Key Points
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Provides an overview of appropriate prescribing of antibiotics in the management of the adult patient with a dentoalveolar abscess.
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Highlights the need for surgical/non-surgical drainage as the primary treatment modality in the management of the acute dentoalveolar abscess.
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Discusses the role of antibiotics as an adjunct to treatment for patients showing signs of systemic involvement.
Abstract
Antibiotics are the most widely prescribed category of drugs issued on prescription by general dental practitioners. Despite this there remains little evidence-based literature on what should be prescribed for any given clinical situation, at what dosage and for how long. Given the current climate of evidence-based research, the need to keep antibiotic prescribing to an acceptable minimum, increasing levels of resistance of micro-organisms and widespread hospital infections with 'superbugs', there is a distinct need for appropriate prescribing guidelines. Considering best practice, an extensive review of the literature and a thorough understanding of current empirical treatment regimes, an attempt has been made to recommend suitable antibiotic prescribing for the adult patient suffering from acute dentoalveolar infections based on evidence.
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References
The United Kingdom Parliament. House of Lords Select Committee on Science and Technology – Seventh Report. The path of least resistance. London: Department of Health, 1998.
Standing Medical Advisory Committee (SMAC), Department of Health. The path of least resistance. London: Department of Health, 1998.
Poveda Roda R, Bagan J V, Sanchis Bielsa J M, Carbonell Pastor E . Antibiotic use in dental practice. A review. Med Oral Patol Oral Cir Bucal 2007; 12: E186–E192.
Palmer N O, Martin M V, Pealing R, Ireland R S . An analysis of antibiotic prescriptions from general dental practitioners in England. J Antimicrob Chemother 2000; 46: 1033–1035.
Palmer N A, Pealing R, Ireland R S, Martin M V . A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J 2000; 188: 554–558.
Roy K M, Bagg J . Antibiotic prescribing by general dental practitioners in the Greater Glasgow Health Board, Scotland. Br Dent J 2000; 188: 674–676.
Palmer N O, Martin M V, Pealing R et al. Antibiotic prescribing knowledge of National Health Service general dental practitioners in England and Scotland. J Antimicrob Chemother 2001; 47: 233–237.
Dailey Y M, Martin M V . Are antibiotics being used appropriately for emergency dental treatment? Br Dent J 2001; 191: 391–393.
Palmer N, Martin M V . An investigation of antibiotic prescribing by general dental practitioners: a pilot study. Primary Dent Care 1998; 5: 11–14.
Thomas D W, Satterthwaite J, Absi E G, Lewis M A, Shepherd J P . Antibiotic prescription for acute dental conditions in the primary care setting. Br Dent J 1996; 182: 401–404.
Anderson R, Calder L, Thomas D W . Antibiotic prescribing for dental conditions: general medical practitioners and dentists compared. Br Dent J 2000; 188: 398–400.
UK Dental Survey. An analysis of 6,000 responses from UK dentists on the 2004 UK dental register. Pfizer. 2005, publication no. DLC-002-05.
Lewis M A, Meechan C, MacFarlane T W, Lamey P J, Kay E . Presentation and antimicrobial treatment of acute orofacial infections in general dental practice. Br Dent J 1989; 166: 41–45.
Marsh P, Martin M V . Oral microbiology. 4th ed. Edinburgh: Wright, 1999.
Dirks S J, Terezhalmy G T . The patient with an odontogenic infection. Quintessence Int 2004; 35: 482–502.
Pallasch T J . How to use antibiotics effectively. J Calif Dent Assoc 1993; 21: 46–50.
Stefanopoulos P K, Kolokotronis A E . The significance of anaerobic bacteria in acute orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98: 398–408.
Sandor G K, Low D E, Judd P L, Davidson R J . Antimicrobial treatment options in the management of odontogenic infections. J Can Dent Assoc 1999; 65: 508–514.
Lewis M A, MacFarlane T W, McGowan D A . A microbialogical and clinical review of the acute dentoalveolar abscess. Br J Oral Maxillofac Surg 1990; 28: 359–366.
Lewis M A O, MacFarlane T W, McGowan D A . Antibiotic susceptibilities of bacteria isolated from acute dentoalveolar abscesses. J Antimicrob Chemother 1989; 23: 69–77.
Lewis M A, MacFarlane T W, McGowan D A . Quantitative bacteriology of acute dento-alveolar abscesses. J Med Microbiol 1986; 21: 101–104.
Gill Y, Scully C . The microbiology and management of acute dentoalveolar abscess: views of British oral and maxillofacial surgeons. Br J Oral Maxillofac Surg 1988; 26: 452–457.
Rothwell B R . Odontogenic infections. Emerg Med Clin North Am 1985; 3: 161–178.
Johnson B D, Engel D . Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. J Periodontol 1986; 57: 141–149.
