Evidence-based recommendations for antibiotic usage to treat endodontic infections and pain: A systematic review of randomized controlled trials

Abstract

Background: The purpose of this investigation was to identify evidence-based scientific methodologies to aid dental clinicians in establishing the indications for prescribing antibiotics for endodontic infection or pain.

Methods: The authors prepared and registered a protocol on PROSPERO. They conducted electronic searches in MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov. In addition, the authors hand searched the bibliographies of all relevant articles, the gray literature, and textbooks for randomized controlled clinical studies. The authors independently selected the relevant articles.

Results: The overall quality of the studies was fair with a low risk of bias, but 2 studies had a moderate risk of bias.

Conclusions: The best available clinical evidence signals no indications for prescribing antibiotics preoperatively or postoperatively to prevent endodontic infection or pain unless the spread of infection is systemic, the patient is febrile, or both. Generally, an accurate diagnosis coupled with effective endodontic treatment will decrease microbial flora enough for healing to occur.

Practical implications: To help decrease the number of drug-resistant microbes, oral health care providers should not prescribe antibiotics when they are not indicated.

Keywords: Endodontics; antibiotics; flare-ups; pain; randomized controlled clinical trials.