Toothache caused by inflammation or infection at the root of the tooth: do antibiotics help?

Dental pain is a common problem and can arise when the nerve within a tooth dies due to progressing decay or injury. Without treatment, bacteria can infect the dead tooth and cause a dental abscess, which can lead to swelling and spreading infection, which can occasionally be life threatening.

The recommended treatment for these forms of toothache is removal of the dead nerve and associated bacteria. This is usually done by extraction of the tooth or root canal treatment (a procedure where the nerve and pulp are removed and the inside of the tooth cleaned and sealed). Antibiotics are only recommended when there is severe infection that has spread from the tooth into the surrounding tissues. However, some dentists still routinely prescribe oral antibiotics to patients with acute dental conditions who have no signs of spreading infection, or without dental treatment to remove the infected material.

Use of antibiotics contributes to the development of antibiotic‐resistant bacteria. It is therefore important that antibiotics are only used when they are likely to result in benefit for the patient. Dentists prescribe approximately 8% to 10% of all primary care antibiotics in high‐income countries, and therefore it is important to ensure that dentists have good information about when antibiotics are likely to be beneficial for patients. Continue reading

Do the drugs work? Cochrane evidence on antibiotics in dentistry

799px-Medication_amoxycillin_capsule13-17 November is World Antibiotic Awareness Week. The World Health Organization (WHO) has said that antibiotic resistance is:  “one of the biggest threats to global health, food security, and development today”. Antibiotics are used to prevent and treat bacterial infections, but if over-used they can cause bacteria to change and become resistant. This makes infections more difficult to treat, and results in longer hospital stays, higher medical costs and increased mortality (World Health Organization, 2017).

Antibiotics are still commonly used in dentistry, Cope et al (2014) estimate that 8-10% of antibiotics used in primary care are prescribed by dentists in some parts of the world. Their effectiveness has been explored by several Cochrane Oral Health reviews over the years, looking at some of the scenarios where they might be prescribed. Today we have a look back over the evidence… Continue reading

Treatments for osteonecrosis of the jaw bones associated with bisphosphonate drugs

Woman face with visible jaws and teeths

Bisphosphonates are drugs very similar to pyrophosphate (a normal substance found in bone). They are used to lessen symptoms and complications due to the spread of cancer to the bones, and to prevent and treat fragile bones in osteoporosis (a conditon where tiny holes in the bones makes them brittle). These drugs can cause a rare but serious condition called bisphosphonate-related osteonecrosis of the jaw or ‘BRONJ’. BRONJ affects the healing of bone damage by interrupting the process of removing dead bone and laying down new bone. When this happens, parts or all of the jaw bone becomes friable (a bit like chalk), and eventually this dead bone can be exposed. This makes it difficult for people to eat, speak or brush their teeth, and it often causes severe pain. Many different treatments are currently used for BRONJ. They can be categorised as non-invasive treatments (such as antibiotics and mouth rinses), surgical approaches or “add-on” treatments used to enhance usual care (for example, ozone therapy or use of blood plasma that has been enriched with platelets). Different treatments may be combined. Continue reading

Antibiotic use for severe toothache

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799px-Medication_amoxycillin_capsuleIrreversible pulpitis occurs where the dental pulp (tissue inside the tooth which contains the nerve) has been damaged beyond repair. It is characterised by intense pain (toothache), sufficient to wake someone up at night and is considered to be one of the most frequent reasons that patients attend for emergency dental care. Any tooth may be affected, it is not restricted to particular age groups, and it usually occurs as a direct result of dental decay, a cracked tooth or trauma and thus tends to occur more frequently in older patients. The ‘standard of care’ for irreversible pulpitis – immediate removal of the pulp from the affected tooth – is now widely accepted and yet in certain parts of the world antibiotics continue to be prescribed. Continue reading

Should antibiotics be prescribed for toothache caused by infection of the tooth root?

Antibiotics

Photo copyright The Global Panorama, under Creative Commons Licence

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. Continue reading

Antibiotic use for severe toothache

Antibiotics - irreIrreversible pulpitis occurs where the tissue inside the tooth which contains the nerve (tooth pulp) has been damaged beyond repair. It is characterised by severe toothache, and is one of the main reasons for emergency dental care. Any tooth can be affected, and it usually occurs because of dental decay, a cracked tooth or trauma to the tooth. The standard care is to remove the pulp from the affected tooth, however in some parts of the world antibiotics continue to be prescribed. Continue reading

Oral Health Group publications in the new issue of the Cochrane Library

Cochrane Review on distalising upper first molars - does an extraoral appliance work better than an intraoral appliance?

Cochrane Review on distalising upper first molars – does an extraoral appliance work better than an intraoral appliance?

October’s edition of the Cochrane Library saw the publication of one new review and one updated review from the Cochrane Oral Health Group. Continue reading