RESUMO
BACKGROUND: The inadequate use of antibiotics by dentists can contribute to antibiotic resistance. The European Society of Endodontology (ESE) has published a scientific evidence-based position on antibiotic use in endodontic infec-tions. The aim of this study was to analyze the antibiotics prescription habits of Spanish endodontists in the management of endodontic infections, comparing them with those they had 10 years ago, to assess the impact of the ESE awareness campaign and position statement on antibiotics in endodontics. MATERIAL AND METHODS: One hundred Spanish endodontists were requested to answer to a one-page survey, similar to that used previously ten years ago in another study, on indications for systemic antibiotics in the management of endodontic infections. Data were analyzed using descriptive statistics and chi-square test. Seventy-seven endodontists (77%) completed satisfactorily the survey and were included in the study. RESULTS: The average duration of antibiotic therapy was 5.64 ± 1.75 days. In patients with no medical allergies, 97.1% selected amoxicillin as the first-choice antibiotic. The first drug of choice for patients with an allergy to penicillin, was clindamycin 300 mg (74.03%). For cases of pulp necrosis with asymptomatic apical periodontitis, fistulous tract and mild/symptomatic symptoms, 100% of endodontists would prescribe antibiotics. For the scenario of a pulp necrosis with symptomatic periodontitis apical and no swelling, 20% endodontists would prescribe antibiotics. CONCLUSIONS: Antibiotics prescription habits of Spanish endodontists has improved after the ESE awareness campaign and position statement on antibiotics in endodontics. Even so, there are a percentage of professionals that still prescribe antibiotics erro-neously. Key words:Antibiotic, antibiotics resistance, dentistry, endodontists, endodontics, prescription habits, primary care.
RESUMO
La concrescencia es una anomalía dentaria poco frecuente que se define como la unión de las raíces de dos dientes adyacentes a través del cemento. Aunque en la práctica clínica el término "concrescencia" es utilizado para referirse a todos los casos de unión entre las raíces de dos dientes adyacentes, para confirmar el diagnóstico de concrescencia es necesario un estudio histológico que demuestre la unión a nivel del cemento. Esta anomalía se ha identificado en el 0,8% de los casos de exodoncia de dientes permanentes, siendo su incidencia mayor en la región posterior del maxilar superior. La detección previa de la concrescencia mediante la exploración clínica y radiográfica es, la mayoría de las ocasiones, casi imposible, por lo que el diagnostico suele hacerse después de la extracción. No obstante, es conveniente que el clínico evalúe cada paciente y cada diente de forma exhaustiva para poder planificar, caso de que exista concrescencia, la técnica quirúrgica adecuada para la extracción. Por lo tanto, deben conocerse la incidencia e implicaciones de esta anomalía para llevar a cabo un diagnóstico y plan de tratamiento correcto. En este artículo se presenta un caso clínico de aparente concrescencia diagnosticado post-extracción y cuyo estudio histológico no mostró unión de cemento entre ambas raíces. Por lo tanto, en la práctica clínica es más conveniente utilizar el término "raíces fusionadas" que "concrescencia", el cual sólo debería ser utilizado después del examen histológico de la pieza extraída
Concrescence is a rare dental anomaly defined as the cemental union of two adjacent teeth. Concrescence diagnosis requires histological confirmation, but in the clinical practice the term "concrescence" is used to refer to all the cases of union of the roots of two adjacent teeth. The anomaly has been reported in extraction cases with an incidence of 0.8% in the permanent dentition. Also has been reported a higher incidence of concrescence in the posterior maxilla. It is prudent for the clinician to evaluate carefully each patient and each tooth to be removed for the possibility and desirability of a surgical extraction technique. Therefore, consideration should be given to the possible occurrence, recognition, and implications of this anomaly in diagnosis and treatment planning. Clinically and radiographically is nearly impossible to detect concrescent teeth, and most of these cases are diagnosed post extraction. The purpose of this article is to report a case of clinical concrescence between a retained third molar and an erupted second molar identified during the extraction, which histological study did not show cementum union between both roots. Thus, in the clinical practice is better to use the term "fused roots" than "concrescence", which would be used only after the histological examination of the specimen
