Published Article

Antibiotics for the urgent management of symptomatic irreversible pulpitis: Systematic review and meta-analysis -- a report of the American Dental Association

Original Publisher or Platform

Journal of the American Dental Association

Original Article Link

https://doi.org/10.1016/j.adaj.2019.09.011

Publication Date

12-2019

Abstract

This search strategy was constructed to support the research for the peer reviewed article listed above. Full article abstract:

 

Background

Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use.

Type of Studies Reviewed

The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results

The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence).

Conclusions and Practical Implications

Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.

Search Type

Systematic Review

Databases included

PubMed or PubMed subsidiary, Embase, Cochrane, Other

Acknowledgments

The ADA Council on Scientific Affairs commissioned this work. This study was funded by the American Dental Association.

The full article was authored by:

Malavika P. Tampi, MPH; Lauren Pilcher, MSPH; Olivia Urquhart, MPH; Erinne Kennedy, DMD, MPH, MMSc; Kelly K. O’Brien, MLIS; Peter B. Lockhart, DDS; Elliot Abt, DDS, MS, MSc; Anita Aminoshariae, DDS, MS; Michael J. Durkin, MD, MPH; Ashraf F. Fouad, DDS, MS; Prerna Gopal, BDS, PhD; Benjamin W. Hatten, MD, MPH; Melanie S. Lang, DDS, MD; Lauren L. Patton, DDS; Thomas Paumier, DDS; Katie J. Suda, PharmD, MS; Hannah Cho, BS; Alonso Carrasco-Labra, DDS, MSc

The authors acknowledge the special contributions of Sarah Pahlke, MS, Jeff Huber, MBA, and Tyharrie Woods, MA, of the Science Institute, American Dental Association, Chicago, IL, and Laura Pontillo, ADA Library & Archives, Chicago, IL. The authors also acknowledge Michele Neuburger, DDS, MPH, Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, the ADA Council on Scientific Affairs’ Clinical Excellence Subcommittee; Marcelo W.B. Araujo, DDS, MS, PhD, Ruth Lipman, PhD, Jim Lyznicki, MS, MPH, and Roger Connolly from the Science Institute, ADA, Chicago, ILs; the ADA Council on Scientific Affairs; the ADA Council on Dental Practice; the ADA Council on Advocacy for Access and Prevention; Centers for Disease Control and Prevention; American College of Emergency Physicians; American Association of Oral Maxillofacial Surgeons; American Association of Endodontists; American Pharmacists Association; American Academy of Physician Assistants; American Association of Public Health Dentistry; National Institute of Dental and Craniofacial Research; American Academy of Periodontology; American Academy of Oral Medicine; American Association of Nurse Practitioners; Organization for Safety Asepsis and Prevention; Veterans Health Administration Office of Dentistry; Infectious Diseases Society of America; Society of Infectious Disease Pharmacists; Dwayne Boyers, PhD; Radhika Tampi, MHS, Inova, Fairfax, VA; Anwen Cope, BDS, PhD, MPH, Cardiff University, Cardiff, Wales.

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