1
|
Cope AL, Francis N, Wood F, Thompson W, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2024; 5:CD010136. [PMID: 38712714 PMCID: PMC11075121 DOI: 10.1002/14651858.cd010136.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for these conditions should be removal of the source of inflammation or infection by local operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacteria. This review is the second update of the original version first published in 2014. OBJECTIVES To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults. SEARCH METHODS We searched Cochrane Oral Health's Trials Register (26 February 2018 (discontinued)), CENTRAL (2022, Issue 10), MEDLINE Ovid (23 November 2022), Embase Ovid (23 November 2022), CINAHL EBSCO (25 November 2022) and two trials registries, and performed a grey literature search. There were no restrictions on language or date of publication. SELECTION CRITERIA Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage, or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS Two review authors independently screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias. We used a fixed-effect model in the meta-analysis as there were fewer than four studies. We contacted study authors to request missing information. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS There was one new completed trial on this topic since the last update in 2018. In total, we included three trials with 134 participants. Systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscess One trial (72 participants) compared the effects of a single preoperative dose of clindamycin versus a matched placebo when provided with a surgical intervention (endodontic chemo-mechanical debridement and filling) and analgesics to adults with symptomatic apical periodontitis. We assessed this study at low risk of bias. There were no differences in participant-reported pain or swelling across trial arms at any time point assessed. The median values for pain (numerical rating scale 0 to 10) were 3.0 in both groups at 24 hours (P = 0.219); 1.0 in the antibiotic group versus 2.0 in the control group at 48 hours (P = 0.242); and 0 in both groups at 72 hours and seven days (P = 0.116 and 0.673, respectively). The risk ratio of swelling when comparing preoperative antibiotic to placebo was 0.50 (95% confidence interval (CI) 0.10 to 2.56; P = 0.41). The certainty of evidence for all outcomes in this comparison was low. Two trials (62 participants) compared the effects of a seven-day course of oral phenoxymethylpenicillin (penicillin VK) versus a matched placebo when provided with a surgical intervention (total or partial endodontic chemo-mechanical debridement) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. Participants in both trials also received oral analgesics. We assessed one study at high risk of bias and the other at unclear risk of bias. There were no differences in participant-reported pain or swelling at any time point assessed. The mean difference for pain (short ordinal numerical scale 0 to 3, where 0 was no pain) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The standardised mean difference for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The certainty of evidence for all the outcomes in this comparison was very low. Adverse effects, as reported in two studies, were diarrhoea (one participant in the placebo group), fatigue and reduced energy postoperatively (one participant in the antibiotic group) and dizziness preoperatively (one participant in the antibiotic group). Systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscess We found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS The evidence suggests that preoperative clindamycin for adults with symptomatic apical periodontitis results in little to no difference in participant-reported pain or swelling at any of the time points included in this review when provided with chemo-mechanical endodontic debridement and filling under local anaesthesia. The evidence is very uncertain about the effect of postoperative phenoxymethylpenicillin for adults with localised apical abscess or a symptomatic necrotic tooth when provided with chemo-mechanical debridement and oral analgesics. We found no studies which compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults.
Collapse
Affiliation(s)
- Anwen L Cope
- Dental Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - Nick Francis
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester, UK
| | - Ivor G Chestnutt
- Dental Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| |
Collapse
|
2
|
Banerjee K, Kakkar A, Shamsi KA, Bansal D, Mathur P, Potode NM, Pagariya P, Azher SP, Chaudhari A, Mandal R, Karadkhele AS, Markandeywar N, Dharmadhikari S, Khandhedia C, Mane A, Mehta S, Joglekar S. Effectiveness of Oral Cephalexin-Clavulanic Acid, Cefuroxime, and Amoxicillin-Clavulanic Acid in the Management of Dental Infections: A Real-World, Retrospective, Electronic Medical Record-Based Study in India. Drugs Real World Outcomes 2024; 11:53-68. [PMID: 38109028 DOI: 10.1007/s40801-023-00406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Despite multiple antibiotics being available to manage dental infections (DI), there is lack of data comparing commonly prescribed antibiotics in India. OBJECTIVES The aim of this study was to evaluate the real-world effectiveness and tolerability of cephalexin-clavulanic acid fixed-dose combination (cephalexin CV FDC) in contrast with amoxicillin-clavulanic acid (co-amoxiclav FDC) and cefuroxime among patients with dental infections (odontogenic) in India. METHODS This retrospective, multi-centric, observational, real-world electronic medical record (EMR)-based study was conducted between January 2022 and December 2022. The EMRs of 355 adults with DI receiving oral cephalexin CV, co-amoxiclav, or cefuroxime were categorized into two distinct groups: Group I (Test Group) with patients prescribed cephalexin extended release 375/750 mg along with clavulanic acid 125 mg; and Group II (Comparator Group) with patients prescribed co-amoxiclav 625 mg (500 mg amoxicillin + 125 mg clavulanic acid) or cefuroxime (250 mg/500 mg). RESULTS Toothache was the most common complaint, reported by 95.5% of patients, followed by swelling (46.8%), tooth sensitivity (35.5%), pus discharge (33.0%), redness and halitosis (30.4% each). Dental caries was observed in 81.1% of patients. Clinical improvement, defined as improvement/partial resolution of infection-related clinical signs and symptoms (composite measure of pain, swelling, fever, requirement of additional antimicrobial therapy) as per dentists' judgment, was recorded in 98.3% of patients with cephalexin CV, 96.8% of patients with co-amoxiclav, and 98.9% of patients treated with cefuroxime within 10 days. Time (days) to clinical improvement was numerically lesser among patients receiving cephalexin CV (4.6 ± 2.0) compared with cefuroxime (4.9 ± 2.1) and co-amoxiclav (5.0 ± 2.6). All treatments were well tolerated. CONCLUSION Cephalexin CV was as effective as co-amoxiclav and cefuroxime, with faster clinical improvement and better resolution of certain symptoms.
Collapse
Affiliation(s)
- Kalyan Banerjee
- Asansol Dental and Maxillofacial Clinic, Kolkata, West Bengal, India
| | - Ajay Kakkar
- Le Visage Dental Clinic, Mumbai, Maharashtra, India
| | | | - Deepak Bansal
- Dr. Bansal's Dental Care and Implant Clinic, Delhi, India
| | | | | | | | | | - Apurva Chaudhari
- Lotus Dental Care and Implant Centre, Mumbai, Maharashtra, India
| | - Ritu Mandal
- Dr. Ritu's Dental Care, Mumbai, Maharashtra, India
| | | | | | | | | | - Amey Mane
- Sun Pharmaceutical Industries Ltd., Mumbai, Maharashtra, India
| | - Suyog Mehta
- Sun Pharmaceutical Industries Ltd., Mumbai, Maharashtra, India
| | - Sadhna Joglekar
- Ex Sun Pharmaceutical Industries Ltd., Mumbai, Maharashtra, India
| |
Collapse
|
3
|
Nosrat A, Valancius M, Mehrzad S, Dianat O, Verma P, Aminoshariae A, Fouad AF. Flare-ups After Nonsurgical Retreatments: Incidence, Associated Factors, and Prediction. J Endod 2023; 49:1299-1307.e1. [PMID: 37451334 DOI: 10.1016/j.joen.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION The aims of this study were to determine the incidence, associated factors, and predictability of flare-ups after nonsurgical retreatments (NSRetx). METHODS All patients (n = 3,666) who received NSRetx by 3 endodontists in 2 endodontic offices during a period of 6 years (2016-2022) were included. Demographic, diagnostic, and procedural data were collected. A flare-up was defined as moderate-severe pain with/without swelling that took place within 14 days of initiation of NSRetx and resulted in an unscheduled appointment. Bivariate analyses on the entire cohort and multivariable analyses on cases with complete dataset (n = 2,846) were performed to identify significant associations. A Random Forest algorithm was used to make a prediction model. RESULTS Incidence of flare-ups was 3.95% (n = 145). Increased risk of flare-ups was associated with diabetes (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI], 1.01-3.97), mandibular teeth (AOR = 1.67; 95% CI, 1.11-2.52), moderate-severe preoperative pain on percussion (AOR = 2.13; 95% CI, 1.31-3.50), and pain on palpation (AOR = 1.63; 95% CI, 1.01-2.64). Lower risk of flare-up was associated with high blood pressure (AOR = 0.44; 95% CI, 0.21-0.82) (P < .05). The prediction model was not able to predict flare-ups with sufficient confidence (precision = 0.13). CONCLUSIONS Incidence of flare-ups following NSRetx was low (∼4%) and had a weak but significant association with the history of diabetes. Moderate-severe pain on percussion, pain on palpation (any intensity), and mandibular teeth had a significant association with flare-ups. The history of high blood pressure was associated with lower risk of flare-ups. Flare-ups were difficult to predict in this clinical setting.
