ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title |
Antibiotics Do Not Lower Pain or Infection with Acute Apical Abscess |
Clinical Question |
In adults receiving emergency treatment for their periapical abscess, will antibiotic supplement to pulpectomy treatment with irrigation and drainage of their abscess be more beneficial in reducing the patient's pain compared to treatment without antibiotics? |
Clinical Bottom Line |
Pain with acute apical abscess of permanent dentition is managed well by pulpectomy with irrigation and drainage. The addition of antibiotic therapy does not improve the patient's relief from pain or infection. |
Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
#1) 14611715 | Matthews/2003 | 35 relevant citations including 8 randomized clinical trials with 618 adults experiencing a symptomatic acute abscess or symptomatic necrotic tooth | Meta-Analysis | Key results | There were 8 randomized trials included in this study. Four studies measured the absence of pain without significant results with the addition of antibiotics (OR 1.21, 95% confidence interval [CI] 0.59–2.51). Three measured absence of infection without statistically significant results (OR .73, CI .32-1.69).
The antibiotics used in these studies were in addition to incising and draining abscess, extraction, or pulpectomy.
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Evidence Search |
(antibiotics [All Fields] AND abscess[All Fields] AND permanent[All Fields] AND tooth[All Fields]) AND RTC[ptyp] AND meta-analysis[ptyp] |
Comments on
The Evidence |
Validity: The authors used multiple databases to search for trials that pertained to adults with acute apical abscesses. They also consulted with endodontic experts on publications.
Perspective: The source had a worldwide perspective and included citations from established endodontists and scientific researchers when the authors felt like they had exhausted their database resources. It included a wide perspective.
The antibiotics and dosage varied among the 8 studies included and 2 studies included the concomitant use of ibuprofen and Tylenol 3, this may cause a discrepancy in the results because of the addition of analgesics. |
Applicability |
It is established in literature that pain associated with acute apical abscesses are the result of an infectious process. Since the infectious process from an apical abscess are localized to the tooth and the periodontium treating pain and infection by antibiotics is questionable. Antibiotics are not recommended unless there is evidence of systemic involvement or if patient is immunocompromised. |
Specialty/Discipline |
(Endodontics) |
Keywords |
acute apical abscess; emergency treatment/management; urgent care; periapical abscess/therapy; pain management; root canal therapy; permanent teeth/dentition
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ID# |
3216 |
Date of submission: |
04/29/2017 |
E-mail |
wongpw@livemail.uthscsa.edu |
Author |
Penny Wong |
Co-author(s) |
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Co-author(s) e-mail |
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Faculty mentor/Co-author |
William Rudy Izzard, DDS |
Faculty mentor/Co-author e-mail |
Izzard@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
None available | |
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