Loesche W J, Giordano J R . Metronidazole in periodontitis v: debridement should precede medication. Compendium 1994; 15: 1198–1217.
Blakey G H, White R P, Offenbacher S, Phillips C et al. Clinical/biological outcomes of treatment for pericoronitis. J Oral Maxillofac Surg 1996; 54: 1150–1160.
Rosenberg E S, Torosian J P, Hammond B F, Cutler S A . Routine anaerobic bacterial culture and systemic antibiotic usage in the treatment of adult periodontitis: a 6 year longitudinal study. Int J Periodontics Restorative Dent 1993; 13: 213–241.
Walton R E, Zerr M, Peterson L . Antibiotics in dentistry – a boon or a bane? Alliance for the Prudent Use of Antibiotics Newsletter 1997; 15: 1–5.
Klein P B . Antibiotic therapy: maximize the benefits, minimize the risks. Dent Today 1994; 13: 42, 44–47.
Johnson B S . Principles and practice of antibiotic therapy. Infect Dis Clin North Am 1999; 13: 851–870.
Faculty of General Dental Practitioners (UK). The Royal College of Surgeons of England. Primary Dental Care for General Dental Practitioners. 2000.
Martin M V, Longman L P, Hill J B, Hardy P . Acute dentoalveolar infections: an investigation of the duration of antibiotic therapy. Br Dent J 1997; 183: 135–137.
Pogrel M A . Antibiotics in general practice. Dent Update 1994; 21: 272–280.
Haas D A, Epstein J B, Eggert F M . Antimicrobial resistance: dentistry's role. J Can Dent Assoc 1998; 64: 496–502.
Palmer N A . Revisiting the role of dentists in prescribing antibiotics. Dent Update 2003; 30: 570–574.
Kuriyama T, Absi E G, Williams D W, Lewis M A . An outcome audit of the treatment of acute dentoalveolar infection: impact of penicillin resistance. Br Dent J 2005; 198: 759–763.
Abbott P V, Hume W R, Pearman J W . Antibiotics and endodontics. Aus Dent J 1990; 35: 50–60.
Longman L P, Preston A J, Martin M V, Wilson N H . Endodontics in the adult patient: the role of antibiotics. J Dent 2000; 28: 539–548.
Lewis M A O, MacFarlane T W . Short-course high-dosage amoxicillin in the treatment of acute dento-alveolar abscess. Br Dent J 1986; 161: 299–302.
Flynn T R, Shanti R M, Levi M H, Adamo A K et al. Severe odontogenic infections, part 1: prospective report. J Oral Maxillofac Surg 2006; 64: 1093–1103.
Office for National Statistics, Annal, Mortality Statistics: Deaths registered in England and Wales. Series DH2 No 27–32.
Baker K A, Fotos P G . The management of odontogenic infections. A rationale for appropriate chemotherapy. Dent Clin North Am 1994; 38: 689–706.
Swift J Q, Gulden W S . Antibiotic therapy – managing odontogenic infections. Dent Clin North Am 2002; 46: 623–633.
Martindale W . The extra pharmacopoeia. 33rd ed. London: Royal Pharmaceutical Society, 2002.
Longman L P, Martin M V . The use of antibiotics in the prevention of postoperative infection: a re-appraisal. Br Dent J 1991; 170: 257–262.
Molerinari J A . Microbial disease trends and acquired resistance: Part 1. Compend Contin Educ Dent 1997; 18: 106–108.
Pallasch T J . Global antibiotic resistance and its impact on the dental community. J Calif Dent Assoc 2000; 28: 215–233.
Samaranayake L P, Johnson N W . Guidelines for the use of antimicrobial agents to minimise development of resistance. Int Dent J 1999; 49: 189–195.
Standing Medical Advisory Committee (SMAC). Department of Health. Report on impact of clinical prescribing on antimicrobial resistance published. London: Department of Health, 1998.
Sweeney L C, Dave J, Chambers P A, Heritage J . Antibiotic resistance in general dental practice – a cause for concern? Antimicrob Chemother 2004; 53: 567–576.
Fine D H, Hammond B F, Loesche W J . Clinical use of antibiotics in dental practice. Int J Antimicrob Agents 1998; 9: 235–238.
American Dental Association Council on Scientific Affairs. Antibiotics in Dentistry 1997; 128: 648.
Lewis M A, Parkhurst C L, Douglas C W et al. Prevalence of penicillin resistant bacteria in acute suppurative oral infection. J Antimicrob Chemother 1995; 35: 785–791.
Lewis M A O, Carmichael F, MacFarlane T W, Milligan S G . A randomised trial of co-amoxiclav versus penicillin V in the treatment of acute dentoalveolar abscess. Br Dent J 1993; 175: 169–174.