Collapse
Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
| | - Michael Valancius
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Sahar Mehrzad
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Fairfax, Virginia
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia; Private Practice, Capitol Endodontics, Washington, District of Columbia
| | - Anita Aminoshariae
- Department of Endodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ashraf F Fouad
- Department of Endodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
4
|
Patel B, Eskander MA, Fang-Mei Chang P, Chapa B, Ruparel SB, Lai Z, Chen Y, Akopian A, Ruparel NB. Understanding painful versus non-painful dental pain in female and male patients: A transcriptomic analysis of human biopsies. PLoS One 2023; 18:e0291724. [PMID: 37733728 PMCID: PMC10513205 DOI: 10.1371/journal.pone.0291724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
Dental pain from apical periodontitis is an infection induced-orofacial pain condition that presents with diversity in pain phenotypes among patients. While 60% of patients with a full-blown disease present with the hallmark symptom of mechanical allodynia, nearly 40% of patients experience no pain. Furthermore, a sexual dichotomy exists, with females exhibiting lower mechanical thresholds under basal and diseased states. Finally, the prevalence of post-treatment pain refractory to commonly used analgesics ranges from 7-19% (∼2 million patients), which warrants a thorough investigation of the cellular changes occurring in different patient cohorts. We, therefore, conducted a transcriptomic assessment of periapical biopsies (peripheral diseased tissue) from patients with persistent apical periodontitis. Surgical biopsies from symptomatic male (SM), asymptomatic male (AM), symptomatic female (SF), and asymptomatic female (AF) patients were collected and processed for bulk RNA sequencing. Using strict selection criteria, our study found several unique differentially regulated genes (DEGs) between symptomatic and asymptomatic patients, as well as novel candidate genes between sexes within the same pain group. Specifically, we found the role of cells of the innate and adaptive immune system in mediating nociception in symptomatic patients and the role of genes involved in tissue homeostasis in potentially inhibiting nociception in asymptomatic patients. Furthermore, sex-related differences appear to be tightly regulated by macrophage activity, its secretome, and/or migration. Collectively, we present, for the first time, a comprehensive assessment of peripherally diseased human tissue after a microbial insult and shed important insights into the regulation of the trigeminal system in female and male patients.
Collapse
Affiliation(s)
- Biraj Patel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Michael A. Eskander
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Phoebe Fang-Mei Chang
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Brett Chapa
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Shivani B. Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Zhao Lai
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Yidong Chen
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Armen Akopian
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Nikita B. Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| |
Collapse
|
5
|
Thompson W, Howe S, Pitkeathley C, Coull C, Teoh L. Outcomes to evaluate care for adults with acute dental pain and infection: a systematic narrative review. BMJ Open 2022; 12:e057934. [PMID: 35190445 PMCID: PMC8860024 DOI: 10.1136/bmjopen-2021-057934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify outcomes reported in peer-reviewed literature for evaluating the care of adults with acute dental pain or infection.DesignSystematic narrative review. SETTING/PARTICIPANTS Primary research studies published in peer-reviewed literature and reporting care for adults with acute dental pain or infection across healthcare settings. Reports not in English language were excluded. STUDY SELECTION Seven databases (CINAHL Plus, Dentistry and Oral Sciences Source, EMBASE, MEDLINE, PsycINFO, Scopus, Web of Science) were searched from inception to December 2020. Risk of bias assessment used the Critical Appraisal Skills Programme checklist for randomised controlled trials and Quality Assessment Tool for Studies of Diverse Design for other study types. OUTCOMES Narrative synthesis included all outcomes of care for adults with acute dental pain or infection. Excluded were outcomes about pain management to facilitate treatment, prophylaxis of postsurgical pain/infection or traumatic injuries. RESULTS Searches identified 19 438 records, and 27 studies (dating from 1993 to 2020) were selected for inclusion. Across dental, pharmacy, hospital emergency and rural clinic settings, the studies were undertaken in high-income (n=20) and low/middle-income (n=7) countries. Two clinical outcome categories were identified: signs and symptoms of pain/infection and complications following treatment (including adverse drug reactions and reattendance for the same problem). Patient-reported outcomes included satisfaction with the care. Data collection methods included patient diaries, interviews and in-person reviews. DISCUSSION A heterogeneous range of study types and qualities were included: one study, published in 1947, was excluded only due to lacking outcome details. Studies from dentistry reported just clinical outcomes; across wider healthcare more outcomes were included. CONCLUSIONS A combination of clinical and patient-reported outcomes are recommended to evaluate care for adults with acute dental pain or infection. Further research is recommended to develop core outcomes aligned with the international consensus on oral health outcomes. PROSPERO REGISTRATION NUMBER CRD42020210183.
Collapse
Affiliation(s)
- Wendy Thompson
- The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Shaun Howe
- Public Dental Service, NHS Shetland, Lerwick, UK
| | | | - Carly Coull
- Oral and Maxillofacial Services, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Teoh
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Milani AS, Froughreyhani M, Taghiloo H, Nouroloyouni A, Jafarabadi MA. The effect of antibiotic use on endodontic post-operative pain and flare-up rate: a systematic review with meta-analysis. Evid Based Dent 2022:10.1038/s41432-021-0205-z. [PMID: 35165442 DOI: 10.1038/s41432-021-0205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/14/2021] [Indexed: 06/14/2023]
Abstract
Aim Antibiotics are widely used to prevent flare-ups after endodontic treatment of non-vital teeth. This systematic review assessed the effect of antibiotic administration on post-endodontic treatment pain and flare-up rate.Methods Five major databases including Web of Science, Cochrane Library, PubMed, Scopus and Embase were searched to identify randomised clinical trials (RCTs) published until September 2020. Retrieved papers were critically appraised using the revised Cochrane risk of bias tool (RoB 2). To reduce the clinical heterogeneity, the included studies were divided into two groups: studies on symptomatic non-vital teeth and studies on asymptomatic non-vital teeth. The primary outcomes were 'post-operative pain' and 'flare-up rate'. The data of included studies were statistically combined through meta-analysis using random-effect model. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence.Results Six RCTs involving two RCTs (N = 61) on symptomatic teeth and four RCTs (N = 310) on asymptomatic teeth were included. In two RCTs on asymptomatic teeth, prophylactic antibiotic had been used, while in the remaining two RCTs, antibiotics had been administered after treatment. Quantitative synthesis of the RCTs showed that antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment (weighted mean difference [WMD] = -0.03; 95% confidence interval [CI]: -0.53 to 0.47), and the use of antibiotics before endodontic treatment of asymptomatic non-vital teeth has no effect on flare-up rate (relative risk [RR] = 0.58; 95% CI: 0.22-1.54). The GRADE approach revealed that the overall quality of evidence on the topic is low.Conclusions The antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment. Also, prophylactic antibiotics are ineffective in reducing the flare-up rate following treatment of asymptomatic non-vital teeth. However, to evaluate the effect of post-treatment antibiotics on flare-up rate in asymptomatic non-vital teeth, more high-quality RCTs are needed.
Collapse
Affiliation(s)
- Amin Salem Milani
- Associate Professor of Endodontics, Research Centre for Evidence-Based Medicine (EBM), Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Froughreyhani
- Professor of Endodontics, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Taghiloo
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical sciences, Tabriz, Iran
| | - Ahmad Nouroloyouni
- Assistant Professor of Endodontics, Department of Endodontics, Faculty of Dentistry, Ardebil University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
7
|
Šimundić Munitić M, Šutej I, Ćaćić N, Tadin A, Balić M, Bago I, Poklepović Peričić T. Knowledge and attitudes of Croatian Dentists Regarding Antibiotic Prescription in Endodontics: A Cross-sectional Questionnaire-based Study. Acta Stomatol Croat 2021; 55:346-358. [PMID: 35001930 PMCID: PMC8734455 DOI: 10.15644/asc55/4/2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess dentists' level of knowledge and practice concerning antibiotic usage in endodontics using the European Society of Endodontology position statement as a reference. MATERIALS AND METHODS A cross-sectional study was conducted in the form of an electronic questionnaire consisting of 23 questions, including dentists' demographic and professional characteristics, attitudes as well as experiences regarding antibiotics in endodontics. Data were evaluated by the Mann-Whitney test or the Kruskal Wallis 1-way ANOVA, α = 5%. RESULTS The overall mean self-reported knowledge of antibiotics usage in endodontics was 11.7±2.5 points, out of a maximum possible score of 23. The factors associated with a higher knowledge were: age (P≤0.001), clinical experience (P≤0.001), specialist training (P=0.008), and adherence to the guidance on the use of systemic antibiotics in endodontics (P=0.006). Dentists who specialized in endodontics (16.1±2.2) achieved higher levels of knowledge. CONCLUSION Knowledge on antibiotic usage in endodontics among dentists in Croatia is insufficient. There is a need for continuing education on the use of antibiotics among general dentists.
