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Antibiotics Not Recommended for Most Toothaches

Antibiotics recommended for systemic involvement or with high risk for experiencing progression

dental xrays

FRIDAY, Oct. 25, 2019 (HealthDay News) -- Antibiotics are not recommended for urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis, and symptomatic apical periodontitis or for pulp necrosis and localized acute apical abscess in immunocompetent adults, according to an evidence-based clinical practice guideline published in the November issue of the Journal of the American Dental Association.

Peter B. Lockhart, D.D.S., from Carolinas Medical Center-Atrium Health in Charlotte, North Carolina, and colleagues 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 alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults.

The authors formulated five clinical recommendations and two good practice statements, which were specific to the target conditions. In most clinical scenarios, regardless of DCDT availability, the panel recommended against using antibiotics due to likely negligible benefits and potentially large harms. In patients with systemic involvement due to the dental conditions or when the risk experiencing progression to systemic involvement was deemed high, antibiotics were recommended.

"Antibiotics are, of course, tremendously important medications," Lockhart said in a statement. "However, it's vital that we use them wisely so that they continue to be effective when absolutely needed."

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