Routine systemic antibiotic prescription in the management of permanent avulsed teeth – should we...
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Routine systemic antibiotic prescription in the management of permanent avulsed teeth – should we stop? LETTER TO THE EDITOR The current accepted guidance for the management of avulsed teeth includes the routine prescription of sys- temic antibiotics. Work by the authors (currently unpublished) assessed various guidelines on the management of avulsed teeth, namely the British Society of Paediatric Dentistry (BSPD) guidelines (1), American Academy of Pediatric Dentistry (AAPD) guidelines (2), International Associ- ation of Dental Traumatology (IADT) guidelines (3) and the Malaysian Ministry of Oral Health (MOH) guide- lines (4), and they all recommend the prescription of antibiotics after an avulsion injury. The guidelines do vary in their recommendations, with the BSPD and AAPD guidelines not specifying a particular antibiotic, the IADT guidelines recommending the use of Doxycycline three times a day for 7 days (or Penicillin V in children under the age of 12 years old) and the Malaysian guidelines recommending a Penicillin based antibiotic for 5 days. These recommendations have a poor evidence base. Hinkfuss SE and Messer LB (5) concluded that the evidence for an association between prescribing systemic antibiotic therapy (SAT) and an increased likelihood of acceptable periodontal healing outcome is inconclusive and that the investigation of antibiotic use as defined in the clinical guidelines indicates there is inconclusive clinical evidence from studies of replanted avulsed human teeth to either contradict or support the guide- line. Pending future research to the contrary, dentists are recommended to follow current guidelines in prescribing SAT when replanting avulsed teeth. In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) has provided recommendations stopping the routine prescription of antibiotic prophylaxis in the prevention of infective endocarditis for at-risk cardiac patients undergoing dental procedures.(6) The guideline states that there is little evidence to support the practise of routinely providing antibiotics as a preventative measure to people at risk of infective endocarditis undergoing interventional proce- dures. The risks of adverse effects and antibiotic resistance developing outweigh the benefits of any prophylaxis. Considering the weak evidence base in the prescrip- tion of systemic antibiotics for the management of avulsed teeth on one hand and the potential of serious side effects and development of antibiotic resistance that can occur from antibiotic ingestion on the contrary, should we still be prescribing systemic antibiotics in the management of avulsed teeth? Purvi Shah 1 , Paul Ashley 2 1 Unit of Paediatric Dentistry, Eastman Dental Hospital; 2 Unit of Paediatric Dentistry, Eastman Dental Institute, London, UK Correspondence to: Purvi Shah, Unit of Paediatric Dentistry, Eastman Dental Hospital, 256 Gray’s Inn Road London WC1X 8LD, UK Tel.: +44 (0)2079151273 Fax: +44 (0)2079152329 e-mail: [email protected]/[email protected] References 1. Gregg TA, Boyd DH. Treatment of avulsed permanent teeth in children. Int J Paediatr Dent 1998;8:75–81. 2. American Academy of Pediatric Dentistry Council on Clinical Affairs (2007). Guideline on management of acute dental trauma. http://www.aapd.org/media/Policies_Guidelines/G_Trauma. pdf [accessed on 15 November 2007]. 3. Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F et al. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol 2007;23:130–6. 4. Malaysian Ministry of Health (2002). Clinical practice guidelines: management of avulsed permanent anterior teeth in children. http://www.infosihat.gov.my/media/garisPanduan/GP_CPG/ CPG%20Management%20of%20avulsed%20permanent% 20anterior%20teeth%20in%20childrem/CPG%20Management% 20of%20avulsed%20permanent%20anterior%20teeth%20in% 20childrem.pdf [accessed on 15 November 2007]. 5. Hinkfuss SE, Messer LB. An evidence-based assessment of the clinical guidelines for replanted avulsed teeth. Part II: pre- scription of systemic antibiotics. Dent Traumatol 2009;25:158– 64. 6. National Institute for Health and Clinical Excellence (2008). NICE clinical guideline 64. Prophylaxis against infective endo- carditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. http://www.nice.org.uk/nicemedia/pdf/CG64NICEguidance.pdf [accessed on 20 October 2009]. Dental Traumatology 2010; 26: 301–302 doi: 10.1111/j.1600-9657.2010.0875a.x Ó 2010 John Wiley & Sons A/S 301
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Transcript of Routine systemic antibiotic prescription in the management of permanent avulsed teeth – should we...
Routine systemic antibiotic prescription in themanagement of permanent avulsed teeth –should we stop?
