Antibiotic use for irreversible pulpitis

Fedorowicz Z, Keenan JV, Farman AG, Newton T

Published Online:

July 8, 2009

Antibiotics do not appear to significantly reduce toothache caused by irreversible pulpitis.
Irreversible pulpitis, where the dental pulp (nerve) has been damaged beyond repair is characterised by intense pain and considered to be one of the most frequent reasons that patients attend for emergency dental care.
This review, which included one trial (40 participants), found that there is a small amount of evidence to suggest that the administration of penicillin does not significantly reduce the pain perception, the percussion perception or the quantity of pain medication required by patients with irreversible pulpitis.

Abstract (click to read)

Background:

Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from removal of the tooth the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant minority of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.

Objectives:

To provide reliable evidence regarding the effects of prescribing systemic antibiotics for irreversible pulpitis by comparing clinical outcomes expressed as pain relief.

Search strategy:

We searched the Cochrane Oral Health Group Trials Register (to 2nd February 2009); CENTRAL (The Cochrane Library 2009, Issue 1); MEDLINE (1966 to January 2009); and EMBASE (1980 to February 2009). There were no language restrictions.

Selection criteria:

Randomised controlled trials which compared pain relief with systemic antibiotics and analgesics, against placebo and analgesics in the acute preoperative phase of irreversible pulpitis.

Data collection and analysis:

Two review authors screened studies and extracted data independently. Pooling of data was not possible and a descriptive summary is presented.

Main results:

One trial involving 40 participants was included. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the 7-day study period. The between-group differences in sum pain intensity differences (SPID) for the penicillin group were (6.0±10.5), and for placebo (6.0±9.5) P = 0.776. The sum pain percussion intensity differences (SPPID) for the penicillin group were (3.5±7.5) and placebo (2.0±7.0) P = 0.290, with differences as assessed by the Mann-Whitney-Wilcoxon test considered to be statistically significant at P < 0.05. There was no significant difference in the mean total number of ibuprofen tablets (P = 0.839) and Tylenol tablets (P = 0.325), in either group over the study period. The administration of penicillin over placebo did not appear to significantly reduce the quantity of analgesic medication taken (P > 0.05) for irreversible pulpitis.

Authors' conclusions:

This review which was based on one methodologically sound but low powered small sample trial provides some evidence that there is no significant difference in pain relief for patients with untreated irreversible pulpitis who did or did not receive antibiotics in addition to analgesics.

This record should be cited as:

Fedorowicz Z, Keenan JV, Farman AG, Newton T. Antibiotic use for irreversible pulpitis. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004969. DOI: 10.1002/14651858.CD004969.pub2

Assessed as up to date:

February 17, 2009

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Antibiotic therapy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Antibiotic use for irreversible pulpitis

More like this

Copyright © 2011 - The Cochrane Collaboration