From the Guidelines
Doxycycline is not the first-line treatment for most dental infections, and its use should be limited to specific cases where other antibiotics are not suitable. When considering the treatment of dental infections, it's essential to prioritize the type of infection and the underlying cause. According to the European Society of Endodontology (2018) 1, surgical drainage is key for acute apical periodontitis and acute apical abscesses, and antibiotics are only recommended in specific patient groups, such as those with systemic involvement or progressive infections.
- For acute dental abscesses, the treatment is primarily surgical, with amoxicillin prescribed for 5 days in cases of acute dentoalveolar abscesses, as recommended by Medecins sans frontieres (2019) 1.
- The American Dental Association (2015) 1 suggests the use of systemic sub-antimicrobial dose doxycycline as an adjunct to scaling and root planning for chronic periodontitis, but this is a specific indication and not a general recommendation for dental infections.
- The Scottish Dental Clinical Effectiveness Programme (2014) 1 and the Canadian Collaboration on Clinical Practice Guidelines in Dentistry (2004) 1 advise against the use of antimicrobials for chronic periodontitis or peri-implantitis, highlighting the importance of careful consideration before prescribing antibiotics for dental infections. It's crucial to note that while doxycycline can be effective in certain cases, its use should be guided by the specific type of infection, patient factors, and the potential for antibiotic resistance. The most recent and highest-quality evidence recommends a cautious approach to antibiotic use in dental infections, prioritizing surgical treatment and reserving antibiotics for specific indications.
From the Research
Dental Infections and Antibiotic Therapy
- Dental infections can result in severe consequences, affecting both soft and hard tissues of the oral cavity, and are commonly treated with surgical and endodontic treatments, followed by antibiotic therapy 2.
- Antibiotics are generally used in dental procedures to treat odontogenic infections, nonodontogenic infections, local infection, focal infection, and prophylaxis, but their prescription may result in adverse effects such as hypersensitivity reactions and dermatological and allergic disorders 2.
Effectiveness of Specific Antibiotics
- Amoxicillin/clavulanic acid has been shown to be comparable to clindamycin in achieving clinical success in acute odontogenic infections, with a similar safety profile 3.
- Clindamycin may not be the preferred antibiotic for penicillin-allergic patients with odontogenic infections, as it has been associated with a higher rate of treatment failure and resistance 4.
- A systematic review found that various oral antibiotics, including amoxicillin, amoxicillin/clavulanic acid, cefalexin, and clindamycin, can be effective in managing acute dentoalveolar infections, but the ideal choice and regimen are unclear 5.
Guidelines for Antibiotic Use
- The American Dental Association recommends against using antibiotics in most clinical scenarios for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling, except in cases with systemic involvement or high risk of progression to systemic involvement 6.
- The use of antibiotics should be prioritized based on the presence of systemic involvement, and immediate definitive, conservative dental treatment (DCDT) should be prioritized in all cases 6.