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Are systemic antibiotics indicated in children presenting with an odontogenic abscess in the primary dentition? A systematic review of the literature

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Abstract

Objectives

This systematic review aimed to assess (1) whether systemic antibiotics are beneficial or harmful in healthy children who present with an odontogenic abscess in the primary dentition with or without systemic involvement and (2) if antibiotics are beneficial, which type, dosage and duration are the most effective.

Materials and methods

Electronic databases (Medline, Embase, and the Cochrane Library) were screened from 1948 up to August 2020. No filters with respect to study design were applied. Outcomes of interest included pain, swelling, pain relief, adverse effects, signs of infection, quality-of-life measurements and medication required for pain relief.

Results

Altogether, 352 titles and abstracts were screened for eligibility; of these, 19 were selected for full text assessment. All were excluded because none of them fulfilled the inclusion criteria and addressed the (adjunctive) use of antibiotics in children who present with an odontogenic abscess in the primary dentition.

Conclusions

At present, there is no single randomised or non-randomised clinical study evaluating the effectiveness and harms of systemic antibiotics administered in children who present with an odontogenic abscess in the primary dentition.

Clinical relevance

There is no clinical evidence to support nor to refute the use of antibiotics in children who present with an odontogenic abscess in the primary dentition without signs of local spread or systemic involvement. Given this lack of scientific evidence, the use of antibiotics cannot be recommended in these children. Well-designed clinical trials are indicated to fully understand the impact and necessity of antibiotics in these situations.

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References

  1. Schnabl D, Fleischer F, Riedmann M, Laimer J, Gaßner R (2019) Prevalence and distribution of deep caries and abscess formation in children who required emergency dental general anaesthesia. A retrospective analysis. Eur J Paediatr Dent 20(2):119–122. https://doi.org/10.23804/ejpd.22019.23820.23802.23807

    Article  PubMed  Google Scholar 

  2. Azodo CC, Chukwumah NM, Ezeja EB (2012) Dentoalveolar abscess among children attending a dental clinic in Nigeria. Odontostomatol Trop 35(139):41–46

    PubMed  Google Scholar 

  3. Kratunova E, Silva D (2018) Pulp therapy for primary and immature permanent teeth: an overview. Gen Dent 66(6):30–38

    PubMed  Google Scholar 

  4. Alaluusua S, Veerkamp J, Declerck D (2002) European Academy of Paediatric Dentistry (EAPD) Policy document for the use of antibiotics in paediatric dentistry

  5. American Academy of Pediatric Dentistry (2019) Guideline on Use of Antibiotic Therapy for Pediatric Dental Patients. The reference manual of pediatric dentistry

  6. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  7. Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G, Alderson P, Glasziou P, Falck-Ytter Y, Schünemann HJ (2011) GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 64(4):395–400. https://doi.org/10.1016/j.jclinepi.2010.1009.1012

    Article  PubMed  Google Scholar 

  8. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna SE, Littlejohns P, Makarski J, Zitzelsberger L (2010) AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 182(18):E839–E842. https://doi.org/10.1503/cmaj.090449

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008. https://doi.org/10.1136/bmj.j4008

    Article  PubMed  PubMed Central  Google Scholar 

  10. Higgins JPT, Altman DG, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (2012) Assessing risk of bias in included studies. In: Higgins JPT, Green S (eds) . John Wiley & Sons, Cochrane handbook for systematic reviews of interventions, pp 187–241

    Google Scholar 

  11. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  12. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64(4):401–406. https://doi.org/10.1016/j.jclinepi.2010.1007.1015

    Article  PubMed  Google Scholar 

  13. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schunemann HJ (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64(4):383–394. https://doi.org/10.1016/j.jclinepi.2010.1004.1026

    Article  PubMed  Google Scholar 

  14. Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, Brozek J, Norris S, Meerpohl J, Djulbegovic B, Alonso-Coello P, Post PN, Busse JW, Glasziou P, Christensen R, Schunemann HJ (2013) GRADE guidelines: 12. Preparing summary of findings tables-binary outcomes. J Clin Epidemiol 66(2):158–172. https://doi.org/10.1016/j.jclinepi.2012.1001.1012

