American College of Emergency Physicians endorses ADA's antibiotics guideline

The American College of Emergency Physicians has endorsed the American Dental Association's clinical practice guideline on the use of antibiotics for the management of pulpal- and periapical-related pain and swelling.

The guideline advises against using antibiotics to manage most dental pain and intraoral swelling associated with pulpal and periapical infections and instead recommends only the use of dental treatment and, if needed, over-the-counter pain relievers, such as acetaminophen or ibuprofen.

The American College of Emergency Physicians sent ADA President Chad P. Gehani a letter April 14, letting him know of the endorsement. This is the first time an external dental or medical group has endorsed an ADA guideline.

Dr. Geisinger

"Dentists are estimated to be the third-highest prescribing group for antibiotics in the U.S., and many of these prescriptions may be suboptimal. Furthermore, up to 2 million emergency room visits are associated with dental emergencies every year," said Dr. Mia Geisinger, chair of the ADA Council on Scientific Affairs. "We look forward to engaging our emergency medicine colleagues to create referral systems for dental treatment in response to pulpal and periapical pain and swelling and cohesive standards for antibiotic prescribing to decrease risks associated with inappropriate antibiotic prescriptions."

The ADA may now use the wording "endorsed by the American College of Emergency Physicians" in association with the guideline. The Journal of the American College of Emergency Physicians also will publish a piece featuring the guideline's recommendations.

"Evidence-Based Clinical Practice Guideline on Antibiotic Use for the Urgent Management of Pulpal- and Periapical-Related Dental Pain and Intraoral Swelling: A Report from the American Dental Association" was published in the November 2019 issue of The Journal of the American Dental Association.

The panel that developed the guideline was convened by the Council on Scientific Affairs and worked alongside methodologists in the ADA Center for Evidence-Based Dentistry and ADA Library & Archives. It reviewed existing literature on the harms and benefits of antibiotics as treatment for pulpal and periapical conditions, finding the medications may cause significant harm while providing negligible benefits.

The guideline helped the ADA fulfill its pledged commitment to the Antimicrobial Resistance Challenge, an initiative organized by the U.S. government to combat antimicrobial resistance.