A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry

Abstract

This work provides a narrative review covering evidence-based recommendations for pericoronitis management (Part A) and a systematic review of antibiotic prescribing for pericoronitis from January 2000 to May 2021 (Part B). Part A presents the most recent, clinically significant, and evidence-based guidance for pericoronitis diagnosis and proper treatment recommending the local therapy over antibiotic prescribing, which should be reserved for severe conditions. The systematic review includes publications analyzing sets of patients treated for pericoronitis and questionnaires that identified dentists' therapeutic approaches to pericoronitis. Questionnaires among dentists revealed that almost 75% of them prescribed antibiotics for pericoronitis, and pericoronitis was among the top 4 in the frequency of antibiotic use within the surveyed diagnoses and situations. Studies involving patients showed that antibiotics were prescribed to more than half of the patients with pericoronitis, and pericoronitis was among the top 2 in the frequency of antibiotic use within the monitored diagnoses and situations. The most prescribed antibiotics for pericoronitis were amoxicillin and metronidazole. The systematic review results show abundant and unnecessary use of antibiotics for pericoronitis and are in strong contrast to evidence-based recommendations summarized in the narrative review. Adherence of dental professionals to the recommendations presented in this work can help rapidly reduce the duration of pericoronitis, prevent its complications, and reduce the use of antibiotics and thus reduce its impact on patients' quality of life, healthcare costs, and antimicrobial resistance development.

Keywords: antibiotic resistance; antibiotics; dentistry; pericoronitis.

Figure 1

Pericoronitis development—illustrative scheme. Images demonstrate a partially erupted third molar covered by soft tissue. Plaque and detritus (green) stagnation lead to soft tissue inflammation.

Figure 2

Pell and Gregory classification. The classes are based on the relationship between the lower wisdom tooth (third molar) and the mandible ramus. The positions are based on the vertical relationship between the second and third molars.

Figure 3

Winters’s classification. The classification is based on the inclination of the impacted wisdom tooth (third molar) to the long axis of the second molar.

Figure 4

Clinical manifestation of pericoronitis and panoramic radiograph. Image (A) demonstrates inflamed soft tissues covering incompletely erupted right lower third molar. Image (B) displays a preoperative panoramic radiograph of the same patient demonstrating incompletely erupted third molars.

Figure 5

Flow diagram. A total of 65 potentially relevant records were identified searching Web of Science and Medline and further processed. Additional 5 records were identified through other sources. After duplicate removal, 56 records were further examined based on title and abstract. Then, 19 records were removed as they did not cover the eligibility criteria (described in Table S1). A total of 37 articles were identified to be full-text read. Thereafter, 26 articles were excluded due to the reasons described in Table S1. Finally, a total of 11 studies were included in the present review.