Collapse
Affiliation(s)
| | - Ivana Šutej
- Department of Pharmacology, School of Dental Medicine, University of Zagreb, Croatia
| | - Nensi Ćaćić
- Study of Dental Medicine, University of Split School of Medicine, Split, Croatia
| | - Antonija Tadin
- Department of Restorative Dental Medicine and Endodontics, Study of Dental Medicine, University of Split School of Medicine, Split, Croatia
| | | | - Ivona Bago
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Croatia
| | - Tina Poklepović Peričić
- Department of Prosthodontics, Study of Dental Medicine, University of Split School of Medicine, Split, Croatia
| |
Collapse
|
8
|
Sabeti M, Zhong J, Hildebrandt K, Slots J. Valacyclovir in Pain Management of Acute Apical Abscesses: A Randomized Placebo-Controlled Double-Blind Pilot Study. J Endod 2021; 47:1724-1728. [PMID: 34363831 DOI: 10.1016/j.joen.2021.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The acute (symptomatic) apical abscess is characterized by pulp necrosis, rapid onset, spontaneous pain, percussion pain, pus formation, and tissue swelling. The etiopathology of acute apical abscesses includes active (lytic) herpesviruses and gram-negative anaerobic bacteria. The present study examined the potential of valacyclovir, an anti-herpesvirus agent, and systemic amoxicillin to manage the pain of acute apical abscesses. METHODS Twenty emergency patients with moderate to severe apical abscess pain received randomly either amoxicillin (1 g immediate dose followed by 500 mg, 4 times a day, totally 7 days) + valacyclovir (2 g immediate dose followed by 500 mg, twice a day, totally 3 days) ("valacyclovir" group, 10 patients) OR amoxicillin (1 g immediate dose followed by 500 mg, 4 times a day, totally 7 days) + placebo ("placebo" group, 10 patients). Daily telephone calls during the 6-day follow-up period assessed pain level on a numeric rating scale and analgesic intake. The Mann-Whitney and the Friedman statistical tests analyzed the outcome data. RESULTS At the baseline examination, all 10 valacyclovir and 9 placebo patients exhibited moderate to severe pain and 18 patients needed pain medication. On the first day after baseline, the valacyclovir group showed 2 patients with moderate/severe pain and 1 patient on pain medication, but the placebo group revealed as many as 8 patients with moderate/severe pain and 9 patients on pain medication. The difference in pain level and analgesic usage between the valacyclovir and the placebo group remained statistically significant during the entire post-baseline study period (P < .05). CONCLUSION The present study points to valacyclovir as a promising adjunctive agent in pain control with acute apical abscesses.
Collapse
Affiliation(s)
- Mohammad Sabeti
- Department of Preventive and Restorative Dental Science, University of California, San Francisco, San Francisco, California.
| | - John Zhong
- Division of Endodontics, University of California, San Francisco, San Francisco, California
| | - Kevin Hildebrandt
- Community Health Clinic, University of California, San Francisco, San Francisco, California
| | - Jørgen Slots
- Division of Periodontology, Diagnostic Sciences and Dental Hygiene, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Los Angeles, California
| |
Collapse
|
9
|
Antibiotic prescription for endodontic infections among Italian dental practitioners: what is the extent of over-prescription? Antimicrob Agents Chemother 2021; 65:e0091421. [PMID: 34252306 DOI: 10.1128/aac.00914-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: Objectives of this study were to evaluate the pattern of antibiotic prescription for endodontic infections (EIs) among Italian dental practitioners (DPs), and to explore the role of potential predictors of antibiotic over-prescription. Methods: A nationwide cross-sectional survey was conducted between 1st April to 30th October 2019 using a structured questionnaire. Information was gathered on demographics and professional characteristics, and practices regarding antibiotic prescription both for therapeutic and prophylactic purposes. Results: Of the 1250 invited DPs, 563 answered the general questionnaire (response rate 52.6%). The proportions of DPs who prescribed an antibiotic without indication for therapeutic and prophylactic purposes is 33.3% and 30.2%, respectively. The acute alveolar abscess without systemic involvement represents the clinical scenario at high risk of over-prescription for therapeutic purposes. Possible predictors of over-prescribing included demographics and professional characteristics, and it was found to be higher in EIs without indication than in the cases in which the prescription is indicated for therapeutic purposes. The odds of over-prescription for prophylactic purposes were higher in the cases of acute apical periodontitis and lower in the cases of symptomatic irreversible pulpitis compared with acute and chronic alveolar abscess, in which the prescription is indicated. Conclusions: The main findings of the present study provide an up-to-date insight about the pattern of antibiotic prescriptions for EIs and evidence useful to identify opportunities to reduce over-prescription among DPs through tailored interventions. The development of practical antibiotic prescribing guidelines with a clear description of indications and regimens ease of use is strongly needed.
Collapse
|
10
|
Leroy R, Bourgeois J, Verleye L, Carvalho JC, Eloot A, Cauwels R, Declerck D. Are systemic antibiotics indicated in children presenting with an odontogenic abscess in the primary dentition? A systematic review of the literature. Clin Oral Investig 2021; 25:2537-2544. [PMID: 33791867 DOI: 10.1007/s00784-021-03862-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/24/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This systematic review aimed to assess (1) whether systemic antibiotics are beneficial or harmful in healthy children who present with an odontogenic abscess in the primary dentition with or without systemic involvement and (2) if antibiotics are beneficial, which type, dosage and duration are the most effective. MATERIALS AND METHODS Electronic databases (Medline, Embase, and the Cochrane Library) were screened from 1948 up to August 2020. No filters with respect to study design were applied. Outcomes of interest included pain, swelling, pain relief, adverse effects, signs of infection, quality-of-life measurements and medication required for pain relief. RESULTS Altogether, 352 titles and abstracts were screened for eligibility; of these, 19 were selected for full text assessment. All were excluded because none of them fulfilled the inclusion criteria and addressed the (adjunctive) use of antibiotics in children who present with an odontogenic abscess in the primary dentition. CONCLUSIONS At present, there is no single randomised or non-randomised clinical study evaluating the effectiveness and harms of systemic antibiotics administered in children who present with an odontogenic abscess in the primary dentition. CLINICAL RELEVANCE There is no clinical evidence to support nor to refute the use of antibiotics in children who present with an odontogenic abscess in the primary dentition without signs of local spread or systemic involvement. Given this lack of scientific evidence, the use of antibiotics cannot be recommended in these children. Well-designed clinical trials are indicated to fully understand the impact and necessity of antibiotics in these situations.
Collapse
Affiliation(s)
- Roos Leroy
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, B-1000, Brussels, Belgium.
| | - Jolyce Bourgeois
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, B-1000, Brussels, Belgium
| | - Leen Verleye
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, B-1000, Brussels, Belgium
| | - Joana C Carvalho
- Faculty of Medicine and Dentistry, UCLouvain, Av. Hippocrate 10, B-1200, Brussels, Belgium
| | - Anouk Eloot
- Private Dental Practice, Emiel Verhaerenlaan 37, B-9050, Gentbrugge, Belgium
| | - Rita Cauwels
- Department of Oral Health Sciences, UGent, C. Heymanslaan 10, B-9000, Ghent, Belgium
| | - Dominique Declerck
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Kapucijnenvoer 7/a-box 7001, B-3000, Leuven, Belgium
| |
Collapse
|
11
|
Liapis D, De Bruyne MAA, De Moor RJG, Meire MA. Postoperative pain after ultrasonically and laser-activated irrigation during root canal treatment: a randomized clinical trial. Int Endod J 2021; 54:1037-1050. [PMID: 33595920 DOI: 10.1111/iej.13500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022]
Abstract
AIM To compare the intensity of postoperative pain after primary root canal treatment of asymptomatic teeth when using ultrasonically (UAI) or laser-activated irrigation (LAI). METHODOLOGY In this superiority randomized clinical trial (ClinicalTrials.gov ID: NCT03981237) with parallel design, fifty-six patients with an asymptomatic tooth in need of primary root canal treatment were enrolled. After chemo-mechanical canal preparation using rotary instruments and NaOCl irrigation, teeth were randomly assigned to two groups and patients were blinded to the final irrigation protocol. In the UAI group (n = 28), 60s activation with an Irrisafe tip was done per canal. In the LAI group (n = 28), NaOCl was activated with a pulsed Er:YAG (2940 nm) laser, equipped with a conical tip, with settings of 50 µs, 20 mJ at 15 Hz for 60 s. Patients recorded their pain intensity 6, 24, 48 and 72 h after treatment on a 100 mm visual analogue scale (VAS), as well as their analgesic consumption. Pain levels and incidence were compared across groups using the Mann-Whitney U-test and chi-square test. RESULTS Overall, mean postoperative pain intensity was low, with the majority of patients having no or minimal pain 24 h postoperatively. At 6 h postoperatively, pain intensity and incidence were significantly higher in the UAI group compared to the LAI group (P < 0.05). For the other time intervals, no significant differences in postoperative pain incidence or intensity were found. The frequency of analgesic intake did not differ significantly between the two groups. Neither of the activation methods resulted in any adverse effects. CONCLUSIONS Ultrasonically and laser-activated irrigation resulted in low and comparable levels of postoperative pain in asymptomatic patients receiving primary root canal treatment.
