13-17 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) estimated 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…
Antibiotic use for severe toothache
Irreversible 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.
A Cochrane review by Agnihotry et al (2016) found that antibiotics do not appear to significantly reduce toothache caused by irreversible pulpitis; however, only one clinical trial was found on the topic. The administration of penicillin does not significantly reduce the pain perception, or the quantity of pain medication required by people with irreversible pulpitis.
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