Recommendations for Patients with Pulp Necrosis and Acute Apical Abscess (PN-AAA) with Systemic Involvement

Once systemic symptoms have developed, the clear advantage of the use of oral systemic antibiotics in the balance of benefits/harms is well-established. The expert panel suggests that dentists prescribe oral amoxicillin (500mg, three times daily for 3-7 days) or oral penicillin V potassium (500mg, four times daily for 3-7 days) for patients with PN-AAA. In addition, urgent referral for DCDT to avoid delay to definitive treatment. If conditions worsen or if the clinician is concerned about deeper space infection or an immediate threat to life, the patient should be referred for an urgent evaluation. Once DCDT is prescribed, adjunctive use of oral systemic antibiotics should also be used.