Collapse
Affiliation(s)
- D Liapis
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A A De Bruyne
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - R J G De Moor
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| |
Collapse
|
12
|
B. Abraham S, Abdulla N, Himratul-Aznita WH, Awad M, Samaranayake LP, Ahmed HMA. Antibiotic prescribing practices of dentists for endodontic infections; a cross-sectional study. PLoS One 2020; 15:e0244585. [PMID: 33378378 PMCID: PMC7773263 DOI: 10.1371/journal.pone.0244585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The indiscriminate prescription of antibiotics has led to the emergence of resistance microbes worldwide. This study aimed to investigate the antibiotic prescribing practices amongst general dental practitioners and specialists in managing endodontic infections in the United Arab Emirates (UAE). Design General dental practitioners and specialists in the UAE were invited to participate in an online questionnaire survey which included questions on socio-demographics, practitioner’s antibiotic prescribing preferences for various pulpal and periapical diseases, and their choice, in terms of the type, dose and duration of the antibiotic. The link to the survey questionnaire was sent to 250 invited dentists. Data were analyzed by descriptive statistics and chi-square tests for independence and level of significance was set at 0.05. Results A total of 174 respondents participated in the survey (response rate = 70%). The respondents who prescribed antibiotics at least once a month were 38.5% while 17.2% did so, more than three times a week; amoxicillin 500 mg was the antibiotic of choice for patients not allergic to penicillin (43.7%), and in cases of penicillin allergies, erythromycin 500 mg (21.3%). There was a significant difference in the antibiotic prescribing practices of GDPs compared to endodontists and other specialties especially in clinical cases such as acute apical abscesses with swelling and moderate to severe pre-operative symptoms and retreatment of endodontic cases (p<0.05). Approximately, three quarters of the respondents (78.7%) did not prescribe a loading dose when prescribing antibiotics. About 15% respondents prescribed antibiotics to their patients if they were not accessible to patients due to a holiday/weekend. Conclusions In general, the antibiotic prescribing practices of UAE dentists are congruent with the international norms. However, there were occasions of inappropriate prescriptions such as in patients with irreversible pulpitis, necrotic pulps with no systemic involvement and/or with sinus tracts.
Collapse
Affiliation(s)
- Sheela B. Abraham
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Nizam Abdulla
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Wan Harun Himratul-Aznita
- Department of Oral & Craniofacial Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Manal Awad
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Lakshman Perera Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| |
Collapse
|
13
|
Almuthhin M, Afify M, Alshammari Y, Alkatheeri N, Altuwaijri SM, Alhussain B, Albaij SMA, Alanazi F, Alsheri Y. The Safety and Efficacy of Pre- and Post-Medication for Postoperative Endo- dontic Pain: A Systematic Review and Network Meta-analysis. Open Dent J 2020. [DOI: 10.2174/1874210602014010563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Postoperative Endodontic Pain is a major concern for dentists and their patients, with pain having been reported to occur in 25%–40% of patients treated. Therefore, the aim of this systematic review and Network Meta-analysis (NMA) was to identify the safety and efficacy of pre- and post-medication for reducing postoperative endodontic pain.
Methods:
A literature search was performed in the SCOPUS, MEDLINE, and ScienceDirect, and Cochrane Central databases until December 2019 with no language restriction. Randomized controlled trials evaluating the efficacy of pre- or post-medications compared with other agents, placebo, or no treatment in adult patients who underwent endodontic surgery for postoperative pain were included. The mean difference of postoperative pain was measured using the Standardized Mean Difference (SMD) with its 95% confidence interval (95% CI).
Results:
This Systematic Review included 62 Articles. Of them, 50 studies were included in the NMA. Among all medications, corticosteroids were ranked as the best treatment for the reduction of postoperative pain at 6 and 12 hours with a significant reduction in postoperative pain scores [SMD= -1.18, 95% CI (-1.51: -0.85)] and [SMD= -1.39, 95% CI (-1.77: -1.02)], respectively. Cyclooxygenase-2 (COX-2) inhibitors were ranked as the best treatment for the reduction of postoperative pain at 8 and 24 hours with a significant reduction in postoperative pain scores [SMD= -2.86, 95% CI (-6.05: -1.66)] and [SMD= -1.27, 95% CI (-2.10: -0.43)], respectively. Non-steroidal anti-inflammatory drugs (NSAIDs) significantly reduced the postoperative pain scores in all durations. For postoperative pain at 6 hours, Indomethacin, Novafen, Naproxen, Prednisolone, Ketorolac, Betamethasone, Dexamethasone, Deflazacort, Rofecoxib, Piroxicam, and Ibuprofen significantly reduced the pain score when compared with a placebo. All of these drugs demonstrated a significant reduction at 12 hours except Ketorolac.
Conclusion:
The current evidence suggests that pre- and post-medication can reduce postoperative pain after nonsurgical root canal treatment. Corticosteroids and COX-2 inhibitors showed significant control of the pain up to 12 hours after administration. However, NSAIDs demonstrated a high efficacy from administration and until two days after treatment. Indomethacin, Novafen, prednisolone, and Naproxen were ranked first in most analyzed durations.
Collapse
|
14
|
Shamszadeh S, Asgary S, Shirvani A, Eghbal MJ. Effects of antibiotic administration on post-operative endodontic symptoms in patients with pulpal necrosis: A systematic review and meta-analysis. J Oral Rehabil 2020; 48:332-342. [PMID: 32681652 DOI: 10.1111/joor.13057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The current systematic review and meta-analysis aimed to assess the efficacy of prophylactic oral antibiotics in the management of post-operative endodontic symptoms in adults with necrotic pulp. MATERIALS AND METHODS A systematic search up to April 2020 was performed to find all randomised controlled trials (RTCs) comparing oral antibiotics with placebo to manage post-endodontic symptoms. The outcome measures were post-operative pain, swelling and/or the combined pain and swelling at different follow-ups. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were estimated using random-effect inverse-variance method. Additional analysis was performed if heterogeneity existed (P < .05). RESULTS For post-endodontic pain, 8 RCTs (n = 690) were included. Antibiotic prescription had no significant effect on endodontic pain at 6 (SMD = -0.008, 95% CI -0.279 - 0.264, P = .95), 12 (SMD = -0.080, 95% CI -1.39 - 1.23, P = .90), 24 (SMD = -0.044, 95% CI -0.29 - 0.20, P = .72), 48 (SMD = 0.18, 95% CI -0.26 - 0.62, P = .42) and 72 h (SMD= -0.050, 95% CI -0.33 - 0.23, P = .723) post-operatively. For post-endodontic swelling, 4 RCTs (n = 149) were included. Antibiotic prescription had no significant effect on endodontic swelling at 24 (SMD = 0.29, 95% CI -0.72 - 1.32, P = .56), 48 (SMD = -0.23, 95% CI -0.98 - 0.51, P = .54) and 72 hours (SMD= -0.03, 95% CI -1.25 - 1.33, P = .96), post-operatively. For combined pain and swelling, no meta-analysis was performed. CONCLUSION The administration of prophylactic antibiotics to prevent post-operative endodontic symptoms is not supported by the current evidence.
Collapse
Affiliation(s)
- Sayna Shamszadeh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Armin Shirvani
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mohammad Jafar Eghbal
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| |
Collapse
|
15
|
Zanjir M, Sgro A, Lighvan NL, Yarascavitch C, Shah PS, da Costa BR, Azarpazhooh A. Efficacy and Safety of Postoperative Medications in Reducing Pain after Nonsurgical Endodontic Treatment: A Systematic Review and Network Meta-analysis. J Endod 2020; 46:1387-1402.e4. [DOI: 10.1016/j.joen.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 12/25/2022]
|
16
|
Mohaved SB, Shilpa G, Li Q, Austah O, Bendele M, Brock R, Ruparel NB. Apical periodontitis-induced mechanical allodynia: A mouse model to study infection-induced chronic pain conditions. Mol Pain 2020; 16:1744806919900725. [PMID: 31902318 PMCID: PMC6977224 DOI: 10.1177/1744806919900725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Infection-induced chronic pain is an under-studied pain condition. One example is apical periodontitis, which evokes considerable mechanical allodynia that persists after treatment in 7% to 12% of patients. Available analgesics often provide incomplete relief. However, a preclinical model to study pain mechanisms associated with apical periodontitis is not available. Here, we report a mouse model of apical periodontitis to facilitate studies determining mechanisms mediating persistent infection-induced pain. Mice were anesthetized and the left first molar was exposed to the oral environment for six weeks. Bone resorption, as an indicator of apical periodontitis, was quantified using microcomputed tomography. Mechanical allodynia was determined using extraoral von-Frey filaments in both male and female mice. The expression of c-fos in the medullary dorsal horn was assessed using immunohistochemistry. Mice with apical periodontitis developed significant mechanical allodynia by day 7 that was maintained for 42 days. Mechanical thresholds were significantly lower in females compared to males. Administration of ibuprofen, morphine, or MK-801 reversed mechanical allodynia. Finally, apical periodontitis triggered an upregulation of c-fos in the medullary dorsal horn. Collectively, this model simulates signs of clinical pain experienced by patients with apical periodontitis, detects sex differences in allodynia, and permits the study of peripheral and central trigeminal pain mechanisms.
