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Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling
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11 2019
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Source: J Am Dent Assoc. 150(11):906-921.e12
[PDF-555.54 KB]
Details:
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Alternative Title:J Am Dent Assoc
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Personal Author:
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Description: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 CINAHL to retrieve evidence on benefits and harms associated with antibiotic use. Authors used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty in the evidence, and the Evidence-to-Decisions Framework.
Results:
The panel formulated five clinical recommendations and two good practice statements, each specific to the target conditions, for settings where DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in the majority of clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (e.g., malaise, fever) due to the dental conditions, or when the risk of progression to systemic involvement is high.
Conclusion and Practical Implications:
Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contributes to large harms. The expert panel only suggests antibiotics for target conditions when systemic involvement is present, and immediate DCDT should be prioritized in all cases.
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Pubmed ID:31668170
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Pubmed Central ID:PMC8270006
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