Good treatment is the solution to dental pain, not antibiotics

I don’t often comment on the provision of root canal treatment as part of the National Health Service. But I am drawn to do so following a critical article in The Times on this topic.

First, I should draw your attention to the excellent response from the British Endodontic Society’s President, Mike Waplington. I completely agree that the importance of endodontic treatment to overall dental health is not adequately recognised by the NHS dental contract, nor the complexity. Units of Dental Activity, the NHS payment system, do not adequately reward dentists. Perhaps it’s time to recognise that not all dentists working in the NHS should be expected to carry out root canal treatments without additional funding. After all, even for the best of us a complex endodontic case can take well over an hour to complete. There are many committed dentists who excel at root canal treatment and some of them have invested in technology to help improve outcomes. These dentists with a special interest should be adequately recompensed for providing endodontic treatments.

This brings me to another point. I would like to highlight publication of a study from earlier this year which showed the high numbers of unnecessary prescriptions for antibiotics made by medical doctors. This carries a double cost – the first is the prescription itself and the second that unnecessary antibiotics are contributing to the threat of antimicrobial resistance. The argument goes that if too many of us consume antibiotics anti-microbial resistance will develop and we will have no protection against superbugs. Prescriptions for antibiotics are still handed out too routinely and too many dentists are as much to blame as our medical colleagues when it comes to the issue of over-prescribing.

The American Association of Endodontists (AAE) of which I am a member has recently added an interesting article to its website which shows there is no evidence that antibiotics are effective for the control or prevention of endodontic infection. There are times when they are called for but these are limited. A painful irreversible pulpits or an endodontic abscess require treatment and not antibiotics. Gaining access and then shaping and cleaning the canals will ensure symptoms are eliminated.

Treatment is what’s required when you have pulpits, not antibiotics and the more dentists capable of undertaking quality endodontics the more teeth will be saved.