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Antibiotic use for irreversible pulpitisFedorowicz Z, Keenan JV, Farman AG, Newton T
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SummaryAntibiotic use for irreversible pulpitisAntibiotics do not appear to significantly reduce toothache caused by irreversible pulpitis.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 20. 2005 AbstractBackgroundIrreversible 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. ObjectivesTo provide reliable evidence regarding the effects of prescribing systemic antibiotics for irreversible pulpitis by comparing clinical outcomes expressed as pain relief. Search strategyWe 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 criteriaRandomised 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 analysisTwo review authors screened studies and extracted data independently. Pooling of data was not possible and a descriptive summary is presented. Main resultsOne 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' conclusionsThis 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. |