Role of antibiotics in paediatric endodontics
with endodontic infection, at times culturing may provide valuable information for a better selection of antibiotics. Culturing of the root canal for endodontic infections is rarely recommended. The variety of microorganisms involved makes a positive identiﬁcation of the main pathogen unlikely. Culturing may be helpful if the infection persists/progresses, or in the case of a medically compromised patient where extra precaution is necessary to prevent a systemic infection.
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n Problems in root canal cultures t Sampling: a technical difﬁculty, associated with obtaining samples for culturing, as sterile asepsis is necessary during sampling due to the risk of contamination from teeth (plaque of caries), oral mucosa, saliva, ﬁngers and instruments. t Transport: death of microorganisms/overgrowth of others. t Cultivation: inadequate media, uncultivable organisms. t Identiﬁcation: time-consuming – as it takes 1 to 2 weeks to identify anaerobes – and expensive. t Exact time of initial infection is difﬁcult to ascertain. The antibiotic treatment should begin immediately, even when culture is taken, because oral infections progress very rapidly. In future, the advent of molecular genetic methods may solve some of these problems and help rapid detection and identiﬁcation of known opportunistic bacteria within 24 to 48 hours.
n Duration of antibiotic therapy As each infection is unique, clinical judgement must be applied; a standard therapy of the same dose and duration for all cases will not only lead to bacterial resistance but also treatment failures. The ideal duration should be the shortest cycle capable of preventing both clinical and microbiological relapse. Thus a high-dose regimen for a short duration is preferred to a low dose for a longer time. The patient must be instructed clearly that adherence to the dosing schedule is critical in order to eliminate the infection5,8,11,14.
Fig 1 Persistent swelling.
Fig 2 Swelling continues to spread despite disinfection of the root canal system.
n Indications for the use of systemic antibiotics in endodontics4,5,8,9,11 t Antibiotics should only be used as an adjunct to deﬁnitive non-surgical or surgical endodontic therapy. Removal of the aetiology should be the ultimate goal of treatment. Pulpal debridement and/or surgical access are the primary treatment for all endodontic infections. t For progressive or persistent infections that have systemic signs and symptoms, the use of adjunctive antibiotics is recommended in conjunction with appropriate endodontic treatment for the effective debridement of the root canal (Fig 1). t Use of antibiotics is indicated if swelling continues to spread despite attempts to disinfect the root canal system and establish drainage (Fig 2). t If bacteria are too virulent or the immune system becomes too weak to control their growth, then antibiotics are necessary.
n Contraindications for the use of systemic antibiotics in endodontics4,5,8,13 t Irreversible pulpitis with or without acute periradicular periodontitis (no systemic signs of infection): it is an immune system mediated event, usually not due to bacterial infection but, rather, a result of inﬂammatory mediators overcoming the host defences. A Cochrane systematic review15 found no evidence to support the use
ENDO (Lond Engl) 2010;4(1):41–48
Bacteria have been implicated in the pathogenesis and progression of pulpal and periapical diseases.