Flynn T R, Shanti R M, Hayes C . Severe odontogenic infections, part 2: prospective outcomes study. J Oral Maxillofac Surg 2006; 64: 1104–1113.
Lewis M A O . Why we must reduce dental prescription of antibiotics: European Union Antibiotic Awareness Day. Br Dent J 2008; 205: 537–538.
Eick S, Pfister W, Straub E . Antimicrobial susceptibility of anaerobic and capnophilic bacteria isolated from odontogenic abscesses and rapidly progressive periodontitis. Int J Antimicrob Agents 1999; 12: 41–46.
Kuriyama T, Williams D W, Yanagisawa M et al. Antimicrobial susceptibility of 800 anaerobic isolates from patients with dentoalveolar infection to 13 oral antibiotics. Oral Microbiol Immunol 2007; 22: 285–258.
Brook I, Lewis M A, Sandor G K et al. Clindamycin in dentistry: more than just effective prophylaxis for endocarditis? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100: 550–558.
Addy L D, Martin M V . Clindamycin and dentistry. Br Dent J 2005; 199: 23–26.
Stefanopoulos P K, Kolokotronis A E . Controversies in antibiotic choices for odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 697–698.
Zetner K, Schmidt H, Pfeiffer S . concentrations of clindamycin in the mandibular bone of companion animals. Int J Antimicrob Agents 2003; 4: 166–171.
Kirkwood K L . Update on antibiotics used to treat orofacial infections. Alpha Omegan 2003; 96: 28–34.
Mueller S C, Henkel K, Neumann J et al. Perioperative antibiotic prophylaxis in maxillofacial surgery: penetration of clindamycin into various tissues. J Craniomaxillofac Surg 1999; 27: 172–176.
Gilbert D N, Moellering R C Jr, Eliopoulos G M, Sande M A . The Sandford Guide to Antimicrobial Therapy, Inc. 2005; 30: 33.
Reese R E, Betts R F, Gumustop B . Clindamycin. In Handbook of antibiotics. 3rd ed. pp 435–440. Philadelphia: Lippincott-Williams & Wilkins, 2000.
Simmons N A, Ball A P, Cawson R A et al. Antibiotic prophylaxis and infective endocarditis. Lancet 1992; 339: 1292–1293.
Dajani A S, Taubert K A, Wilson W et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA 1997; 277: 1794–1801.
Pallasch T J . Clostridium difficile-associated diarrhoea and colitis. J Calif Dent Assoc 1999; 27: 405–409, 411–413.
Bignardi G E . Risk factors for Clostridium difficile infection. J Hosp Infect 1998; 40: 1–15.
Johnson S, Gerding D N . Clostridium difficile – associated diarrhea. Clin Infect Dis 1998; 26: 1027–1036.
Baxter R, Ray G T, Fireman B H . Case-control study of antibiotic use and subsequent Clostridium difficle-associated diarrhea in hospitalized patients. Infect Control Hosp Epidemiol 2008; 29: 44–50.
Thibault A, Miller M A, Gaese C . Risk factors for the development of Clostridium difficile-associated diarrhea during a hospital outbreak. Infect Control Hosp Epidemiol 1991; 12: 345–348.
Andrejak M, Schmit J L, Tondriaux A . The clinical significance of antibiotic associated pseudomembranous colitis in the 1990s. Drug Saf 1991; 6: 339–349.
Greenwood D, O'Grady F . Antibiotics and host defences. The Scientific basis of antimicrobial chemotherapy. Cambridge University Press, 1985.
Brause B D, Romankiewicz J A, Gotz V et al. Comparative study of diarrhea associated with clindamycin and ampicillin therapy. Am J Gastroenterol 1980; 73: 244–248.
Lewis J S, Jorgensen J H . Inducible clindamycin resistance in Staphylococci: should clinicians and microbiologists be concerned? Clin Infect Dis 2005; 40: 280–285.
Limeres J, Tomas I, Alvarez M, Diz P . Empirical antimicrobial therapy for odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100: 263–264.
Barker G R, Qualtrough A J . An investigation into antibiotic prescribing at a dental teaching hospital. Br Dent J 1987; 162: 303–306.
Olson A K, Mac Edington E, Kulid J C, Weller R N . Update on antibiotics for endodontic practice. Compend Contin Educ Dent 1990; 11: 328–332.
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I would like to thank Dr Mike Martin, Consultant Microbiologist, for his help, encouragement and expertise in the preparation of this paper.
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Ellison, S. The role of phenoxymethylpenicillin, amoxicillin, metronidazole and clindamycin in the management of acute dentoalveolar abscesses – a review. Br Dent J 206, 357–362 (2009). https://doi.org/10.1038/sj.bdj.2009.257
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DOI: https://doi.org/10.1038/sj.bdj.2009.257
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