    Article  PubMed  Google Scholar 

  15. Deeks JJ, Higgins JPT, Altman DG, on behalf of the Cochrane Statistical Methods Group (2012) Anylising data and undertaking meta-analyses. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions. Wiley, pp 243–296

  16. The Nordic Cochrane Centre, The Cochrane Collaboration (2014) Review Manager (RevMan). 5.3 edn, Copenhagen

  17. Fouad AF, Rivera EM, Walton RE (1996) Penicillin as a supplement in resolving the localized acute apical abscess. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 81(5):590–595. https://doi.org/10.1016/s1079-2104(96)80054-0

    Article  PubMed  Google Scholar 

  18. Henry M, Reader A, Beck M (2001) Effect of penicillin on postoperative endodontic pain and swelling in symptomatic necrotic teeth. J Endod 27(2):117–123. https://doi.org/10.1097/00004770-200102000-200100016

    Article  PubMed  Google Scholar 

  19. Gillies M, Ranakusuma A, Hoffmann T, Thorning S, McGuire T, Glasziou P, Del Mar C (2015) Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication. CMAJ 187(1):E21–E31. https://doi.org/10.1503/cmaj.140848

    Article  PubMed  PubMed Central  Google Scholar 

  20. World Health Organization (2015) Global Action Plan on Antimicrobial Resistance.

  21. European Commission (2015) Commission Notice. Guidelines for the prudent use of antimicrobials in veterinary medicine. Official Journal of the European Union 2015/C 299/04

  22. World Health Organization (2012) The evolving threat of antimicrobial resistance. Options for action. http://www.who.int/patientsafety/implementation/amr/publication/en/

  23. Yesudian GT, Gilchrist F, Bebb K, Albadri S, Aspinall A, Swales K, Deery C (2015) A multicentre, multicycle audit of the prescribing practices of three paediatric dental departments in the North of England. Br Dent J 218(12):681–685. https://doi.org/10.1038/sj.bdj.2015.1440

    Article  PubMed  Google Scholar 

  24. Sivaraman SS, Hassan M, Pearson JM (2013) A national survey of pediatric dentists on antibiotic use in children. Pediatr Dent 35(7):546–549

    PubMed  Google Scholar 

  25. Cherry WR, Lee JY, Shugars DA, White RP Jr, Vann WF Jr (2012) Antibiotic use for treating dental infections in children: a survey of dentists' prescribing practices. J Am Dent Assoc 143(1):31–38

    Article  PubMed  Google Scholar 

  26. Ahsan S, Hydrie MZI, Hyder Naqvi SMZ, Shaikh MA, Shah MZ, Jafry SIA (2020) Antibiotic prescription patterns for treating dental infections in children among general and pediatric dentists in teaching institutions of Karachi. Pakistan. PLoS One 15(7):e0235671. https://doi.org/10.1371/journal.pone.0235671 eCollection 0232020

    Article  PubMed  Google Scholar 

  27. Ricotta EE, Olivier KN, Lai YL, Prevots DR, Adjemian J (2018) Hospital-based antibiotic use in patients with Mycobacterium avium complex. ERJ Open Res 4(4):00109–02018. https://doi.org/10.1183/23120541.23100109-23122018 eCollection 23122018 Oct

    Article  PubMed  PubMed Central  Google Scholar 

  28. Taverner J, Ross L, Bartlett C, Luthe M, Ong J, Irving L, Smallwood N (2019) Antimicrobial prescription in patients dying from chronic obstructive pulmonary disease. Intern Med J 49(1):66–73. https://doi.org/10.1111/imj.13959

    Article  PubMed  Google Scholar 

  29. O'Keefe C, Thompson A, McKenzie D, Lee K (2019) Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior-to-hospital therapy. Int J Clin Pract 1(10):13427

    Google Scholar 

  30. Dowson L, Bennett N, Buising K, Marshall C, Friedman ND, Stuart RL, Kong DCM (2020) Urinary tract infections in Australian aged care homes: Antibiotic prescribing practices and concordance to national guidelines. Am J Infect Control 48(3):261–266. https://doi.org/10.1016/j.ajic.2019.1008.1034

    Article  PubMed  Google Scholar 

  31. Yu JY, McKenna VA, Dumyati GK, Lubowski TJ, Carreno JJ (2020) Antibiotic Prescribing in New York State Medicare Part B Beneficiaries Diagnosed With Cystitis Between 2016 and 2017. Open Forum Infect Dis 7(1):ofz544. https://doi.org/10.1093/ofid/ofz1544 eCollection 2020 Jan

