When are antibiotics indicated in endodontic therapy?

• A. For acute apical abscess with systemic involvement or spreading infection
• B. For asymptomatic necrotic teeth
• C. For chronic apical periodontitis without swelling
• D. For all necrotic teeth regardless of symptoms

Answer: (A)

Antibiotics in endodontic therapy are indicated only when there is systemic involvement or a spreading infection from an acute apical abscess. In these situations, antibiotics help control bacterial infection in the body while definitive local treatment—drainage and thorough cleaning and shaping of the root canal—removes the source of infection. They are not needed for asymptomatic necrotic teeth or for chronic apical periodontitis without swelling, since there are no systemic signs to justify systemic therapy, and antibiotics won’t substitute for proper local treatment. Likewise, not all necrotic teeth require antibiotics; use is reserved for cases with systemic or immunocompromised involvement, or other signs of spreading infection.