Antibiotics in Endodontics
The widespread use of antibiotics presumably cause antibiotic‐resistant bacterial strains. This is also important in terms of the oral microbiota and the use of antibiotics to deal with oral and dental infections. The aim of this speech is to review the current literature on the indications and contraindications use of antibiotics and give some recommendations to endodontists for prevent overuse of antibiotics. Endodontic infections, resulting in pulpitis, apical periodontitis or apical abscess, are polymicrobial, involving a combination of gram-positive, gram-negative, facultative anaerobes and strict anaerobic bacteria. Most endodontic infections are confined within the tooth and can be successfully managed by root canal treatment. Antibiotics are unnecessary in irreversible pulpitis, necrotic pulps and localized acute apical abscesses. However, when there is systemic involvement and rapid, and diffuse spread of infection, antibiotics may be used as an adjunct to root canal treatment. The use of topical antibiotics during root canal treatment is not supported by the evidence. Prevention of bacterial contamination in traumatic injuries especially avulsion affects the prognosis of the affected teeth. Current guidelines recommend systemic antibiotic therapy for patients with avulsion of a permanent tooth, which is replanted. For the other traumatic injuries, such as fracture or luxation injuries, antibiotic administration does not necessary. In healthy individuals, any bacteraemia generated by endodontic treatments are rapidly scavenged and cause no complications, but antibiotics should be prescribed in patients having systemic diseases with compromised immunity or patients with infective endocarditis, prosthetic cardiac valves or recent prosthetic joint replacement.