Systemic Antibiotic Use in Endodontic Infections: A Narrative Review

Abstract

Endodontic infections are predominantly of bacterial origin and require accurate diagnosis and appropriate treatment aimed at eliminating the source of infection and preserving the functional integrity of the tooth. Most endodontic infections can be effectively controlled with local treatment approaches such as root canal therapy, drainage, or tooth extraction when necessary. However, the unnecessary use of antibiotics contributes to the development of antimicrobial resistance, which is a major global health concern. The aim of this review is to evaluate the microbiology and pathogenesis of endodontic infections, the fundamental principles of infection control, and the clinical indications for systemic antibiotic use in light of the current literature. In addition, clinical guidelines published by the European Society of Endodontology (ESE) and the American Association of Endodontists (AAE) were reviewed. Current guidelines recommend that systemic antibiotics should be used only as an adjunctive therapy in cases of systemic involvement, spreading infections, or in medically high-risk patients. In contrast, the use of antibiotics is not recommended in conditions such as symptomatic irreversible pulpitis, localized acute apical abscesses, or chronic apical abscesses with a sinus tract. In conclusion, rational antibiotic use in endodontics can be achieved through adherence to evidence-based guidelines and prioritization of local treatments aimed at eliminating the source of infection.