Review of the 2019 ADA Clinical Practice Guidelines for Antibiotic Use

In response to the high rates of suboptimal prescribing patterns and inadequate patient adherence, an expert panel convened by the ADA Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis (SIP) with or without symptomatic apical periodontitis (SAP), apical periodontitis, pulp necrosis and symptomatic apical periodontitis, (PN-SAP) or pulpal necrosis and localized acute apical abscess (PN-LAAA) using antibiotics, either alone or as adjuncts to definitive conservative dental treatment in immunocompetent adults.⁷ Dental pain and intraoral swelling are commonly cited as reasons for seeking dental care with a dentist or in an emergency department (ED) with a physician.^1,33 These signs and symptoms are associated with pulpal and periapical conditions usually resulting from untreated dental caries. Patients often initially report sharp pain in response to tactile or temperature stimuli, which can progress to spontaneous and/or continuous pain. If this condition is left untreated, it can also progress to systemic infection.^16,34 Given the frequency of this presentation in dental and emergency clinics and the potential severity for undertreatment, as well as the global public health and fiscal impact of inappropriate treatment, development of evidence-based clinical practice guidelines for antibiotic use is timely for applications in dental practice.