Collapse
Affiliation(s)
- Saeed B Mohaved
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ganatra Shilpa
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Qun Li
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Obadah Austah
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Michelle Bendele
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Robert Brock
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nikita B Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| |
Collapse
|
17
|
Tampi MP, Pilcher L, Urquhart O, Kennedy E, O'Brien KK, Lockhart PB, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Lang MS, Patton LL, Paumier T, Suda KJ, Cho H, Carrasco-Labra A. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: Systematic review and meta-analysis-a report of the American Dental Association. J Am Dent Assoc 2019; 150:e179-e216. [PMID: 31761029 DOI: 10.1016/j.adaj.2019.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use. TYPE OF STUDIES REVIEWED The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.
Collapse
|
18
|
Bansal R, Jain A, Goyal M, Singh T, Sood H, Malviya HS. Antibiotic abuse during endodontic treatment: A contributing factor to antibiotic resistance. J Family Med Prim Care 2019; 8:3518-3524. [PMID: 31803645 PMCID: PMC6881914 DOI: 10.4103/jfmpc.jfmpc_768_19] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 12/24/2022] Open
Abstract
Antibiotic resistance is one of our most serious global health threats. The adverse effects of overusing and misusing antibiotics are highly publicized in the health professional literature. Antibiotic abuse occurs during routine endodontic treatment and there are deficiencies in knowledge regarding prescribing antibiotic and appropriate prophylactic antibiotic use. Multidisciplinary coordination and cooperation among dentists, pharmacists, and patients is needed to curb antibiotic abuse. As endodontists, we can become part of the solution to the antibiotic resistance crisis and deal with it conclusively. This review article discusses antibiotic resistance resulting from antibiotic abuse during endodontic treatment, various factors contributing to it, and measures required for stopping antibiotic abuse in endodontic treatment. A web-based research on MedLine was performed with terms Review Articles published in the last 10 year's dental journals in English for literature researching, extracting, and synthesizing data. Relevant articles were shortlisted. Important cross-reference articles were also reviewed.
Collapse
Affiliation(s)
- Ramta Bansal
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Aditya Jain
- Department of Physiology, Government Medical College, Patiala, Punjab, India
| | - Mehak Goyal
- Department of Oral and Maxillofacial Surgery, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Tejveer Singh
- Department of Oral and Maxillofacial Surgery, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Himanshu Sood
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Harjeet Singh Malviya
- Department of Conservative Dentistry and Endodontics, Geetanjali Dental and Research Institute, Udaipur, Rajasthan, India
| |
Collapse
|
19
|
Lockhart PB, Tampi MP, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Kennedy E, Lang MS, Patton LL, Paumier T, Suda KJ, Pilcher L, Urquhart O, O'Brien KK, Carrasco-Labra A. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. J Am Dent Assoc 2019; 150:906-921.e12. [PMID: 31668170 PMCID: PMC8270006 DOI: 10.1016/j.adaj.2019.08.020] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults. TYPES OF STUDIES REVIEWED The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework. RESULTS The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high. CONCLUSION AND PRACTICAL IMPLICATIONS Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.
Collapse
|
20
|
Abstract
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 number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.This review updates the previous version published in 2016. OBJECTIVES To assess the effects of systemic antibiotics for irreversible pulpitis. SEARCH METHODS We searched Cochrane Oral Health's Trials Register (to 18 February 2019); the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library (searched 18 February 2019); MEDLINE Ovid (1946 to 18 February 2019); Embase Ovid (1980 to 18 February 2019); US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (searched 18 February 2019); and the World Health Organization International Clinical Trials Registry Platform (searched 18 February 2019). There were no language restrictions in the searches of the electronic databases. 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 Three review authors screened studies and extracted data independently. We assessed the certainty of the evidence of included studies using GRADE. Pooling of data was not possible and a descriptive summary is presented. MAIN RESULTS No additional trials could be included in this update. One trial at low risk of bias evaluating oral penicillin in combination with analgesics versus placebo with analgesics, involving 40 participants was included in a former update of the review. The certainty of the evidence was rated low for the different outcomes. Our primary outcome was patient-reported pain (intensity/duration) and pain relief. There was a close parallel distribution of the pain ratings in both the intervention (median 6.0, interquartile range (IQR) 10.5), and for placebo (median 6.0, IQR 9.5) over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.20 (standard deviation (SD) 6.02) in the penicillin group versus 9.60 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.90 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. AUTHORS' CONCLUSIONS This Cochrane Review which was based on one low-powered small sample trial assessed as at low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.
Collapse
Affiliation(s)
| | | | | | - Esther J van Zuuren
- Leiden University Medical CenterDepartment of DermatologyPO Box 9600B1‐QLeidenNetherlands2300 RC
| | - Julie Sprakel
- University of Sao PauloDepartment of Gynecology and Obstetrics, Ribeiro Preto Medical SchoolSao PauloBrazil
| | | |
Collapse
|
21
|
Salvadori M, Audino E, Venturi G, Garo ML, Salgarello S. Antibiotic prescribing for endodontic infections: a survey of dental students in Italy. Int Endod J 2019; 52:1388-1396. [DOI: 10.1111/iej.13126] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/10/2019] [Indexed: 12/28/2022]
Affiliation(s)
- M. Salvadori
- Department of Medical and Surgery Specialties Radiological Sciences and Public Health, School of Dentistry Brescia University Brescia Italy
| | - E. Audino
- Department of Medical and Surgery Specialties Radiological Sciences and Public Health, School of Dentistry Brescia University Brescia Italy
| | - G. Venturi
- Department of Medical and Surgery Specialties Radiological Sciences and Public Health, School of Dentistry Brescia University Brescia Italy
| | | | - S. Salgarello
- Department of Medical and Surgery Specialties Radiological Sciences and Public Health, School of Dentistry Brescia University Brescia Italy
| |
Collapse
|
22
|
Nagendrababu V, Pulikkotil SJ, Jinatongthai P, Veettil SK, Teerawattanapong N, Gutmann JL. Efficacy and Safety of Oral Premedication on Pain after Nonsurgical Root Canal Treatment: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. J Endod 2019; 45:364-371. [DOI: 10.1016/j.joen.2018.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/23/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
|
23
|
Coppla FM, Rezende M, de Paula E, Farago PV, Loguercio AD, Kossatz S, Reis A. Combination of Acetaminophen/Codeine Analgesics Does Not Avoid Bleaching-Induced Tooth Sensitivity: A Randomized, Triple-Blind Two-Center Clinical Trial. Oper Dent 2018; 43:E53-E63. [PMID: 29504880 DOI: 10.2341/17-092-c] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bleaching-induced tooth sensitivity (TS) is highly prevalent. OBJECTIVE This study aimed to determine if the combination of opioids and nonopioids analgesics (Tylex) may provide a better analgesic effect. METHOD A triple-blind, parallel, randomized two-center clinical trial was conducted with 105 healthy patients who received either a placebo or a combination of acetaminophen/codeine. The first dose of Tylex 30 mg (acetaminophen 500 mg/codeine 30 mg) or placebo was administered one hour before the in-office bleaching (35% hydrogen peroxide), and extra doses were administered every six hours for 48 hours. The TS was recorded using a visual analog scale of 0 to 10 and a numeric rating scale of 0 to 4 in different periods: during bleaching, one hour up to 24 hours, and 24 hours up to 48 hours postbleaching. The color was measured before and one month after dental bleaching with a visual shade guide (Vita Classical), Vita Bleachedguide 3D-MASTER, and the spectrophotometer Vita Easyshade. The absolute risk of TS was evaluated using the Fisher exact test. Data of TS intensity with numeric rating scale of the two groups were compared with the Mann-Whitney U-test and the Friedman test, while data from the visual analog scale were evaluated by two-way repeated measures analysis of variance and the Tukey test for pairwise comparison. The color changes between groups were compared using the Student t-test (α=0.05). RESULTS No significant differences between the groups were observed in the risk and intensity of TS. The overall absolute risk of TS was approximately 96%. No significant differences between groups were observed in terms of color change ( p>0.05) for any scale. CONCLUSION The use of an acetaminophen/codeine combination prior to in-office bleaching does not reduce the risk and intensity of bleaching-induced TS.
