A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry

Abstract

This work provides a narrative review covering evidence-based recommendations for pericoronitis management (Part A) and a systematic review of antibiotic prescribing for pericoronitis from January 2000 to May 2021 (Part B). Part A presents the most recent, clinically significant, and evidence-based guidance for pericoronitis diagnosis and proper treatment recommending the local therapy over antibiotic prescribing, which should be reserved for severe conditions. The systematic review includes publications analyzing sets of patients treated for pericoronitis and questionnaires that identified dentists' therapeutic approaches to pericoronitis. Questionnaires among dentists revealed that almost 75% of them prescribed antibiotics for pericoronitis, and pericoronitis was among the top 4 in the frequency of antibiotic use within the surveyed diagnoses and situations. Studies involving patients showed that antibiotics were prescribed to more than half of the patients with pericoronitis, and pericoronitis was among the top 2 in the frequency of antibiotic use within the monitored diagnoses and situations. The most prescribed antibiotics for pericoronitis were amoxicillin and metronidazole. The systematic review results show abundant and unnecessary use of antibiotics for pericoronitis and are in strong contrast to evidence-based recommendations summarized in the narrative review. Adherence of dental professionals to the recommendations presented in this work can help rapidly reduce the duration of pericoronitis, prevent its complications, and reduce the use of antibiotics and thus reduce its impact on patients' quality of life, healthcare costs, and antimicrobial resistance development.

Interventions for Early-Stage Pericoronitis: Systematic Review of Randomized Clinical Trials

“…Pericoronitis is the common term used to describe the inflammation of soft tissues around the dental crown in a semi-erupted lower third molar [ 1 ]. The pseudo-pocket formed around the third molar accumulates bacterial plaque underneath the soft tissue cap, predisposing to inflammatory complications [ 2 , 3 ]. Usually, patients with early stage pericoronitis report: pain, intra-oral swelling, redness, mucosal ulceration, and loss of function [ 4 ].…”

“…Usually, patients with early stage pericoronitis report: pain, intra-oral swelling, redness, mucosal ulceration, and loss of function [ 4 ]. Its cure is easy, quick, cheap, and no need for systemic antibiotics if detected early and appropriately treated [ 3 ]. Proper treatment of the initial phase is the local therapy over antibiotic prescribing [ 3 ].…”

“…Its cure is easy, quick, cheap, and no need for systemic antibiotics if detected early and appropriately treated [ 3 ]. Proper treatment of the initial phase is the local therapy over antibiotic prescribing [ 3 ]. Antibiotics should be reserved for severe cases where the spread of infection with systemic symptoms are present [ 5 ] because of the risk of developing resistance [ 6 ].…”

“…However, a large proportion of dentists routinely prescribe unnecessary antibiotics for pericoronitis [ 7 ]. The problem is the lack of evidence-based standardized treatment for initial pericoronitis [ 3 ].…”

“…It is well known that the evolution of the initial condition causes lymphadenopathy, fever, malaise, palatoglossal arch asymmetry, difficulty swallowing and trismus, indicating a more severe course of this condition [ 3 ] and may lead to a life-threatening condition called Ludwig’s angina [ 8 ]. Pericoronitis complications resulting in severe emergencies and must be treated in a hospital, with antibiotic cover.…”