![](media/image1.png){width="5.96875in" height="0.41944444444444445in"}

Top of Form

## Complete Summary

#### GUIDELINE TITLE

Clinical guideline on appropriate use of antibiotic therapy for
pediatric dental patients.

#### BIBLIOGRAPHIC SOURCE(S)

American Academy of Pediatric Dentistry (AAPD). Clinical guideline on
appropriate use of antibiotic therapy for pediatric dental patients.
Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2005. 3 p.
\[26 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: American Academy of Pediatric
Dentistry. Clinical guideline on appropriate use of antibiotic therapy.
Chicago (IL): American Academy of Pediatric Dentistry; 2001. 2 p.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Pediatric dental diseases requiring antibiotic therapy, including oral
wounds, dental trauma, orofacial infections, and periodontal disease

#### GUIDELINE CATEGORY

Management\
Treatment

#### CLINICAL SPECIALTY

Dentistry\
Pediatrics

#### INTENDED USERS

Allied Health Personnel\
Dentists\
Nurses\
Physicians

#### GUIDELINE OBJECTIVE(S)

To provide guidance in the proper and judicious use of antibiotic
therapy in the treatment of oral conditions

#### TARGET POPULATION

Infants, children, and adolescents with oral conditions requiring
antibiotic therapy

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Antibiotic therapy

    -   Intravenous

    -   Intramuscular

    -   Oral

2.  Monitoring of clinical effectiveness of antibiotic therapy

    -   Culture and susceptibility testing of isolates from the
        infective site

3.  Duration of drug therapy

4.  Patient education regarding the importance of completing a full
    course of antibiotics

5.  Tooth extraction

6.  Assessment of anesthesia requirements

7.  Additional birth control measures for patients taking antibiotics
    and oral contraceptives

#### MAJOR OUTCOMES CONSIDERED

Incidence of antibiotic resistant bacteria colonization

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

A MEDLINE search was conducted using the keywords \"antibiotic
therapy,\" \"antibacterial agents in children,\" \"dental trauma,\"
\"oral wound management,\" and \"orofacial infections.\"

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The oral health policies and clinical guidelines of the American Academy
of Pediatric Dentistry (AAPD) are developed under the direction of the
Board of Trustees, utilizing the resources and expertise of its
membership operating through the Council on Clinical Affairs (CCA).

Proposals to develop or modify policies and guidelines may originate
from 4 sources:

1.  The officers or trustees acting at any meeting of the Board of
    Trustees

2.  A council, committee, or task force in its report to the Board of
    Trustees

3.  Any member of the AAPD acting through the Reference Committee
    hearing of the General Assembly at the Annual Session

4.  Officers, trustees, council and committee chairs, or other
    participants at the AAPD\'s Annual Strategic Planning Session

Regardless of the source, proposals are considered carefully, and those
deemed sufficiently meritorious by a majority vote of the Board of
Trustees are referred to the CCA for development or review/revision.

Once a charge (directive from the Board of Trustees) for development or
review/revision of an oral health policy or clinical guideline is sent
to the CCA, it is assigned to 1 or more members of the CCA for
completion. CCA members are instructed to follow the specified format
for a policy or guideline. All oral health policies and clinical
guidelines are based on 2 sources of evidence: (1) the scientific
literature; and (2) experts in the field. Members may call upon any
expert as a consultant to the council to provide expert opinion. The
Council on Scientific Affairs provides input as to the scientific
validity of a policy or guideline.

The CCA meets on an interim basis (midwinter) to discuss proposed oral
health policies and clinical guidelines. Each new or reviewed/revised
policy and guideline is reviewed, discussed, and confirmed by the entire
council.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Once developed by the Council on Clinical Affairs (CCA), the proposed
policy or guideline is submitted for the consideration of the Board of
Trustees. While the board may request revision, in which case it is
returned to the council for modification, once accepted by majority vote
of the board, it is referred for Reference Committee hearing at the
upcoming Annual Session. At the Reference Committee hearing, the
membership may provide comment or suggestion for alteration of the
document before presentation to the General Assembly. The final document
then is presented for ratification by a majority vote of the membership
present and voting at the General Assembly. If accepted by the General
Assembly, either as proposed or as amended by that body, the document
then becomes the official American Academy of Pediatric Dentistry (AAPD)
oral health policy or clinical guideline for publication in the AAPD\'s
Reference Manual and on the AAPD\'s Web site.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Conservative use of antibiotics is indicated to minimize the risk of
developing resistance to current antibiotic regimens. The following
general principles should be adhered to when prescribing antibiotics for
the pediatric population.

**Oral Wound Management**

Oral wounds are associated with an increased risk of bacterial
contamination as 1 mL of saliva contains 10^8-9^ bacteria. Based upon
the amount of bacterial contamination, wounds can be classified as: (1)
clean, (2) potentially contaminated, or (3) contaminated/dirty. If the
insult to the oral cavity/dentition appears to be have been contaminated
by extrinsic bacteria, antibiotic therapy should be considered. If it is
determined that antibiotics would be beneficial to the healing process,
the timing of the administration of antibiotics is critical in order to
supplement the natural host resistance in bacterial killing. The drug
should be administered as soon as possible for the best result. The most
effective route of drug administration (intravenous vs intramuscular vs
oral) also must be considered. The clinical effectiveness of the drug
also must be monitored. If the infection is not responsive to the
initial drug selection, a culture and susceptibility testing of isolates
from the infective site may be indicated. The minimal duration of drug
therapy should be limited to 5 days beyond the point of substantial
improvement or resolution of signs and symptoms; this is usually a 5- to
7-day course of treatment dependent upon the specific drug selected. The
importance of completing a full course of antibiotic must be emphasized.
If the patient discontinues the antibiotic prematurely, the surviving
bacteria can restart an infection that may be resistant to the original
antibiotic. Examples of oral wounds are: (1) soft tissue laceration, (2)
complicated crown fracture (i.e., pulp exposure), (3) severe tooth
displacement, (4) extensive gingivectomy, or (5) severe ulcerations.