Collapse
|
24
|
Wolf E, Dragicevic M, Fuhrmann M. Alleviation of acute dental pain from localised apical periodontitis: A prospective randomised study comparing two emergency treatment procedures. J Oral Rehabil 2018; 46:120-126. [DOI: 10.1111/joor.12730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/23/2018] [Accepted: 09/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Eva Wolf
- Department of Endodontics; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Mille Dragicevic
- Department of Endodontics; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Märta Fuhrmann
- Department of Endodontics; Faculty of Odontology; Malmö University; Malmö Sweden
| |
Collapse
|
25
|
Fuller M, Younkin K, Drum M, Reader A, Nusstein J, Fowler S. Postoperative Pain Management with Oral Methylprednisolone in Symptomatic Patients with a Pulpal Diagnosis of Necrosis: A Prospective Randomized, Double-blind Study. J Endod 2018; 44:1457-1461. [DOI: 10.1016/j.joen.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/20/2018] [Accepted: 06/05/2018] [Indexed: 11/27/2022]
|
26
|
Cope AL, Francis N, Wood F, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2018; 9:CD010136. [PMID: 30259968 PMCID: PMC6513530 DOI: 10.1002/14651858.cd010136.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with these conditions should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies within both the individual and the community. This review is an update of the original version that was published in 2014. OBJECTIVES To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 26 February 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 26 February 2018), MEDLINE Ovid (1946 to 26 February 2018), Embase Ovid (1980 to 26 February 2018), and CINAHL EBSCO (1937 to 26 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. A grey literature search was conducted using OpenGrey (to 26 February 2018) and ZETOC Conference Proceedings (1993 to 26 February 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS Two authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MD) (standardised mean difference (SMD) when different scales were reported) and 95% confidence intervals (CI) for continuous data. A fixed-effect model was used in the meta-analysis as there were fewer than four studies. We contacted study authors to obtain missing information. MAIN RESULTS We included two trials in this review, with 62 participants included in the analyses. Both trials were conducted in university dental schools in the USA and compared the effects of oral penicillin V potassium (penicillin VK) versus a matched placebo when provided in conjunction with a surgical intervention (total or partial pulpectomy) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. The patients included in these trials had no signs of spreading infection or systemic involvement (fever, malaise). We assessed one study as having a high risk of bias and the other study as having unclear risk of bias.The primary outcome variables reported in both studies were participant-reported pain and swelling (one trial also reported participant-reported percussion pain). One study reported the type and number of analgesics taken by participants. One study recorded the incidence of postoperative endodontic flare-ups (people who returned with symptoms that necessitated further treatment). Adverse effects, as reported in one study, were diarrhoea (one participant, placebo group) and fatigue and reduced energy postoperatively (one participant, antibiotic group). Neither study reported quality of life measurements.Objective 1: systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscessTwo studies provided data for the comparison between systemic antibiotics (penicillin VK) and a matched placebo for adults with acute apical abscess or a symptomatic necrotic tooth when provided in conjunction with a surgical intervention. Participants in one study all underwent a total pulpectomy of the affected tooth, while participants in the other study had their tooth treated by either partial or total pulpectomy. Participants in both trials received oral analgesics. There were no statistically significant differences in participant-reported measures of pain or swelling at any of the time points assessed within the review. The MD for pain (short ordinal numerical scale 0 to 3) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The SMD for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The body of evidence was assessed as at very low quality.Objective 2: systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscessWe found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS There is very low-quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.
Collapse
Affiliation(s)
- Anwen L Cope
- Cardiff and Vale University Health BoardHeath ParkCardiffUKCF14 4YS
- School of Dentistry, Cardiff UniversityApplied Clinical Research and Public HealthCardiffUK
| | - Nick Francis
- School of Medicine, Cardiff UniversityDivision of Population MedicineHeath ParkCardiffUKCF14 4YS
| | - Fiona Wood
- School of Medicine, Cardiff UniversityDivision of Population MedicineHeath ParkCardiffUKCF14 4YS
| | - Ivor G Chestnutt
- School of Dentistry, Cardiff UniversityApplied Clinical Research and Public HealthCardiffUK
| | | |
Collapse
|
27
|
Beus H, Fowler S, Drum M, Reader A, Nusstein J, Beck M, Jatana C. What Is the Outcome of an Incision and Drainage Procedure in Endodontic Patients? A Prospective, Randomized, Single-blind Study. J Endod 2018; 44:193-201. [DOI: 10.1016/j.joen.2017.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/23/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
|
28
|
Germack M, Sedgley CM, Sabbah W, Whitten B. Antibiotic Use in 2016 by Members of the American Association of Endodontists: Report of a National Survey. J Endod 2017; 43:1615-1622. [DOI: 10.1016/j.joen.2017.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
|
29
|
|
30
|
Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. Antibiotics in Endodontics: a review. Int Endod J 2017; 50:1169-1184. [DOI: 10.1111/iej.12741] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 12/20/2022]
Affiliation(s)
- J. J. Segura-Egea
- Department of Endodontics; School of Dentistry; University of Sevilla; Sevilla Spain
| | - K. Gould
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | | | - P. Jonasson
- Department of Endodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Cotti
- Department of Conservative Dentistry and Endodontics; University of Cagliari; Cagliari, Sardinia Italy
| | - A. Mazzoni
- Department of Biomedical and Neuromotor Sciences; DIBINEM; University of Bologna; Bologna Italy
| | - H. Sunay
- Department of Endodontology; Dental Faculty of Istanbul Kemerburgaz University; Istanbul Turkey
| | - L. Tjäderhane
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
- Research Unit of Oral Health Sciences; Medical Research Center Oulu (MRC Oulu); Oulu University Hospital and University of Oulu; Oulu Finland
| | - P. M. H. Dummer
- School of Dentistry; College of Biomedical & Life Sciences; Cardiff University; Cardiff UK
| |
Collapse
|
31
|
Lalloo R, Solanki G, Ramphoma K, Myburgh NG. Endodontic treatment-related antibiotic prescribing patterns of South African oral health professionals. Int Endod J 2016; 50:1027-1033. [PMID: 27977869 DOI: 10.1111/iej.12731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/07/2016] [Indexed: 11/29/2022]
Abstract
AIM To assess the antibiotic prescribing patterns of South African dentists for patients undergoing endodontic treatment. METHODOLOGY This study used data from 2013 health insurance claims submitted by South African oral health professionals to determine the antibiotic prescribing patterns related to endodontic treatment. A logistic regression model was used to test the fully adjusted statistical significance of the association between the exploratory variables (gender, age group, event type, abscess treatment, chronic health) and the dependent variable (antibiotic prescription). Odds ratios with 95% confidence intervals (CI) are reported, and a 95% CI excluding 1 was considered statistically significant. RESULTS Almost 10% of endodontic treatments were prescribed an antibiotic. There were no significant differences in prescribing patterns by gender, age and chronic health status. Prescriptions were more common at the preparatory stage (9.4%) of root canal treatment compared to the therapy (4.7%) and canal filling (2%) stages. Patients who received apical surgery (OR = 2.28; 95% CI 1.38-3.76) and treatment of an abscess (OR = 2.57; 95% 1.82-3.63) had a significantly increased odds of being prescribed an antibiotic. Almost three-quarters of prescriptions were for narrow spectrum antibiotics. CONCLUSION The frequency of antibiotic prescribing by South African dental practitioners for patients undergoing endodontic treatment is relatively low and predominantly involved narrow spectrum antibiotics. It, however, remains important that antibiotics are only prescribed when clinically essential, such as when there are obvious systemic effects. These include fever above 37 degrees, malaise, lymphadenopathy, trismus, increase swelling, cellulitis, osteomyelitis and persistent infection. The wider dissemination and adherence to clear evidence-based prescribing guidelines for antibiotics in this clinical area are important.
Collapse
Affiliation(s)
- R Lalloo
- School of Dentistry, University of Queensland, Brisbane, Qld, Australia
| | - G Solanki
- Towers Watson, Cape Town, South Africa.,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - K Ramphoma
- Faculty of Dentistry, University of Western Cape, Cape Town, South Africa.,Discipline of Public Health and Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - N G Myburgh
- Faculty of Dentistry, University of Western Cape, Cape Town, South Africa
| |
Collapse
|
32
|
Aminoshariae A, Kulild JC. Authors’ response. J Am Dent Assoc 2016; 147:601-2. [DOI: 10.1016/j.adaj.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Does Liposomal Bupivacaine (Exparel) Significantly Reduce Postoperative Pain/Numbness in Symptomatic Teeth with a Diagnosis of Necrosis? A Prospective, Randomized, Double-blind Trial. J Endod 2016; 42:1301-6. [PMID: 27461787 DOI: 10.1016/j.joen.2016.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Medical studies have shown some potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA), a slow-release bupivacaine solution, to extend postoperative benefits of numbness/pain relief for up to several days. Because the Food and Drug Administration has approved Exparel only for infiltrations, we wanted to evaluate if it would be effective as an infiltration to control postoperative pain. The purpose of this study was to compare an infiltration of bupivacaine with liposomal bupivacaine for postoperative numbness and pain in symptomatic patients diagnosed with pulpal necrosis experiencing moderate to severe preoperative pain. METHODS One hundred patients randomly received a 4.0-mL buccal infiltration of either bupivacaine or liposomal bupivacaine after endodontic debridement. For postoperative pain, patients were given ibuprofen/acetaminophen, and they could receive narcotic pain medication as an escape. Patients recorded their level of numbness, pain, and medication use the night of the appointment and over the next 5 days. Success was defined as no or mild postoperative pain and no narcotic use. RESULTS The success rate was 29% for the liposomal group and 22% for the bupivacaine group, with no significant difference (P = .4684) between the groups. Liposomal bupivacaine had some effect on soft tissue numbness, pain, and use of non-narcotic medications, but it was not clinically significant. There was no significant difference in the need for escape medication. CONCLUSIONS For symptomatic patients diagnosed with pulpal necrosis experiencing moderate to severe preoperative pain, a 4.0-mL infiltration of liposomal bupivacaine did not result in a statistically significant increase in postoperative success compared with an infiltration of 4.0 mL bupivacaine.
