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

Peter B. Lockhart, Malavika P. Tampi, Elliot Abt, Anita Aminoshariae, Michael J. Durkin, Ashraf F. Fouad, Prerna Gopal, Benjamin W. Hatten, Erinne Kennedy, Melanie S. Lang, Lauren L. Patton, Thomas Paumier, Katie J. Suda, Lauren Pilcher, Olivia Urquhart, Kelly K. O'Brien, Alonso Carrasco-Labra

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

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.

Original languageEnglish
Pages (from-to)906-921.e12
JournalJournal of the American Dental Association
Volume150
Issue number11
DOIs
StatePublished - Nov 2019

Keywords

  • Antibiotics
  • antibiotic stewardship
  • clinical practice guideline
  • localized acute apical abscess
  • pulp necrosis
  • symptomatic apical periodontitis
  • symptomatic irreversible pulpitis

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