**Special Conditions**

**Pulpitis/Apical Periodontitis/Draining Sinus Tract/Localized Intraoral
Swelling**

Bacteria can gain access to the pulpal tissue through caries, exposed
pulp or dentinal tubules, cracks into the dentin, and defective
restorations. If a child presents with acute symptoms of pulpitis,
treatment should be rendered (i.e., pulpotomy, pulpectomy, or
extraction). Antibiotic therapy *usually* is not indicated if the dental
infection is contained within the pulpal tissue or the immediately
surrounding tissue. In this case, the child will have no systemic signs
of an infection (i.e., no fever and no facial swelling).

**Acute Facial Swelling of Dental Origin**

A child presenting with a facial swelling secondary to a dental
infection should receive immediate dental attention. Depending on
clinical findings, treatment may consist of treating or extracting the
tooth/teeth in question with antibiotic coverage or prescribing
antibiotics for several days to contain the spread of infection and then
treating the involved tooth/teeth. The clinician should consider the
ability to obtain adequate anesthesia, the severity of the infection,
and the medical status of the child. Intravenous antibiotic therapy
and/or referral for medical management may be indicated.

**Dental Trauma**

Local application of an antibiotic to the root surface of an avulsed
tooth has been recommended to reduce root resorption and increase the
rate of pulpal revascularization. Systemic antibiotics have been
recommended as an adjunctive therapy to the recovery of a severely
injured tooth/teeth. However, the value of systemic antibiotics in oral
wound healing remains unclear.

**Pediatric Periodontal Diseases (e.g., Neutropenias, Papillon-LeFevre
Syndrome, Leukocyte Adhesion Deficiency)**

In pediatric periodontal diseases, the immune system is unable to
control the growth of periodontal pathogens, thus necessitating
antibiotic therapy. Culture and susceptibility testing of isolates from
the involved sites is helpful in guiding the drug selection. Prolonged
antibiotic therapy may be indicated in the management of chronic
periodontal disease, especially if the underlying immunodeficiency is
not corrected. Subsequent cultures are beneficial in determining the
timing of the endpoint of antibiotic therapy.

**Viral Diseases**

Conditions such as acute primary herpetic gingivostomatitis should not
be treated with antibiotic therapy unless there is strong evidence to
indicate that a secondary bacterial infection exists.

**Oral Contraceptive Use**

Whenever an antibiotic is prescribed to a female patient taking oral
contraceptives to prevent pregnancy, the patient must be advised to use
additional techniques of birth control during antibiotic therapy and for
at least 1 week beyond the last dose as the antibiotic may render the
oral contraceptive ineffective.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

All oral health policies and clinical guidelines are based on 2 sources
of evidence: (1) the scientific literature; and (2) experts in the
field.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Conservative use of antibiotics is indicated to minimize the risk of
developing resistance to current antibiotic regimens.

#### POTENTIAL HARMS

Antibiotics may render an oral contraceptive ineffective.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Chart Documentation/Checklists/Forms\
Resources

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

American Academy of Pediatric Dentistry (AAPD). Clinical guideline on
appropriate use of antibiotic therapy for pediatric dental patients.
Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2005. 3 p.
\[26 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2001 (revised 2005)

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatric Dentistry - Professional Association

#### SOURCE(S) OF FUNDING

American Academy of Pediatric Dentistry

#### GUIDELINE COMMITTEE

Council on Clinical Affairs

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Not stated

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: American Academy of Pediatric
Dentistry. Clinical guideline on appropriate use of antibiotic therapy.
Chicago (IL): American Academy of Pediatric Dentistry; 2001. 2 p.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatric
Dentistry Web site](http://www.aapd.org/media/policies.asp).

Print copies: Available from the American Academy of Pediatric
Dentistry, 211 East Chicago Avenue, Suite 700, Chicago, Illinois 60611

#### AVAILABILITY OF COMPANION DOCUMENTS

Information about the American Academy of Pediatric Dentistry (AAPD)
mission and guideline development process is available on the [AAPD Web
site](http://www.aapd.org/media/Policies_Guidelines/Intro.pdf).

The following implementation tools are available for download from the
AAPD Web site:

-   [Dental growth and development
    chart](http://www.aapd.org/media/Policies_Guidelines/RS_DentGrowthandDev.pdf)

-   [American Academy of Pediatric Dentistry Caries-Risk Assessment Tool
    (CAT)](http://www.aapd.org/media/Policies_Guidelines/RS_CAT.pdf)

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on August 18, 2005.

#### COPYRIGHT STATEMENT

This summary is based on the original guideline, which is subject to the
guideline developer\'s copyright restrictions.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
clinical practice guidelines and related materials represented on this
site. Moreover, the views and opinions of developers or authors of
guidelines represented on this site do not necessarily state or reflect
those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or
hosting of guidelines in NGC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding guideline content are directed to
contact the guideline developer.

Bottom of Form

© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/10/2008