Pericoronitis Antibiotic Stewardship — ORE Part 1 MCQ

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EasyPharmacology & TherapeuticsPericoronitis Antibiotic StewardshipORE Part 1

An immunocompetent adult presents with acute pericoronitis around a partially erupted mandibular third molar. There is localised opercular inflammation only; there is no facial swelling, trismus, dysphagia, fever or malaise. What is the most appropriate management?

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Correct answer: B — Provide local measures and analgesia; do not prescribe an antibiotic

Explanation lettering: C = shown as A · A = shown as B · B = shown as C · E = shown as D · D = shown as E

A is correct. SDCEP advises that uncomplicated acute pericoronitis is managed with local measures, including irrigation and removal of debris where possible, together with appropriate analgesia and oral hygiene advice. Antibiotics are not indicated where infection is localised and there is no spreading infection, systemic illness or relevant immunocompromise. This patient has no facial swelling, trismus, dysphagia, fever or malaise. Options B–E all inappropriately substitute an antibiotic regimen for local management. Metronidazole may be considered when antibiotic treatment is genuinely indicated, but its availability as a possible regimen does not justify prescribing it for this uncomplicated presentation. Co-amoxiclav and dual therapy are unnecessarily broad in this scenario.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Acute Dental Problems: Acute pericoronitis (including erupting teeth in children), current. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/acute-pericoronitis-including-erupting-teeth-in-children/