Antimicrobials in Endodontics: A Review of the Indications and Contraindications in the Battle Against Antimicrobial Resistance
Bibliographic record
Abstract
Background Odontogenic infections, primarily driven by bacterial invasion causing pulpal and periapical pathology, rank among the most prevalent infections globally, with over 50% of adults affected by apical periodontitis. These infections, if untreated, risk systemic complications, increasing morbidity and mortality. Antibiotics are vital in endodontics for managing severe cases, yet their overuse contributes significantly to antimicrobial resistance (AMR), responsible for 700,000 deaths annually. Dentists prescribe 10% of global antibiotics, with up to 80% deemed unnecessary in some regions, exacerbating AMR and adverse effects like Clostridium difficile infections.Purpose This paper reviews the efficacy of antibiotics in endodontic infections, focusing on post-operative use and appropriate clinical indications. It aims to clarify the etiology of pulpal and periapical pathology, delineate correct treatment protocols, and address the role of dentists in combating AMR through responsible prescribing practices. The study emphasizes the need for educational and guideline-driven interventions to reduce unnecessary prescriptions and mitigate the risk of a post-antibiotic era.Findings The review identifies that antibiotics are essential only in cases of diffuse infections or systemic involvement, such as fever, malaise, lymphadenopathy, or immunocompromised states. Amoxicillin and penicillin are recommended as first-line agents, with metronidazole or macrolides for specific scenarios, using short courses to limit resistance. Incorrect indications, like prescribing for irreversible pulpitis or localized abscesses without systemic signs, are ineffective due to absent pulpal blood supply. Over-prescription stems from factors like patient expectations, managing anxious or unscheduled patients, and reliance on subjective pain rather than objective signs. Systemic antibiotics fail to reduce post-operative pain or flare-up rates, reinforcing their role as adjuncts to primary treatments like root canal therapy or extraction. The absence of national guidelines, such as from the Canadian Association of Endodontists, and inadequate dental education contribute to misinformed prescribing.Implications The findings underscore the urgent need for antibiotic stewardship in endodontics. Initiatives like the MINDME acronym promote evidence-based, narrow-spectrum, and short-duration prescriptions. The FDI World Dental Federation advocates awareness, infection prevention, and stewardship, yet gaps persist. Over 70% of U.S. dental students seek more training on antibiotic use, highlighting educational deficiencies. The paper proposes curriculum reforms and accessible evidence-based protocols to align practices with stewardship principles. By addressing these gaps, dentists can reduce AMR’s impact, preserve antibiotic efficacy, and improve patient outcomes, preventing increased morbidity and mortality in a potential post-antibiotic era.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".