Collapse
|
34
|
Azim AA, Azim KA, Abbott PV. Prevalence of inter-appointment endodontic flare-ups and host-related factors. Clin Oral Investig 2016; 21:889-894. [DOI: 10.1007/s00784-016-1839-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/24/2016] [Indexed: 11/24/2022]
|
35
|
Aggarwal V, Singla M, Subbiya A, Vivekanandhan P, Sharma V, Sharma R, Prakash V, Geethapriya N. Effect of Preoperative Pain on Inferior Alveolar Nerve Block. Anesth Prog 2016; 62:135-9. [PMID: 26650491 DOI: 10.2344/15-00019.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.
Collapse
Affiliation(s)
- Vivek Aggarwal
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Mamta Singla
- Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, India
| | - Arunajatesan Subbiya
- Department of Conservative Dentistry & Endodontics, Sree Balaji Dental College and Hospital, Chennai, India
| | - Paramasivam Vivekanandhan
- Department of Conservative Dentistry & Endodontics, Sree Balaji Dental College and Hospital, Chennai, India
| | - Vikram Sharma
- Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, India
| | - Ritu Sharma
- Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, India
| | - Venkatachalam Prakash
- Department of Conservative Dentistry & Endodontics, Sree Balaji Dental College and Hospital, Chennai, India
| | - Nagarajan Geethapriya
- Department of Conservative Dentistry & Endodontics, Sree Balaji Dental College and Hospital, Chennai, India
| |
Collapse
|
36
|
Sebastian R, Drum M, Reader A, Nusstein J, Fowler S, Beck M. What Is the Effect of No Endodontic Debridement on Postoperative Pain for Symptomatic Teeth with Pulpal Necrosis? J Endod 2016; 42:378-82. [DOI: 10.1016/j.joen.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 11/16/2022]
|
37
|
Agnihotry A, Fedorowicz Z, van Zuuren EJ, Farman AG, Al-Langawi JH. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev 2016; 2:CD004969. [PMID: 26886473 DOI: 10.1002/14651858.cd004969.pub4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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 number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.This review updates the previous version published in 2013. OBJECTIVES To assess the effects of systemic antibiotics for irreversible pulpitis. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 27 January 2016); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 12); MEDLINE via Ovid (1946 to 27 January 2016); EMBASE via Ovid (1980 to 27 January 2016), ClinicalTrials.gov (to 27 January 2016) and the WHO International Clinical Trials Registry Platform (to 27 January 2016). There were no language restrictions in the searches of the electronic databases. 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. We assessed the quality of the evidence of included studies using GRADEpro software. Pooling of data was not possible and a descriptive summary is presented. MAIN RESULTS One trial assessed at low risk of bias, involving 40 participants was included in this update of the review. The quality of the body of evidence was rated low for the different outcomes. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.2 (standard deviation (SD) 6.02) in the penicillin group versus 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P value = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.9 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P value = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. AUTHORS' CONCLUSIONS This systematic review which was based on one low powered small sample trial assessed as at low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.
Collapse
Affiliation(s)
- Anirudha Agnihotry
- Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, USA, CA 90095-1668
| | | | | | | | | |
Collapse
|
38
|
Alsomadi L, Al Habahbeh R. Role of Prophylactic Antibiotics in the Management of Postoperative Endodontic Pain. J Contemp Dent Pract 2015; 16:939-943. [PMID: 27018027 DOI: 10.5005/jp-journals-10024-1785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To investigate the efficacy of using antibiotics in post endodontic treatment as a method to alleviate post-treatment pain. MATERIALS AND METHODS After completion of endodontic treatment 129 patients were randomly divided into two groups: Group A (65 patients) received Ibuprofen 400 mg one tablet before procedure and one tablet every 8 hours for the first day, then one tablet once indicated by pain. Group B (64 patients) received the same regimen as group A in addition to amoxicillin, clavulanic acid tablets (one tablet before the procedure, and then one tablet twice daily for a total of 3 days). Intensity of pain at 8 hours interval using visual analog scale (VAS) and total number of Ibuprofen tablets used was recorded by patients. RESULTS Peak postoperative pain occurred at 16 hours post-treatment in both groups, there was a significant difference in the pain scale between the two groups in favor for group B over group A (3.8 vs 2.1 respectively). Pain scale was significantly lower in group B at 24, 32, 40, and 48 hours post-treatment with a p-value of < 0.05. The pain scale at 56, 64 and 72 hours were also less in group B, although could not show up as statistical difference. Patients in group A used statistically significant more Ibuprofen than patients in group B (486 vs 402). CONCLUSION Antibiotic prescription to manage post endodontic treatment pain results in less pain with less consumption of Ibuprofens. CLINICAL SIGNIFICANCE Pain management in endodontics is a real challenge, nonsteroidal anti-inflammatory drugs (NSAIDS) are used effectively in many patients to alleviate post endodontic pain. Nonsteroidal anti-inflammatory drugs may have adverse reactions or may be contraindicated. Short-term use of antibiotics to alleviate pain can be of clinical benefits in these patients.
Collapse
Affiliation(s)
- Leena Alsomadi
- Associate Professor Department of Conservative Dentistry, University of Jordan PO Box 830453, Amman, Jordan, Phone: 009626797728100 e-mail:
| | - Riyad Al Habahbeh
- Department Conservative Dentistry, Royal Medical Services Amman, Jordan
| |
Collapse
|
39
|
Harreld TK, Fowler S, Drum M, Reader A, Nusstein J, Beck M. Efficacy of a Buffered 4% Lidocaine Formulation for Incision and Drainage: A Prospective, Randomized, Double-blind Study. J Endod 2015; 41:1583-8. [PMID: 26253800 DOI: 10.1016/j.joen.2015.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/28/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Incision and drainage of symptomatic emergency patients with facial swelling is painful even after local anesthetics are administered. The purpose of this prospective, randomized, double-blind study was to compare the pain of infiltration and the pain of an incision and drainage procedure of a buffered versus a nonbuffered 4% lidocaine formulation in symptomatic emergency patients presenting with a diagnosis of pulpal necrosis, associated periapical area, and an acute clinical swelling. METHODS Eighty-eight emergency patients were randomly divided into 2 groups to receive 2 intraoral infiltration injections (mesial and distal to the swelling) of either 4% lidocaine with 1:100,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate using the Onpharma (Los Gatos, CA) buffering system or 4% lidocaine with 1:100,000 epinephrine. Subjects rated the pain of needle insertion, needle placement, and solution deposition for each injection using a 170-mm visual analog scale. An incision and drainage procedure was performed, and subjects rated the pain of incision, drainage, and dissection on a 170-mm visual analog scale. RESULTS No significant differences between the buffered and nonbuffered 4% lidocaine formulations were found for needle insertion, placement, and solution deposition of the infiltration injections or for the treatment phases of incision, drainage, and dissection. CONCLUSIONS Buffering a 4% lidocaine formulation did not significantly decrease the pain of infiltrations or significantly decrease the pain of the incision and drainage procedure when compared with a nonbuffered 4% lidocaine formulation in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling.
Collapse
Affiliation(s)
- Taryn Kratz Harreld
- Private Practice Limited to Endodontics, Norton Shores, Michigan; Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Sara Fowler
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Division of Endodontics, The Ohio State University, Columbus, Ohio.
| | - John Nusstein
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Mike Beck
- Division ofBiosciences, The Ohio State University, Columbus, Ohio
| |
Collapse
|
40
|
Oberoi SS, Dhingra C, Sharma G, Sardana D. Antibiotics in dental practice: how justified are we. Int Dent J 2014; 65:4-10. [PMID: 25510967 DOI: 10.1111/idj.12146] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Antibiotics are prescribed by dentists in dental practice, during dental treatment as well as for prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited because most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. The use of antibiotics in dental practice is characterised by empirical prescription based on clinical and bacteriological epidemiological factors, resulting in the use of a very narrow range of broad-spectrum antibiotics for short periods of time. This has led to the development of antimicrobial resistance (AMR) in a wide range of microbes and to the consequent inefficacy of commonly used antibiotics. Dentists can make a difference by the judicious use of antimicrobials--prescribing the correct drug, at the standard dosage and appropriate regimen--only when systemic spread of infection is evident. The increasing resistance problems of recent years are probably related to the over- or misuse of broad-spectrum agents. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs in dentistry. This paper highlights the need for dentists to improve antibiotic prescribing practices in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. The literature provides evidence of inadequate prescribing practices by dentists for a number of factors, ranging from inadequate knowledge to social factors.
