What is the best antibiotic to prescribe for irreversible pulpitis?
This question was submitted by a general dentist: What is the best antibiotic to prescribe for irreversible pulpitis?
Dr. Mary Dabuleanu, from Dabuleanu Dental, in collaboration with Dr. Suham Alexander, Oasis Clinical Editor, provided this quick initial response
What is irreversible pulpitis?
Irreversible pulpitis is essentially a diagnosis based on both objective and subjective clinical findings which determines that the pulpal tissue has become inflamed but is not capable of healing. The following description(s) apply to teeth diagnosed with irreversible pulpitis.
- ASYMPTOMATIC -tooth has no symptoms or pain but, left untreated with a deep carious lesion or significant tooth structure loss, the tooth will be come painful and/or nonvital
- SYMPTOMATIC -tooth has spontaneous and intermittent pain, exposure to cold or extremes of temperature causes intense and prolonged pain after the stimulus is removed-usually an emergency situation
Emergency Dental Management
Antibiotics are not recommended in the treatment of irreversible pulpitis!
There is insufficient scientific research to ascertain whether the use of antibiotics is helpful, studies show that antibiotics do not have any significant effect of reducing the pain from a toothache.
- Symptomatic irreversible pulpits – remove infected pulp and clean the root canal system. If there are time constraints at the emergency visit, then a pulptomy may be performed. The patient would then be re-appointed soon after to complete root canal treatment.
- NSAIDs and acetaminophen are commonly used to manage endodontic pain. NSAIDs are very effective in managing pain due to inflammation. As organic acids, NSAIDS have low PKa values which aid in the penetration of the active drug into the acidic environment of inflamed tissue. Moreover, there is enhanced delivery of these drugs into inflamed tissues via extravasation of NSAID-bound plasma proteins.
- Fedorowicz Z, van Zuuren EJ, Farman AG, Agnihotry A, Al-Langawi JH. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev. 2013;12:CD004969.
- Greenwood M, Corbett I, editors. Dental Emergencies. Wiley-Blackwell; 2012.
- Hargreaves KM, Cohen S. Cohen’s Pathways of the Pulp. 10th ed. Mosby Elsevier; 2011.
- Ingle JI, Bakland LK, Baumgartner JC, editors. Ingle’s Endodontics 6. Hamilton (ON): BC Decker Inc.; 2008.
- Graf P, Glatt M, Brune K. Acidic nonsteroid anti-inflammatory drugs accumulating in inflamed tissue. Experientia. 1975;31(8):951-3.
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