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Choosing Wisely Canada

The Canadian Association of Hospital Dentists

Infections of orthopedic implants are uncommon events and are rarely caused by bacteria found in the mouth. Although dental procedures such as extractions cause transient bacteremia, most bacteremia of oral origin occurs with activities of daily living, including brushing, flossing and chewing. There is no reliable evidence that antibiotics prior to dental procedures prevents prosthetic joint infections. Patients should not be exposed to the adverse effects of antibiotics when there is no ...

Choosing Wisely Canada

The Canadian Association of Hospital Dentists

Acute dental abscess is a localized infection that occurs as the result of an untreated infection of the dental pulp. The abscess should be drained and the tooth treated with root canal therapy or extraction of the tooth. Antibiotics are of no additional benefit. In the event of systemic complications (e.g., fever, lymph node involvement or spreading infection), or for an immunocompromised patient, antibiotics may be prescribed in addition to drainage of the tooth.

Choosing Wisely Canada

The Canadian Association of Hospital Dentists

Irreversible pulpitis or toothache occurs when the soft tissue and nerve inside the tooth (the dental pulp) becomes damaged as a result of decay, trauma or large fillings. The intense pain is caused by inflammation of the dental pulp and the tissue surrounding the root – not by infection. Because this is not an infection, antibiotics do not relieve the pain and should not be used. Treatment for this condition is the removal of the damaged or diseased dental pulp, either through root canal ...

Choosing Wisely Canada

The Canadian Association of Hospital Dentists

For post-operative dental pain, the dose and frequency of a non-opioid (ibuprofen and/or acetaminophen) analgesic should be optimized. If this is not sufficient for managing pain then an opioid may be considered. If an opioid analgesic is appropriate consider limiting the number of tablets dispensed.

Choosing Wisely Canada

College of Family Physicians of Canada

There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. False positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Chest X-rays for asymptomatic patients with no specific indications for the imaging have a trivial diagnostic yield, but a significant number of false positive reports. Potential harms of such routine screening exceed ...