Journal of Dental Health and Oral Research

Open Access Research Article

An Observational Study: Use of Systemic Antibiotics for

Endodontic Infections Treatment
Constantin Mădălina1, Oana Andreea Diaconu1*, Lelia Mihaela Gheorghiță1, Marilena Bătăiosu2, Lucian
Dragomir3, Andreea Gabriela Nicola4, Cristian Niky Cumpătă5, Constantin Dăguci4, Adina Turcu4,
Mihaela Jana Tuculina1*
1
Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova,
200349 Craiova, Romania
2
Department of Pedodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova,
200349 Craiova, Romania
3
Department of Prosthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova,
200349 Craiova, Romania
4
Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of
Craiova, 200349 Craiova, Romania
5
Faculty of Dental Medicine, University Titu Maiorescu of Bucharest, 67A Gheorghe Petrascu Str., 031593,
Bucharest, Romania
*
Corresponding Author: Professor Mihaela Jana Tuculina MD PhD and Associate professor Oana Andreea
Diaconu MD PhD, Str. Petru Rareș 2-4, 200349, Craiova, Romania; Faculty of Dental Medicine, University of
Medicine and Pharmacy of Craiova; E-mail: mtuculina@yahoo.com; oanamihailescu76@yahoo.com

Received Date: 30-11-2022; Accepted Date: 19-12-2022; Published Date: 26-12-2022

Copyright© 2022 by Mădălina C, et al. All rights reserved. This is an open access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction
in any medium, provided the original author and source are credited.

Abstract

Aim: The purpose of this study was to determine the knowledge and habits of Romanian
dentists about prescribing systemic antibiotics via oral for endodontic infection treatment.

Materials and Methods: In this study we asked Romanian dentists trough social media
platforms and using Google Forms App to answer a 11 questions survey about systemic use of
antibiotics (via oral) for endodontic infections. 116 dentists filled the questionnaire and the
responses were considered valid. The collected data were processed statistically with the
Microsoft Excel program (San 27 Francisco, USA).

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
 2

Results: 116 Romanian dentists responded to this questionnaire. 53% of them prescribed oral
antibiotics for 5 days, 43% for 7 days and only 3% for 3 days. In non-allergic patients the
majority prescribed as a first choice antibiotic amoxicillin in association with Clavulanic acid
- 54% and only 30% prescribed simple amoxicillin. The most prescribed antibiotic for patients
with penicillin allergy was clindamycin (61,3 %). In cases of symptomatic irreversible pulpitis
15,5 % prescribed antibiotic. For cases of pulp necrosis with asymptomatic apical periodontitis
and the presence of a sinus tract 21,7% prescribed antibiotic. Regarding the prophylactic use
of antibiotics 46% of the respondents prescribed it following outdated guide lines (1 g
administered 1 hour before the procedure or 1g before and 1g after the procedure), or
recommended it in cases where was no need for use of antibiotics (11,7% prescribed antibiotics
for patients under treatment with oral bisphosphonates).

Conclusion: The knowledge and habits of Romanian dentists about the use of antibiotics as a
supportive treatment in endodontic infections must be updated and improved because many
prescribe it in a wrong way or in unnecessary cases.

Keywords

Periapical Tissue; Permanent Teeth; Root Canal System; Endodontic Infections Treatment;
Systemic Antibiotics

Introduction

Endodontology represents the study of the morphology, physiology and pathology of dental
pulp and the surrounding periapical tissue. The endodontic infections, such as apical
periodontal abscesses, have a large prevalence among the total dental infections [1,2]. The
endodontic infections are polymicrobial, involving combinations of facultative anaerobic
germs Gram positive and Gram negative and strict anaerobic bacteria [3-5]. These infections
have a quick onset and a short evolution (2-7 days) if the cause is treated or eliminated [3]. The
majority of endodontic infections can be successfully treated only by eliminating the infection
source and establishing favourable condition for local treatment (either by drainage or tooth
extraction), with no need for use of systemic antibiotics, therefore the injury can be solved by
eliminating the cause of pulpo-periapical pathology: the pathogenic microorganisms, their
metabolism products and pulp debris from root canal system [6,7].

With no doubt, in some specific endodontic infections or in immune impaired patients, along
with the local treatment, a systemic antibiotic should be prescribed [6].

