When to Prescribe Systemic Antibiotics
When the abscess remains refractory to scaling and rootplaning, surgical drainage, and/or incision, evaluation as to why this condition persists must be made. Factors which can prevent tissue healing can be listed as follows: failure to remove the causes of irritation, incomplete debridement, presence of underlying systemic disease, or endodontic pathosis.
Treatment must always consist of removing the causative agent such as plaque, calculus, within the pocket or soft tissues. The decision to use systemic antimicrobials should be used as an adjunct to therapy to help manage patient comfort and prevent the lesion from ingressing into fascial planes for acute lesions and not chronic cases.
In patients with compromised immune responses or reduced healing capacity, systemic antibiotics are needed. Examples include uncontrolled diabetics, patients on chemotherapy and HIV positive patients.