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Kwan Google 36
Steven C. Kwan, D.D.S., M.S.D.
Diplomate of the American Board of Endodontics

6715 Fort Dent Way
Tukwila, WA 98188-2540

Winter 2020 (Volume 9, Issue 1)
Happy New Year! In this issue, we're highlighting the new JADA article that provides guidelines on antibiotics in endodontics. Recommendations are made based on the preoperative diagnosis as well as if endodontic care is immediately available. Hopefully this will help provide some guidance on when you should prescribe antibiotics.

As you will see, the availability of emergent or urgent endodontic care is important in the management of these types of patients. At Kwan Endodontics, we do offer a limited number of emergency treatment appointments. Although these can fill up quickly, we do try to make every effort to accommodate your patients who have a true dental emergency, especially if we regularly work with your office. We would love to assist you in providing the best care possible for your patients.

Lockhart PB, Tampi MP, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Kennedy E, Lang MS, Patton LL, Paumier T, Suda KJ, Pilcher L, Urquhart O, O’Brien KK, Carrasco-Labra A. Evidenced-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. J Amer Dent Assoc 2019;150:906-921.

The ADA convened an expert panel to perform a systematic review and provide clinical practice guidelines on the use of antibiotics in various endodontic situations. They formulated five clinical recommendations and two good practice statements (which are less strong as they lack the certainty of evidence of a clinical recommendation). These guidelines, which are targeted at the general dentist population, apply to immunocompetent adults and are based on the preoperative diagnosis and on whether definitive conservative dental treatment (DCDT which includes pulpotomy, pulpectomy, non-surgical root canal therapy or incise & drain) is immediately available. In general, antibiotics are only indicated if a localized acute apical abscess is present and DCDT can NOT be immediately provided, or if the acute apical abscess has systemic involvement (fever, malaise, etc). Antibiotics are not indicated for cases of irreversible pulpitis, pulp necrosis without an acute apical abscess (i.e. just symptomatic apical periodontitis), or pulp necrosis with a localized acute apical abscess where DCDT has been provided. They recommend both amoxicillin (500 mg, tid for 3-7 days) or penicillin (500 mg, qid for 3-7 days) as first line treatments, though simultaneously state that amoxicillin is preferred. Please see Table (next page) and the full article for footnotes and full details. In general these guideline are similar to how Board Certified Endodontists have been practicing for the last decade or so with only minor changes, though the authors suggest that the general population is currently provides antibiotics more frequently than recommended.

SUMMARY: Clinical guidelines for antibiotic use in endodontic infections are provided that suggest that they are only indicated for cases that include a localized acute apical abscess where immediate treatment is NOT provided or for cases with acute apical abscess with systemic involvement.

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Endodontic Spotlight is published quarterly by Steven C. Kwan, D.D.S., M.S.D.
is located at 6715 Fort Dent Way, Tukwila WA 98188
206-248-3330; 206-431-1158 (fax);
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