Abstract
Concerns regarding increasing antibiotic resistance raise the question of the most appropriate oral antibiotic for empirical therapy in dentistry. The aim of this systematic review was to investigate the antibiotic choices and regimens used to manage acute dentoalveolar infections and their clinical outcomes. A systematic review was undertaken across three databases. Two authors independently screened and quality-assessed the included studies and extracted the antibiotic regimens used and the clinical outcomes. Searches identified 2994 studies, and after screening and quality assessment, 8 studies were included. In addition to incision and drainage, the antibiotics used to manage dentoalveolar infections included amoxicillin, amoxicillin/clavulanic acid, cefalexin, clindamycin, erythromycin, metronidazole, moxifloxacin, ornidazole and phenoxymethylpenicillin. Regimens varied in dose, frequency and duration. The vast majority of regimens showed clinical success. One study showed that patients who did not receive any antibiotics had the same clinical outcomes as patients who received broad-spectrum antibiotics. The ideal choice, regimen and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections are unclear. Given that all regimens showed clinical success, broad-spectrum antibiotics as first-line empirical therapy are unnecessary. Narrow-spectrum agents appear to be as effective in an otherwise healthy individual. This review highlights the effectiveness of dental treatment to address the source of infection as being the primary factor in the successful management of dentoalveolar abscesses. Furthermore, the role of antibiotics is questioned in primary space odontogenic infections, if drainage can be established.
Highlights
The majority of dentoalveolar infections arise from necrotic dental pulp, periodontal tissues or pericoronal tissues
The research questions “What oral antibiotics are prescribed as empirical therapy for acute dentoalveolar infections?”, “What is the regimen of oral antibiotics used for empirical therapy for acute dentoalveolar infections?”
Given the anaerobic coverage of amoxicillin with clavulanic acid, the additional benefit of metronidazole is unclear, but this review highlights the effectiveness of dental treatment to address the source of infection as being the primary factor in the successful management of dentoalveolar abscesses
Summary
The majority of dentoalveolar infections arise from necrotic dental pulp, periodontal tissues or pericoronal tissues. An acute dentoalveolar abscess forms from an inflammatory response of the periapical connective tissues, associated with a necrotic pulp. The key principle for the management of these infections involves local dental treatment by addressing the cause of the infection to establish drainage through the soft tissues, by root canal treatment or by extraction of the offending tooth [2]. Antibiotics are only required as an adjunctive measure when the infection has spread beyond the confines of the tooth and cannot be surgically addressed or shows signs of systemic spread, such as an extra-oral facial swelling, cellulitis or temperature elevation, when the bacterial insult exceeds the capacity of the body’s defence mechanisms [2,3]. In community outpatient dental practice, antibiotics are given empirically, as the standard current practice does not involve pus sampling for microbial investigation [2,4]
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