An outcome audit of the treatment of acute dentoalveolar infection: impact of penicillin resistance

Abstract

O Ob bj je ec ct ti iv ve e The aim of this audit was to measure the outcome of treatment of acute dentoalveolar infection and to determine if this was influenced by choice of antibiotic therapy or the presence of penicillin-resistance. S Su ub bj je ec ct ts s a an nd d m me et th ho od ds s A total of 112 patients with dentoalveolar infection were included in the audit. All patients underwent drainage, either incisional (n=105) or opening of the pulp chamber (n=7) supplemented with antibiotic therapy. A pus specimen was obtained from each patient for culture and susceptibility. Clinical signs and symptoms were recorded at the time of first presentation and re-evaluated after 48 or 72 h. R Re es su ul lt ts s A total of 104 (99%) of the patients who underwent incisional drainage exhibited improvement after 72 h. Signs and symptoms also improved in five of the seven patients who underwent drainage by opening of the root canal although the degree of improvement was less than that achieved by incisional drainage. Penicillin-resistant bacteria were found in 42 (38%) of the 112 patients in this study. Of the 65 patients who were given penicillin, 28 had penicillin-resistant bacteria.

Cervicofacial infection of dental origin presenting to maxillofacial surgery units in the United Kingdom: a national audit

“…11,12 The most successful form of drainage is via the soft tissues with drainage via the root canals the next most successful form. 13 Therefore prescription of oral antibiotics without operative intervention represents an inadequate level of treatment for dentoalveolar infections. However, the number of patients successfully treated by GDPs using oral antibiotics alone is unknown and the number presenting to oral and maxillofacial surgery may be the tip of the iceberg.…”

“…The incidence of penicillin resistance in odontogenic infection in the UK has dramatically risen over the last decade and is reported to be at least 55% now. 13,14 This has led to the role of penicillin in the treatment of odontogenic infection being questioned and is certainly not as important as achieving drainage. 13 The proportion of patients receiving operative intervention in dental primary care may improve with education of general dental practitioners or introduction of local or regional audit of the management of dentoalveolar infections.…”

“…13,14 This has led to the role of penicillin in the treatment of odontogenic infection being questioned and is certainly not as important as achieving drainage. 13 The proportion of patients receiving operative intervention in dental primary care may improve with education of general dental practitioners or introduction of local or regional audit of the management of dentoalveolar infections. Regional audit has proved successful in rationalising antimicrobial prescribing but will require multidisciplinary co-operation between primary care dental services and oral and maxillofacial surgery.…”

The role of phenoxymethylpenicillin, amoxicillin, metronidazole and clindamycin in the management of acute dentoalveolar abscesses – a review

“…[4][5][6][7][8][9][10][11] The defi nitive treatment of a dentoalveolar abscess is drainage and removal of the cause of the infection. 14,17,18,[29][30][31][32][33][34][35][36][37][38][39] In the majority of cases this is the only treatment required. However if the patient is showing signs of systemic illness as a result of their dentoalveolar infection, or are signifi cantly immunocompromised, then adjunctive therapy with antibiotics may be indicated.…”

“…A number of studies have shown that patients respond well when treated with amoxicillin 36,49,[52][53][54]57 despite the evidence of resistant strains and Ingham et al 80 found that metronidazole was as benefi cial as penicillin, surmising that this indicated that the anaerobic population of bacteria were most pathogenic. However it may be that effective drainage to reduce the number of bacteria, promote aerobic conditions and optimise a return to health may be the most important part of the process of abscess resolution.…”