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
 3

The first large scale used antibiotic was penicillin, discovered in 1928 by Alexander Fleming,
and yet, only in 1940 Florey was the one who introduced its use in clinical practice. The
introduction of antibiotics in clinical practice was one of the most important aspects regarding
infectious disease control [3,9,10].

The correct use of antibiotics allows a good infection control and a decrease in serious
complications occurrence [7]. In occasion the pulpo-periapical infections might disseminate
leading to abscess formation, in which case along with the conventional root canal treatment,
administration of systemic antibiotics could be required [5].

The European Society of Endodontology created a guide to establish when the use of systemic
antibiotics is required adjunctive to the local endodontic treatment.

Therefore, the indications for systemic antibiotics in Endodontics are [5].

1. Acute apical abscess in medically compromised patients

2. Acute apical abscess with systemic involvement (localised fluctuant swelling, fever >38°,
malaise, lymphadenopathy, trismus)
3. Progressive infections (rapid onset on severe infections in less than 24 h, cellulitis or
spreading infection, osteomyelitis) where onward referral to oral surgeons may be
necessary
4. Replantation of avulsed permanent teeth
5. Soft tissue trauma requiring treatment (e.g. sutures, debridement)

Contra-indications for systemic antibiotics in Endodontics [5].

According to the same position statement of European Society of Endodontology the

adjunctive treatment with systemic antibiotics is not necessary or even contra-indicated in the
following cases:

1. Symptomatic irreversible pulpitis (pain with no other symptoms or signs of infection)

2. Pulp necrosis
3. Symptomatic apical periodontitis (pain, pain to percussion and biting and widening of
periodontal ligament space)
4. Chronic apical abscess (presence of a sinus tract and radiographic periapical modifications)
5. Acute apical abscess without systemic involvement (localised fluctuant swellings)

In general, in endodontic infections, dentists prescribe broad-spectrum antibiotics, given the

polymicrobial nature of these infections [12]. ß-lactam antibiotics (Penicillin V and
Amoxicillin) are the first choice for prescription in dental infections [5]. If in the USA, the
Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
 4

antibiotic of first choice is still penicillin, in Romania Amoxicillin is frequently prescribed,

which is an antibiotic with a wider spectrum and more effective against Gram-negative
anaerobic microbes [10]. Amoxicillin has been shown to have a better spectrum of
gastrointestinal absorption, not being influenced by food [2,7]. The major disadvantage of
amoxicillin is its susceptibility to being destroyed or altered by ß-lactamase-producing bacteria.
Therefore, we more frequently use the combination of amoxicillin and clavulanic acid due to
its high efficiency against almost 100% of endodontic bacteria that can be cultured in the
laboratory [7,13].

About 8% of the world's population is allergic to penicillin [12]. The antibiotic used in patients
with penicillin allergy varies worldwide [10]. Clindamycin is a lincosamide effective against
most aerobic Gram-positive and facultative Gram-positive and Gram-negative bacteria and
anaerobic microorganisms [2]. This drug has good absorption and distribution in the body.
However, high doses have been linked to serious side effects such as pseudomembranous
colitis and neutropenia [7]. Another alternative would be macrolides, which include
Clarithromycin and Azithromycin, effective against a large number of aerobic and anaerobic,
Gram-positive and Gram-negative bacteria. Metronidazole can be used as a complementary
antibiotic in combination with amoxicillin due to its excellent effect against anaerobic bacteria
[4]. To avoid the development of resistance to antimicrobial drugs, antibiotics should be
prescribed for an appropriate period of time, with an appropriate dose and frequency, with
minimal side effects. The prescribed dose of antibiotics should be close to therapeutic values
without harming the body [2]. According to the European Society of Endodontics the initial
loading dose should be double the maintenance dose to reach a concentration 3-4 times higher
than the minimum inhibitory concentration at the start of treatment (Table 1) [5].
Recommendations are to start treatment with ß-lactam antibiotics (Penicillin V or Amoxicillin),
followed by a combination of Penicillin V and Metronidazole or Amoxicillin with clavulanic
acid if initial therapy is not effective [5].

