Local operative measures

Sir, we read with interest the letter by Dr P. R. Williams entitled Fat faces and swellings1 that recently appeared in your publication. We agree with Dr Williams that the importance of local, operative measures in the treatment of odontogenic infections cannot be overstated. Whilst we are presently undertaking a Cochrane Systematic Review regarding the effects of systemic antibiotics on symptomatic apical periodontitis and acute apical abscess in adults,2 current clinical guidelines published by the Scottish Dental Clinical Effectiveness Programme (SDCEP) state that 'dental abscesses should be treated by local measures in the first instance' and only if 'local measures have proved ineffective or there is evidence of cellulitis, spreading infection or systemic involvement' should an antibiotic be prescribed.3 Indeed, in the majority of cases of dentoalveolar abscesses, drainage and removal of the source of infection are the only treatments required.4

Failing to attempt a surgical procedure (be it extraction, endodontic treatment or soft tissue incision and drainage) when a patient presents with a dentoalveolar abscesses represents a missed opportunity to deal with the cause of the infection. Furthermore, prescribing antibiotics and delaying dental extraction risks the patient developing a potentially serious head and neck infection. Inappropriate use of antibiotics also contributes to the emergence of antibiotic resistant bacterial colonies within the worldwide community, which has become one of the most pressing public health threats of our time. When you consider that dentists in England and Wales are responsible for the prescription of 9% of all primary care antibiotics,5,6 it becomes clear that we as dental practitioners have an important role to play in the responsible use of these drugs.

We therefore applaud Dr Williams' attitude to the management of this and other patients and would encourage other colleagues to do the same: always attempt local, operative measures when faced with odontogenic infections.

References

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    Cope A, Francis N, Wood F, Mann M K, Chestnutt I G . Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2012; 10.

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    Scottish Dental Clinical Effectiveness Programme. Drug prescribing for dentistry: dental clinical guidance. Dundee: Scottish Dental Clinical Effectiveness Programme, 2011. Available at www.sdcep.org.uk/?o=2334.

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    Ellison S J . The role of phenoxymethylpenicillin, amoxicillin, metronidazole and clindamycin in the management of acute dentoalveolar abscesses – a review. Br Dent J 2009; 206: 357–362.

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    Karki A J, Holyfield G, Thomas D . Dental prescribing in Wales and associated public health issues. Br Dent J 2011; 210: E21.

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    The NHS Information Centre, Prescribing Support and Primary Care Services. Prescribing by dentists. England - 2011. London: The Health and Social Care Information Centre, Prescribing Support Unit, 2012.

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Cope, A., Chestnutt, I. & Francis, N. Local operative measures. Br Dent J 214, 274–275 (2013). https://doi.org/10.1038/sj.bdj.2013.282

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