Dental pain is a common problem and can be caused when the nerve in the tooth dies due to tooth decay or trauma. The tissue around the end of the tooth root then becomes inflamed and this can lead to pain which gets worse on biting. Without treatment, bacteria can infect the dead tooth and cause a dental abscess, which can lead to swelling and infection, and could be life-threatening. The recommended treatment of this form of toothache is the removal of the dead nerve from the tooth and the associated bacteria. This is usually done by dental extraction or root canal treatment. Oral antibiotics are often also prescribed routinely by some dentists, but concerns about antibiotic resistance are growing. Research is needed to demonstrate whether there is evidence that prescribing antibiotics in these circumstances reduces infection.
What was the research?
A systematic review of the evidence to find out if there is a clinical benefit in prescribing antibiotics for infections of the tooth root.
Who conducted the research?
The research was conducted by a team led by Anwen Cope, on behalf of the Cochrane Oral Health Group. Nick Francis, Fiona Wood, Mala K. Mann and Ivor G. Chestnutt were also on the team.
What evidence was included in the review?
Data was extracted from 2 randomised controlled trials. A total of 62 people participated in the trials, and were randomly assigned to penicillin VK or to a dummy treatment (placebo). Both trials took place after the first stage of root canal treatment, which was delivered under local anesthetic.
What did the evidence say?
The two studies included in this review reported that there were no clear differences in the pain or swelling reported by participants who received oral antibiotics compared with a placebo. However, the studies were small, and neither study examined the effect of antibiotics delivered without dental treatment.
How good was the evidence?
The quality of the evidence was very low. There is currently insufficient evidence to be able to determine the effects of antibiotics in these conditions. One of the trials was at high risk of bias, and the reporting of the other trial was not adequate to determine the risk of bias.
What are the implications for dentists and the general public?
Current evidence is of very low quality and there is insufficient evidence to determine the effects of the administration of antibiotics to adults with acute infections of the tooth root. Dentists should be cautious about prescribing antibiotics in these circumstances, especially given the concerns over their contribution to antibiotic resistance.
What should researchers look at in the future?
Given the considerable number of antibiotics currently prescribed by dentists to adults with acute dental conditions, it is disappointing that there were only two randomized controlled trials which met the inclusion criteria. Large scale randomized controlled trials are needed on this topic. However, all future trials should be carefully designed to ensure the potential benefits of providing systemic antibiotics to participants outweigh risks associated with antibiotic usage, both adverse effects and the possible contribution to antibiotic resistance. Future studies should report results according to the Consolidated Standards of Reporting Trials (CONSORT).
Cope A, Francis N, Wood F, Mann MK, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD010136. DOI: 10.1002/14651858.CD010136.pub2.