Key Points
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Incisional drainage is the first principle in management of acute dentoalveolar infection.
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Penicillin-resistant bacteria are often present in acute dental infection.
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The presence of penicillin resistant bacteria does not adversely affect the outcome of treatment even if penicillin is prescribed.
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It is likely that antibiotic therapy is often prescribed unnecessarily in treatment of acute dental infection.
Abstract
Objectives The aim of this audit was to measure the outcome of treatment of acute dentoalveolar infection and to determine if this was influenced by choice of antibiotic therapy or the presence of penicillin-resistance.
Subjects and methods A total of 112 patients with dentoalveolar infection were included in the audit. All patients underwent drainage, either incisional (n=105) or opening of the pulp chamber (n=7) supplemented with antibiotic therapy. A pus specimen was obtained from each patient for culture and susceptibility. Clinical signs and symptoms were recorded at the time of first presentation and re-evaluated after 48 or 72 h.
Results A total of 104 (99%) of the patients who underwent incisional drainage exhibited improvement after 72 h. Signs and symptoms also improved in five of the seven patients who underwent drainage by opening of the root canal although the degree of improvement was less than that achieved by incisional drainage. Penicillin-resistant bacteria were found in 42 (38%) of the 112 patients in this study. Of the 65 patients who were given penicillin, 28 had penicillin-resistant bacteria. There was no statistical difference in the clinical outcome with regard to the antibiotic prescribed and the presence of penicillin-resistant bacteria. Strains of penicillin-resistant bacteria were isolated more frequently in patients who had previously received penicillin (p<0.05).
Conclusion Incisional drainage appeared to produce a more rapid improvement compared to drainage by opening of the root canal. The presence of penicillin-resistant bacteria did not adversely affect the outcome of treatment. The observations made support surgical drainage as the first principle of management and question the value of prescribing penicillin as part of treatment.
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Acknowledgements
The authors would like to thank Mrs Pat Bishop and Mrs Gillian Fellows at the Oral Microbiology Laboratory, University Dental Hospital, Cardiff for processing the microbiological samples. The authors are also grateful to the patients and clinical staff who contributed to this study. They also acknowledge Professor Tadahiro Karasawa (School of Health Sciences, Faculty of Medicine, Kanazawa University, Kanazawa, Japan) for his helpful suggestions for this paper.
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Kuriyama, T., Absi, E., Williams, D. et al. An outcome audit of the treatment of acute dentoalveolar infection: impact of penicillin resistance. Br Dent J 198, 759–763 (2005). https://doi.org/10.1038/sj.bdj.4812415
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DOI: https://doi.org/10.1038/sj.bdj.4812415
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