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sohn M, Chung D, Winterholler E, Hammershaimb B, Leist C, Kucera M, Trombly M, Tracey J, Dregansky G, Schauer M, Rauch H, Woodwyk A, VanLoo D, Warner A, Klepser ME (2020) Assessment of antibiotic use and concordance with practice guidelines within 3 diverse ambulatory clinic systems. J Am Pharm Assoc 23(20):30312–30315

    Google Scholar 

  33. Leroy R, Bourgeois J, Verleye L, Declerck D, Depuydt P, Eloot A, Carvalho JC, Theughels W, Cauwels R, Leprince J, Toma S, Michiels K, Aryanpour S, Vanden Abbeele A, De Bruyne M (2020) Guideline on the prudent prescription of antibiotics in the dental office. KCE Reports, vol 332. Belgian Health Care Knowledge Centre (KCE), Brussel

  34. European Centre for Disease Prevention and Control (2018) ECDC country visit to Belgium to discuss antimicrobial resistance issues. ECDC, Stockholm. https://doi.org/10.2900/065952

  35. Blommaert A, Coenen S, Gielen B, Goossens H, Hens N, Beutels P (2013) Patient and prescriber determinants for the choice between amoxicillin and broader-spectrum antibiotics: a nationwide prescription-level analysis. J Antimicrob Chemother 68(10):2383–2392. https://doi.org/10.1093/jac/dkt170

    Article  PubMed  Google Scholar 

  36. Leroy R, Christiaens W, Maertens de Noordhout C, Hanquet G (2019) Proposals for a more effective antibiotic policy in Belgium. KCE Reports, vol 311. Belgian Health Care Knowledge Centre (KCE), Brussels

    Google Scholar 

  37. Broom A, Broom J, Kirby E (2014) Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing. Soc Sci Med (1982) 110:81–88. https://doi.org/10.1016/j.socscimed.2014.03.030

    Article  PubMed  Google Scholar 

  38. Md Rezal RS, Hassali MA, Alrasheedy AA, Saleem F, Md Yusof FA, Godman B (2015) Physicians’ knowledge, perceptions and behaviour towards antibiotic prescribing: a systematic review of the literature. Exp Rev Anti-Infect Ther 13(5):665–680. https://doi.org/10.1586/14787210.2015.1025057

    Article  Google Scholar 

  39. Hulscher MEJL, Grol RPTM, van der Meer JWM (2010) Antibiotic prescribing in hospitals: a social and behavioural scientific approach. Lancet Infect Dis 10(3):167–175. https://doi.org/10.1016/S1473-3099(10)70027-X

    Article  PubMed  Google Scholar 

  40. Pereira RS, Bonardi JP, Ferreira A, Latini GL (2017) An unusual case of dental infection by Pseudomonas aeruginosa causing a brain abscess: case report. Aust Dent J 62(4):523–527. https://doi.org/10.1111/adj.12539

    Article  PubMed  Google Scholar 

  41. Rae Yoo J, Taek Heo S, Kim M, Lee CS, Kim YR (2016) Porphyromonas gingivalis causing brain abscess in patient with recurrent periodontitis. Anaerobe 39:165–167. https://doi.org/10.1016/j.anaerobe.2016.1004.1009

    Article  PubMed  Google Scholar 

  42. Greenstein A, Witherspoon R, Leinkram D, Malandreni M (2015) An unusual case of a brain abscess arising from an odontogenic infection. Aust Dent J 60(4):532–535. https://doi.org/10.1111/adj.12266

    Article  PubMed  Google Scholar 

  43. Heckmann JG, Pauli SU (2015) Epidural abscess after dental extraction. Age Ageing 44(5):901. https://doi.org/10.1093/ageing/afv1094

    Article  PubMed  Google Scholar 

  44. Terzi HA, Demiray T, Koroglu M, Cakmak G, Hakki Ciftci I, Ozbek A, Altindis M (2016) Intra-Abdominal Abscess and Primary Peritonitis Caused by Streptococcus anginosus. Jundishapur J Microbiol 9(6):e33863. https://doi.org/10.35812/jjm.33863 eCollection 32016 Jun