Antibiotic of Choice Loading Dose

Maintenance Dose Duration
Penicillin VK 1000 mg 500 mg q4-6h 3-7 days
Amoxicillin 1000 mg 500 mg q8h or 3-7 days
875 mg q12h
Amoxicillin with clavulanic acid 1000 mg 500 mg q8h or 3-7 days
875 mg q12h
Clindamycin 600 mg 300 mg q6h 3-7 days
Clarithromycin 500 mg 250 mg q12h 3-7 days
Azithromycin 500 mg 250 mg q24h 3-7 days
Metronidazole 1000 mg 500 mg q6h 3-7 days
Table 1: Type, dosages and duration of antibiotics prescribed in Endodontics [5].

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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The indicated duration of treatment is 3-7 days. As soon as there is evidence of clinical
symptoms improvement the antibiotic administration must be discontinued [5].

The prophylactic antibiotic therapy in medically impaired individuals who require endodontic
procedures is controversial and it should only be indicated when the benefits are science
evidence based [5]. The European Society of Endodontology recommends antibiotic
prophylaxis for the following categories of patients (Table 2).

Patient group Indications

Impaired imunologic function Non surgical root canal treatment and
(Leukaemia, HIV/AIDS, end-stage renal disease, dialysis, especially endodontic surgery
uncontrolled diabetes, chemotherapy, steroids or
immunosuppressive medications, inherited genetic
defects)
Risk of developing infective endocarditis (Patients with Non surgical root canal treatment
complex congenital heart defects, prosthertic cardiac
valve or a history of infective endocarditis)
Endodontic surgery
Prosthetic Joint Replacement Non surgical root canal treatment
Endodontic surgery
During the first 3 months after joint
operations
Patients whose jawbones are exposed to high-dose Non surgical root canal treatment
irradiation Endodontic surgery
Patients receiving intravenous bisphosphonate treatment Endodontic surgery
Table 2: Indications of antibiotic prophylaxis in Endodontics [5].

The European Society of Endodontology also published antibiotic prophylaxis guide lines for
endodontic infections (Table 3) [5].

Patient Group Antibiotic Route Adults Children Timing Before

Procedure
Standard general prophylaxis Amoxicillin PO 2g 50 mg/kg 1h
Unable to take oral medication Ampicillin IV or IM 2g 50 mg/kg 30 min
Allergic to penicillin Clindamycin PO 600 mg 20 mg/kg 1h
Azithromycin PO 500 mg 15 mg/kg 1h
Clarithromycin PO 500 mg 15 mg/kg 1h
Cephalexin PO 2g 50 mg/kg 1h

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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Allergic to Clindamycin IV 600 mg 20 mg/kg 30 min

penicillin/amoxicillin/ampicillin
and unable to take oral
medications
Cefazolin IV 1g 25 mg /kg 30 min
Table 3: Recommended antibiotic prophylaxis regimens in Endodontics.

There is a growing threat of antibacterial drug resistance which leads to a reduced efficiency
of antibiotics.

Antibacterial drug resistance is defined as the ability of a microorganism to resist antibiotic

action by any means that the resistant bacteria is capable of surviving to an antibiotic
concentration that would normally kill or stop growing individuals from same species [3].
The antibacterial drug resistance can occur naturally or can be acquired.

Natural resistance means that the bacteria is born with resistance to a certain antibiotic, while
the acquired resistance is attributed to the contact between bacteria and antibiotic.

The microorganism acquires the resistance during or after the antibiotic exposure [6].

The indications of systemic antibiotic use in Endodontics must be sustained by a correct

diagnosis and a thorough clinical exam in conjunction with right assessment of complementary
exams. As well the indications must be sustained by science based evidence.

In daily practice dentists prescribe mostly analgesics and antibiotics, many times these habits
proving to be inadequate to clinical situation or even wrong [2,3].

Unfortunately dentists significantly concur to the global problem of antimicrobial drug

resistance by overprescribing antibiotics [3].

Approximately 10 % of antibiotics dispensed in primary care are prescribed by dentists [12].

There are already many microorganisms that are resistant to all known antibiotics, which makes
us think to a potential medical disaster [9].

If we don’t change these tendencies, most likely the future generations may not have available
efficient antibiotics to treat real orofacial infections [4].

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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The wrong use of antibiotics is thought to be related to antimicrobial drug resistance, but also
with higher risk of serious anaphylactic reactions, exposing patients to unnecessary adverse
reactions [2].

