Acute dental pain and swelling associated with pulpal and periapical disease is extremely common. In addition to patient visits in dental offices, there were 2.43 million dental-related visits to emergency departments (ED) in the United States (U.S.) in 2014. The most common oral-health related reasons for these visits were dental pain and intraoral swelling.1 Dentists and doctors often prescribe antibiotics in response to these symptoms and dentists were the third highest prescribing group for antibiotics in the U.S.2 It is estimated in reports from 2017 to 2019, between 30-85% of these prescriptions were suboptimal or not indicated.3-5 Furthermore, patients’ use of antibiotics is often not ideal. Both inappropriate prescribing patterns and failure to thoroughly advise patients on the importance of using antibiotics as directed have led to an increase in the number of multi-drug resistant bacteria. According to the U.S. Centres for Disease Control and Prevention (CDC), multi-drug resistant bacteria infect more than 2.8 million Americans each year and kill at least 35,000.6 To address these concerns, the American Dental Association (ADA) recently published evidence-based clinical practice guidelines for antibiotic use in the urgent management of pulpal- and periapical-related dental pain and intraoral swelling.8 This course will review the evidence regarding antibiotic usage in the dental setting, discuss the mechanisms of action of antibiotics commonly used in the dental setting, and establish the rationale for the ADA guidelines and best practices for their implementation in dental practices.

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