AAE Issues New Guidelines on the Use of Systemic Antibiotics in Endodontics

 by Ashraf F. Fouad, D.D.S., M.S..

Antibiotics frequently are used by dentists and endodontists as part of routine practice in endodontic therapy. In addition, some endodontic patients are at risk of developing bacterial endocarditis or prosthetic joint infections, and several guidelines have been proposed to prevent these infections during endodontic treatment. The AAE produced several previous position statements and guidelines on the use of antibiotics in conjunction with endodontic treatment. However, these guidelines need to be examined periodically to determine their currency and validity.

In this regard, Dr. Linda G. Levin, past president of the AAE, assembled a special committee to examine current usage of antibiotics in endodontics. Specifically, the committee was charged to: 1) develop guidelines for prescribing antibiotics, and 2) review the previous AAE Quick Reference Guide. The committee was to examine the literature, trends and existing guidelines relative to the use of antibiotics in endodontics and provide an update that could guide the specialists on the state of knowledge in this area. This effort was both necessary and timely, given concerns about the overuse of antibiotics in dental practice, and the recent controversies in the guidelines for the antibiotic prophylaxis of patients at risk of serious systemic infections.

After an effort that lasted a few months, the committee generated its findings in the form of a narrative review that was submitted to, and eventually approved by, the AAE Board of Directors. The document examines available literature in areas related to the risks and benefits of antibiotic prescription and the evidence supporting the use of antibiotics to supplement treatment, in cases in which adequate local debridement has been achieved. The review also discusses whether there is value in prescribing antibiotics in cases where local debridement could not be achieved, the indications for culture and sensitivity testing, and the comparative analysis of the available antibiotics. The distinction between localized and spreading infections is defined, as it is very relevant to the indications for antibiotic prescriptions. The role of prophylactic antibiotics prior to endodontic surgery, and whether they affect long-term healing also is addressed.

Finally, the document presents the currently accepted guidelines for antibiotic prophylaxis in cases at risk of bacterial endocarditis and prosthetic joint infection, and recent discussions and debates in this area. These guidelines were excerpted from other dental sources where they were published, with emphasis on special situations and circumstances that commonly arise in practice. There was also additional elaboration on examples of patients who may need special attention with respect to antibiotic prophylaxis, when the guidelines indicated that no coverage was necessary.

The new guidelines are currently available online at www.aae.org/guidelines. They include AAE Guidance on the Use of Systemic Antibiotics in Endodontics, AAE Guidance on Antibiotic Prophylaxis for Patients at Risk of Systemic Disease and an update to the AAE’s Quick Reference Guide on Antibiotic Prophylaxis. The AAE’s Guidance on the Use of Systemic Antibiotics in Endodontics will be published in the Journal of Endodontics in September.

Dr. Ashraf F. Fouad is the chair of the Department of Endodontics at the University of North Carolina School of Dentistry. He earned his master’s degree, certificate of endodontics and D.D.S. from the University of Iowa. Dr. Fouad is a Diplomate and past president of the American Board of Endodontics and an associate editor of the Journal of Endodontics. He served as chair of the AAE Special Committee on Antibiotic Use in Endodontics. Dr. Fouad can be reached at afouad@unc.edu.