The main factors associated with antibacterial drug resistance are the dosage and duration of
treatment. An ineffective dosage or prolonged use of antibiotics contribute to the development
of drug resistant bacteria [12].

All that being said and considering that antibacterial drug resistance is a serious and urgent
global concern for public health, we must assess the habits of Romanian dentists regarding
antibiotic use, this being the aim of this study.

The general aim of this study is to assess the Romanian dentist’s knowledge and habits
regarding indication for systemic antibiotic use in endodontic infections treatment.

Specific aims:
 Appreciate the degree of knowing Romanian dentists have about indications of systemic
antibiotic use in endodontic infections
 Establish the pattern of antibiotic prophylaxis prescription before endodontic procedures
 Compare the collected data with available current scientific evidence

Materials and Methodology

In this study 116 Romanian dentists answered to a 10 question survey about indications of
systemic antibiotics use for endodontic infections treatment and antibiotic prophylaxis.

The group of doctors included in the study was selected from among endodontic specialists,
regardless of age or level of experience. Doctors who do not specialize in endodontics were
excluded from the study. The questionnaires were sent and completed in electronic format.
After completion, the questionnaires were statistically analyzed using the Microsoft Excel
program (San 27 Francisco, USA). Initially, the database was created, on the basis of which
the statistical analysis was made.

The questions in this form were created based on other questionnaires previously published in
USA and Spain [2-4,10,15,17,18].

The participants filled this form anonymously, voluntarily and without any kind of
compensation.

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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Results

The questions in this survey were (Table 4-14):

1. Gender

The gender of the study participants Male Female

Number of study participants 24% 76%
Table 4: What is your gender?

2. Age of Participants

Table 5: What is your age category?

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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3. Experience

Table 6: How many years have you been practicing dentistry?

4. Number of root canal treatments on average per week

Table 7: How many Root Canal Treatments (RCT) do you perform in a week?

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Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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5. Choice of preferred antibiotic

Table 8: If oral antibiotics are indicated, which antibiotic would you choose for the treatment
of an endodontic infection in an adult patient without allergies?

6. The antibiotic of choice for penicillin allergic patients

Table 9: If the administration of oral antibiotics is indicated in an adult patient allergic to

penicillin, which antibiotic do you prescribe?
Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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7. Duration of treatment

Table 10: For how long (how many days) do you prescribe the antibiotic?

8. Antibiotic prescription according to type of endodontic infection.

Table 11: Type of endodontic infection.

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Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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9. Antibiotic prophylaxis

Table 12: Before which therapeutic procedures do you prescribe prophylactic antibiotics
if indicated?

10. Antibiotic prophylaxis regimen

Table 13: If antibiotic prophylaxis is indicated, how do you prescribe the antibiotic to an
adult patient without penicillin allergy?

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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11. Antibiotic prophylaxis for clinical situations

Table 14: In which of the following cases do you think you can indicate antibiotic
prophylaxis? You can choose more than one answer.

Discussion

This study shows the current knowledge and habits of Romanian dentists about indications of
systemic antibiotic treatment for pulpo-periapical infections and antibiotic prophylaxis in
endodontics.

The data analysed in this survey show that many dentists correctly prescribed the antibiotic for
endodontic infections, as well for prophylaxis; still, a large number of dentists have erroneously
prescribed the antibiotic treatment.

The population sample used in this survey was represented by a number of 116 Romanian
dentists. Similar to this study, Martin-Jimenez, et al., found out that the majority of respondents
were females in our study 76% were females versus 24% males [2].

The results of this study have been compared to other similar studies:

A 2009 study of Spanish Endodontic Society (Asociation Española de Endodoncia) revealed

that Amoxicillin was the most prescribed antibiotic - 86.2% [3]

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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 In 2010 members of Spanish Society of Oral and Maxillofacial Surgery (Sociedad

Española de Chirurgia Oral y Maxilofacial) chosen amoxicillin in 95% cases [10]
 Simple amoxicillin (or combined with Clavulanic acid) was the first choice antibiotic
in other similar studies in European countries [19-23]

However, in USA the first choice antibiotic for endodontic infections is penicillin [4,21].

The position statement of European Society of Endodontology, based on current scientific

evidence, recommends amoxicillin as a first choice antibiotic for non-allergic patients and with
no immune conditions, keeping the combination amoxicillin with Clavulanic acid for cases
where first therapy was ineffective [5,12].

