(TC18) Antibiotic Stewardship in Endodontics

Abstract: Antibiotics are commonly prescribed for treatment and prevention of dental infections. However, many practitioners and patients think that antibiotics can also reduce pain. This results in the excessive prescription of antibiotics for prophylaxis against postoperative pain and flare-ups or for pain control. Surveys continue to show that practitioners are prescribing antibiotics in clinical situations for which they are not indicated, most commonly because of patient expectations and for medico-legal reasons. However, the evidence suggests that using antibiotics to complement the definitive treatment of localized endodontic pathosis has little benefit and may instead contribute to larger harms. This inappropriate usage of antibiotics contributes to the spread of antibiotic resistance globally, increases in multidrug-resistant infections, and are associated with adverse reactions including Clostridium difficile infection. Furthermore, antibiotic intake results in substantial changes in the gut microbiome, the long-term effects of which are now being explored. This Table Clinic will review contemporary guidelines from the AAE, the ADA and other professional organizations regarding the optimal use of antibiotics. It will also review national and international efforts to curb the global use of antibiotics in healthcare and farming applications. Evidence will be shown for the public health impact of the spread of antibiotic resistance and other side-effects of the indiscriminate use of antibiotics. The advantages of topical use of antibiotics in endodontics and the use of systemic antibiotics for short periods will be explored. The principles of antibiotic stewardship with be discussed.