LETTER TO THE EDITOR
The current accepted guidance for the management ofavulsed teeth includes the routine prescription of sys-temic antibiotics.
Work by the authors (currently unpublished) assessedvarious guidelines on the management of avulsed teeth,namely the British Society of Paediatric Dentistry(BSPD) guidelines (1), American Academy of PediatricDentistry (AAPD) guidelines (2), International Associ-ation of Dental Traumatology (IADT) guidelines (3) andthe Malaysian Ministry of Oral Health (MOH) guide-lines (4), and they all recommend the prescription ofantibiotics after an avulsion injury.
The guidelines do vary in their recommendations, withthe BSPD and AAPD guidelines not specifying aparticular antibiotic, the IADT guidelines recommendingthe use of Doxycycline three times a day for 7 days (orPenicillin V in children under the age of 12 years old)and the Malaysian guidelines recommending a Penicillinbased antibiotic for 5 days. These recommendationshave a poor evidence base.
Hinkfuss SE and Messer LB (5) concluded that theevidence for an association between prescribing systemicantibiotic therapy (SAT) and an increased likelihood ofacceptable periodontal healing outcome is inconclusiveand that the investigation of antibiotic use as defined inthe clinical guidelines indicates there is inconclusiveclinical evidence from studies of replanted avulsedhuman teeth to either contradict or support the guide-line. Pending future research to the contrary, dentists arerecommended to follow current guidelines in prescribingSAT when replanting avulsed teeth.
In the United Kingdom, the National Institute forHealth and Clinical Excellence (NICE) has providedrecommendations stopping the routine prescription ofantibiotic prophylaxis in the prevention of infectiveendocarditis for at-risk cardiac patients undergoing dentalprocedures.(6) The guideline states that there is littleevidence to support the practise of routinely providingantibiotics as a preventative measure to people at risk ofinfective endocarditis undergoing interventional proce-dures. The risks of adverse effects and antibiotic resistancedeveloping outweigh the benefits of any prophylaxis.
Considering the weak evidence base in the prescrip-tion of systemic antibiotics for the management of
avulsed teeth on one hand and the potential of seriousside effects and development of antibiotic resistance thatcan occur from antibiotic ingestion on the contrary,should we still be prescribing systemic antibiotics in themanagement of avulsed teeth?
Purvi Shah1, Paul Ashley2
1Unit of Paediatric Dentistry, Eastman Dental Hospital;2Unit of Paediatric Dentistry, Eastman Dental Institute,
London, UKCorrespondence to: Purvi Shah, Unit of Paediatric Dentistry,
Eastman Dental Hospital, 256 Gray’s Inn Road LondonWC1X 8LD, UK
Tel.: +44 (0)2079151273Fax: +44 (0)2079152329
e-mail: [email protected]/[email protected]
References
1. Gregg TA, Boyd DH. Treatment of avulsed permanent teeth inchildren. Int J Paediatr Dent 1998;8:75–81.
2. American Academy of Pediatric Dentistry Council on ClinicalAffairs (2007). Guideline on management of acute dental trauma.http://www.aapd.org/media/Policies_Guidelines/G_Trauma.pdf [accessed on 15 November 2007].
3. Flores MT, Andersson L, Andreasen JO, Bakland LK,Malmgren B, Barnett F et al. Guidelines for the managementof traumatic dental injuries. II. Avulsion of permanent teeth.Dent Traumatol 2007;23:130–6.
4. MalaysianMinistry of Health (2002). Clinical practice guidelines:management of avulsed permanent anterior teeth in children.http://www.infosihat.gov.my/media/garisPanduan/GP_CPG/CPG%20Management%20of%20avulsed%20permanent%20anterior%20teeth%20in%20childrem/CPG%20Management%20of%20avulsed%20permanent%20anterior%20teeth%20in%20childrem.pdf [accessed on 15 November 2007].
5. Hinkfuss SE, Messer LB. An evidence-based assessment of theclinical guidelines for replanted avulsed teeth. Part II: pre-scription of systemic antibiotics. Dent Traumatol 2009;25:158–64.
6. National Institute for Health and Clinical Excellence (2008).NICE clinical guideline 64. Prophylaxis against infective endo-carditis: antimicrobial prophylaxis against infective endocarditisin adults and children undergoing interventional procedures.http://www.nice.org.uk/nicemedia/pdf/CG64NICEguidance.pdf[accessed on 20 October 2009].
Dental Traumatology 2010; 26: 301–302 doi: 10.1111/j.1600-9657.2010.0875a.x
� 2010 John Wiley & Sons A/S 301