For the penicillin allergic individuals, the choice of antibiotic varies worldwide or even in
different regions of the same country [21].

Our results are similar to those of the European Society of Endodontology position statement
where the first choice antibiotic for penicillin allergic patients is clindamycin - a medium
spectrum antibiotic which is effective against oral anaerobes and facultative bacteria, but which
in high doses can cause serious side effects such as pseudomembranous colitis and neutropenia
[5,12].

The participants in this study chose the duration of antibiotic treatment depending on the
severity of the endodontic infection as follows: 51.7% for 5 days, 44.8% for 7 days, 3.4% for
3 days.

The reference point for the duration of antibiotic treatment is the improvement of clinical
symptoms. For this reason it is essential that the treatment be personalised and followed.

The recommendations are to prescribe the antibiotic for a 3 day period and reassess the patient
after that, in order to evaluate if the treatment must be continued or stopped [5].

According to our study results, alike to other similar previous studies still persists the wrong
idea that bacterial infections need a complete cycle of antibiotic therapy, although there is no
scientific evidence to support that one week of antibiotic treatment is needed for endodontic
infections [2,3,10,18,25].

The percentages of erroneous prescription of antibiotics are high, which brings to attention the
lack of knowledge of dentists about the current scientific data regarding antibiotic therapy. This

Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
 15

study also highlights the fact that many dentists prescribe antibiotics in clinical situations where
is no need. This shows that many dentists ignore the scientific basis for prescribing antibiotics
in endodontic infections.

The inadequate antibiotic prescribing patterns have been described in many studies from
different countries [2,3,10,19-21,24,25].

For irreversible pulpitis (moderate/severe symptoms) or for irreversible pulpitis with

symptomatic apical periodontitis 16.5% respectively 29/6% of respondents prescribed
antibiotic. These clinical situations DO NOT require systemic antibiotic [5].

For pulp necrosis with asymptomatic apical periodontitis, also there is NO need for systemic
antibiotic treatment [5]. However 3.5% of the dentists involved in this study prescribed
antibiotic.

For pulp necrosis with acute apical periodontitis (no abscess and moderate/severe symptoms)
39.1% of the participants prescribed antibiotic; also 21.7 % respondents prescribed antibiotic
for pulp necrosis with asymptomatic periodontitis, sinus tract and minor/absent symptoms.
These pathologies can be solved by local root canal treatment and analgesics prescription, with
no need to administer systemic antibiotics [2,5].

For the last clinical situation in this survey - pulp necrosis with acute apical periodontitis,
abscess present and moderate/severe symptoms 94.8% of participants prescribed antibiotic. In
this clinical situation, yes, the antibiotic therapy is indicated as adjunctive treatment to root
canal procedures in order to prevent the spread of infection [5].

Regarding the prophylactic use of antibiotics in patients that have indications for such therapy,
53,5% of respondents said that it would be needed before periapical surgery.

European Society of Endodontology recommends for allergy free patients 2 g of amoxicillin

administered via oral 1 hour before the procedure [5].

Conclusion

The antibiotic prescription pattern and the indications for use of antibiotics recommended by
Romanian dentists is inadequate and does not follow current scientific evidence. The
percentage of dentists who chose correctly the type of antibiotic for endodontic infections is
elevated (84.5% - amoxicillin or amoxicillin with Clavulanic acid). In most cases the duration
of treatment was prolonged: 51.7% 5 days or 44.8% 7 days; the percentage of dentists who
Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310
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recommend use of systemic antibiotic in clinical cases where is no need is very high (nearly
100%). There is an urgent need to develop new strategies to make known current
recommendations on antibiotic administration in endodontic infections.

Contribution Note
All the authors equally contributed to the drawing up of the present paper.

Conflict of Interest
The authors declare that they have no conflict of interest.

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Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

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Mădălina C | Volume 3; Issue 3 (2022) | JDHOR-3(3)-072 | Research Article

Citation: Tuculina MJ, et al. An Observational Study: Use of Systemic Antibiotics for Endodontic
Infections Treatment. J Dental Health Oral Res. 2022;3(3):1-17.

DOI: https://doi.org/10.46889/JDHOR.2022.3310