Highlighted review: Effects of antibiotics on toothache caused by inflammation or infection at the root of the tooth in adults

Anwen L Cope, Nick Francis, Fiona Wood, Ivor G Chestnutt

Plain language summary: The effects of antibiotics on toothache caused by inflammation or infection at the root of the tooth in adults

This Cochrane Review has been produced to assess the effects of antibiotics on the pain and swelling experienced by adults in two conditions commonly responsible for causing dental pain.

The review set out to assess the effects of taking antibiotics when provided with, or without, dental treatment.

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.

Study characteristics
The evidence on which this review is based was up‐to‐date as of 26 February 2018. We searched scientific databases and found two trials, with 62 participants included in the analysis.

Both trials were conducted at dental schools in the USA and evaluated the use of oral antibiotics in the reduction of pain and swelling reported by adults after having the first stage of root canal treatment under local anaesthetic. The antibiotic used in both trials was penicillin VK and all participants also received painkillers.

Key results
The two studies included in the review reported that there were no clear differences in the pain or swelling reported by participants who received oral antibiotics compared with a placebo (a dummy treatment) when provided alongside the first stage of root canal treatment and painkillers.

However, the studies were small and produced poor quality evidence, and therefore we cannot be certain if the results are correct. Neither study examined the effect of antibiotics on their own, without surgical dental treatment.

One trial reported side effects among participants: one person who received the placebo medication had diarrhoea and one person who received antibiotics experienced tiredness and reduced energy after their treatment.

Quality of evidence
We judged the quality of evidence to be very low. There is currently insufficient evidence to be able to determine the effects of antibiotics in these conditions.

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Citation: Cope  AL, Francis  N, Wood  F, Chestnutt  IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD010136. DOI: 10.1002/14651858.CD010136.pub3.