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Antimicrobial stewardship in dentistry — ORE Part 1 MCQ

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ModerateDental Public Health, Ethics, Law and Infection ControlAntimicrobial stewardship in dentistryORE Part 1

A healthy 38-year-old has localised spontaneous pain from a lower permanent molar diagnosed with irreversible pulpitis. There is no facial swelling, fever, lymphadenopathy or trismus. The patient asks for antibiotics because tablets helped a friend with toothache. Which statement best explains why systemic antimicrobials are not indicated?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — The inflamed vital pulp requires definitive dental treatment rather than systemic antimicrobials

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

A is correct. This is uncomplicated irreversible pulpitis: a painful inflammatory condition of vital pulp tissue, without swelling, trismus, lymphadenopathy or systemic illness. SDCEP states not to prescribe antibiotics for pulpitis; management is analgesia while arranging definitive dental treatment. For irreversible pulpitis in a permanent tooth, this is pulpotomy or pulpectomy/root canal treatment, or extraction where appropriate. B is incorrect because antibiotics do not decompress or resolve the inflamed pulp within the tooth. C is incorrect because there is no evidence of a spreading odontogenic infection. D is incorrect because antimicrobials are not local anaesthetics. E is incorrect because antibiotics neither remove caries nor restore lost dentine. Antibiotics may be adjunctive in relevant spreading infection or systemic involvement, neither of which is present here.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Management of Acute Dental Problems: Pulpitis, 2026. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/pulpitis/