    Article  PubMed  PubMed Central  Google Scholar 

  45. van Brummelen SE, Melles D, van der Eerden M (2018) A lung abscess caused by bad teeth. Ned Tijdschr Tandheelkd 125(7-8):384–387. https://doi.org/10.5177/ntvt.2018.5107/5108.18160

    Article  PubMed  Google Scholar 

  46. Hannoodi F, Sabbagh H, Kulairi Z, Kumar S (2017) A Rare Case of Fusobacterium Necrophorum Liver Abscesses. Clin Pract 7(1):928. https://doi.org/10.4081/cp.2017.4928 eCollection 2017 Jan 4011

    Article  PubMed  PubMed Central  Google Scholar 

  47. Osawa Y, Isayama H, Mizuno S, Nakai Y, Matsukawa M, Mohri D, Kogure H, Sasaki T, Yamamoto N, Hirano K, Sasahira N, Tada M, Koike K (2015) Two Cases of Liver Abscesses Derived from Dental Disease in Patients with Alcoholic Chronic Pancreatitis. Intern Med 54(13):1623–1625. https://doi.org/10.2169/internalmedicine.1654.4043

    Article  PubMed  Google Scholar 

  48. Schiff E, Pick N, Oliven A, Odeh M (2003) Multiple liver abscesses after dental treatment. J Clin Gastroenterol 36(4):369–371. https://doi.org/10.1097/00004836-200304000-200300020

    Article  PubMed  Google Scholar 

  49. Garcia Vasquez C, Castellon Pavon C, Jimenez de Los Galanes S, Gomez Patino J, Brea de Diego B (2016) Conservative management of splenic abscess septic emboli after tooth extractions. Rev Esp Enferm Dig 108(10):664–666. https://doi.org/10.17235/reed.12016.13939/12015

    Article  PubMed  Google Scholar 

  50. European Commission (2008) Ethical considerations for clinical trials on medicinal products conducted with the paediatric population. Recommendations of the Ad hoc group for the development of implementing guidelines for Directive 2001/20/EC relating to good clinical practice in the conduct of clinical trials on medicinal products for human use. Directive 2001/20/EC

  51. Roth-Cline M, Gerson J, Bright P, Lee CS, Nelson RM (2011) Ethical considerations in conducting pediatric research. In: Seyberth H, Rane A, Schwab M (eds) Pediatric Clinical Pharmacology. Handbook of Experimental Pharmacology, vol 205. Springer, Berlin, pp 219–244

    Chapter  Google Scholar 

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Acknowledgments

The authors would like to thank Nicolas Fairon, information specialist at the Belgian Health Care Knowledge Centre (KCE), who performed the searches in the electronic databases.

Funding

This research was supported by the government approved work program of the Belgian Healthcare Knowledge Centre.

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Authors and Affiliations

  1. Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, B-1000, Brussels, Belgium

    Roos Leroy, Jolyce Bourgeois & Leen Verleye

  2. Faculty of Medicine and Dentistry, UCLouvain, Av. Hippocrate 10, B-1200, Brussels, Belgium

    Joana C. Carvalho

  3. Private Dental Practice, Emiel Verhaerenlaan 37, B-9050, Gentbrugge, Belgium

    Anouk Eloot

  4. Department of Oral Health Sciences, UGent, C. Heymanslaan 10, B-9000, Ghent, Belgium

    Rita Cauwels

  5. Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Kapucijnenvoer 7/a-box 7001, B-3000, Leuven, Belgium

    Dominique Declerck

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  1. Roos Leroy
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Correspondence to Roos Leroy.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Roos Leroy declares no conflict of interest. Jolyce Bourgeois declares no conflict of interest. Leen Verleye declares no conflict of interest. Joana C. Carvalho declares no conflict of interest. Anouk Eloot declares no conflict of interest. Rita Cauwels declares no conflict of interest. Dominique Declerck declares no conflict of interest.

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Leroy, R., Bourgeois, J., Verleye, L. et al. Are systemic antibiotics indicated in children presenting with an odontogenic abscess in the primary dentition? A systematic review of the literature. Clin Oral Invest 25, 2537–2544 (2021). https://doi.org/10.1007/s00784-021-03862-3

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