discontinue antibiotics 24 hours after their symptoms resolve, irrespective of reevaluation after 3 days.
Due to a higher bacterial resistance demonstrated by azithromycin compared to other antibiotics, patients on azithromycin should be instructed to closely monitor their symptoms and call their dentist if their infection worsens while on therapy.
The guideline, titled “Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association,” was published in the November 2019 issue of the Journal of the American Dental Association.