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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) 14611715Matthews/200335 relevant citations including 8 randomized clinical trials with 618 adults experiencing a symptomatic acute abscess or symptomatic necrotic toothMeta-Analysis
Key resultsThere 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.
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
ID# 3216
Date of submission: 04/29/2017spacer
E-mail wongpw@livemail.uthscsa.edu
Author Penny Wong
Co-author(s) e-mail
Faculty mentor/Co-author William Rudy Izzard, DDS
Faculty mentor/Co-author e-mail Izzard@uthscsa.edu
Basic Science Rationale
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