Collapse
Affiliation(s)
- Sukhvinder S Oberoi
- Department of Public Health Dentistry, Sudha College of Dental Sciences and Research, Faridabad, India
| | | | | | | |
Collapse
|
41
|
Root canal therapy reduces multiple dimensions of pain: a national dental practice-based research network study. J Endod 2014; 40:1738-45. [PMID: 25190605 DOI: 10.1016/j.joen.2014.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/13/2014] [Accepted: 07/11/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Initial orthograde root canal therapy (RCT) is used to treat dentoalveolar pathosis. The effect RCT has on pain intensity has been frequently reported, but the effect on other dimensions of pain has not. Also, the lack of large prospective studies involving diverse groups of patients and practitioners who are not involved in data collection suggest that there are multiple opportunities for bias to be introduced when these data are systematically aggregated. METHODS This prospective observational study assessed pain intensity, duration, and its interference with daily activities among RCT patients. Sixty-two practitioners (46 general dentists and 16 endodontists) in the National Dental Practice-Based Research Network enrolled patients requiring RCT. Patient-reported data were collected before, immediately after, and 1 week after treatment using the Graded Chronic Pain Scale. RESULTS The enrollment of 708 patients was completed over 6 months with 655 patients (93%) providing 1-week follow-up data. Before treatment, patients reported a mean (± standard deviation) worst pain intensity of 5.3 ± 3.8 (0-10 scale), 50% had "severe" pain (≥ 7), and mean days in pain and days pain interfered with activities were 3.6 ± 2.7 and 0.5 ± 1.2, respectively. After treatment, patients reported a mean worst pain intensity of 3.0 ± 3.2, 19% had "severe" pain, and mean days in pain and days with pain interference were 2.1 ± 2.4 and 0.4 ± 1.1, respectively. All changes were statistically significant (P < .0001). CONCLUSIONS RCT is an effective treatment for patients experiencing pain, significantly reducing pain intensity, duration, and related interference. Further research is needed to reduce the proportion of patients experiencing "severe" postoperative pain.
Collapse
|
42
|
Cope A, Francis N, Wood F, Mann MK, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2014:CD010136. [PMID: 24967571 DOI: 10.1002/14651858.cd010136.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dental pain can have a considerable detrimental effect on an individual's quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with symptomatic apical periodontitis or an acute apical abscess should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists continue to prescribe antibiotics for these conditions. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies both within the individual and within the community as a whole. OBJECTIVES To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis or acute apical abscess in adults. SEARCH METHODS We searched the following electronic databases: Cochrane Oral Health Group's Trials Register (to 1 October 2013); Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 9); MEDLINE via OVID (1946 to 1 October 2013); EMBASE via OVID (1980 to 1 October 2013) and CINAHL via EBSCO (1980 to 1 October 2013). We searched the World Health Organization (WHO) International Trials Registry Platform and the US National Institutes of Health Trials Registry (ClinicalTrials.gov) on 1 October 2013 to identify ongoing trials. We searched for grey literature using OpenGrey (to 1 October 2013) and ZETOC Conference Proceedings (1993 to 1 October 2013). We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MD) (standardised mean difference (SMD) when different scales were reported) and 95% confidence intervals (CI) for continuous data and, where results were meta-analysed, we used a fixed-effect model as there were fewer than four studies. We contacted study authors to obtain missing information. MAIN RESULTS We included two trials in this review, with 62 participants included in the analyses. Both trials were conducted in university dental schools in the USA and compared the effects of oral penicillin V potassium (penicillin VK) versus a matched placebo given in conjunction with a surgical intervention (total or partial pulpectomy) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth (no signs of spreading infection or systemic involvement (fever, malaise)). We assessed one study as having a high risk of bias and the other study as having unclear risk of bias.The primary outcome variables presented were participant-reported pain and swelling (one trial also reported participant-reported percussion pain). One study reported the type and number of analgesics taken by participants. One study recorded the incidence of postoperative endodontic flare-ups (people who returned with symptoms that necessitated further treatment). Adverse effects as reported in one study were diarrhoea (one participant, placebo group) and fatigue and reduced energy postoperatively (one participant, antibiotic group). No studies reporting quality of life measurements were suitable for inclusion. Objective 1: systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscess. Two studies provided data for the comparison between systemic antibiotics (penicillin VK) and a matched placebo for adults with acute apical abscess or a symptomatic necrotic tooth. Participants in one study all underwent a total pulpectomy of the affected tooth while participants in the other study had their tooth treated by either partial or total pulpectomy. Participants in both trials received oral analgesics. There were no statistically significant differences in participant-reported measures of pain or swelling at any of the time points assessed within the review. The MD for pain (short ordinal numerical scale 0 to 3) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The SMD for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The body of evidence was assessed as at very low quality. Objective 2: systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscess. We found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS There is very low quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.
Collapse
Affiliation(s)
- Anwen Cope
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, PCPH, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, UK, CF14 4YS
| | | | | | | | | |
Collapse
|
43
|
Fedorowicz Z, van Zuuren EJ, Farman AG, Agnihotry A, Al-Langawi JH. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev 2013:CD004969. [PMID: 24353116 DOI: 10.1002/14651858.cd004969.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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 number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis. OBJECTIVES To assess the effects of systemic antibiotics for irreversible pulpitis. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 5 September 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9); MEDLINE via OVID (1946 to 5 September 2013); EMBASE via OVID (1980 to 5 September 2013) and the US National Institutes of Health Trials Register (http://clinicaltrials.gov). There were no language restrictions in the searches of the electronic databases. 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. We assessed the quality of the evidence of included studies using GRADEPro software. Pooling of data was not possible and a descriptive summary is presented. MAIN RESULTS One trial assessed at low risk of bias, involving 40 participants was included in this update of the review. The quality of the body of evidence was rated low for the different outcomes. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.2 (standard deviation (SD) 6.02) in the penicillin group versus 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P value = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.9 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P value = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. AUTHORS' CONCLUSIONS This systematic review which was based on one low powered small sample trial assessed as a low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.
Collapse
Affiliation(s)
- Zbys Fedorowicz
- Bahrain Branch, The Cochrane Collaboration, Box 25438, Awali, Bahrain
| | | | | | | | | |
Collapse
|
44
|
Abstract
Acute apical abscess is the most common form of dental abscess and is caused by infection of the root canal of the tooth. It is usually localized intraorally, but in some cases the apical abscess may spread and result in severe complications or even mortality. The reasons why dental root canal infections can become symptomatic and evolve to severe spreading and sometimes life-threatening abscesses remain elusive. Studies using culture and advanced molecular microbiology methods for microbial identification in apical abscesses have demonstrated a multispecies community conspicuously dominated by anaerobic bacteria. Species/phylotypes commonly found in these infections belong to the genera Fusobacterium, Parvimonas, Prevotella, Porphyromonas, Dialister, Streptococcus, and Treponema. Advances in DNA sequencing technologies and computational biology have substantially enhanced the knowledge of the microbiota associated with acute apical abscesses and shed some light on the etiopathogeny of this disease. Species richness and abundance and the resulting network of interactions among community members may affect the collective pathogenicity and contribute to the development of acute infections. Disease modifiers, including transient or permanent host-related factors, may also influence the development and severity of acute abscesses. This review focuses on the current evidence about the etiology and treatment of acute apical abscesses and how the process is influenced by host-related factors and proposes future directions in research, diagnosis, and therapeutic approaches to deal with this disease.
Collapse
|
45
|
Balasco M, Drum M, Reader A, Nusstein J, Beck M. Buffered lidocaine for incision and drainage: a prospective, randomized double-blind study. J Endod 2013; 39:1329-34. [PMID: 24139250 DOI: 10.1016/j.joen.2013.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/18/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Buffered local anesthetics have not been studied for incision and drainage procedures in dentistry. The purpose of this prospective, randomized, double-blind study was to compare the pain of infiltration and pain of an incision and drainage procedure by using a buffered versus a nonbuffered 2% lidocaine with 1:100,000 epinephrine solution in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling. METHODS Eighty-one adult patients were randomly divided into 2 treatment groups who received 2 infiltrations (mesial and distal to the swelling of the same formulation) by using either 2% lidocaine with 1:100,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate or 2% lidocaine with 1:100,000 epinephrine. Patients rated pain of needle insertion, placement, and solution deposition for each infiltration on a 170-mm visual analog scale. An incision and drainage procedure was performed, and the pain of incision, drainage, and dissection was recorded. RESULTS No significant differences were found between the 2 anesthetic formulations for pain of solution deposition for either the mesial or distal site infiltrations. Moderate-to-severe pain was experienced in the majority of patients with the incision and drainage procedure. No significant differences were found between the 2 formulations. CONCLUSIONS The addition of a sodium bicarbonate buffer to 2% lidocaine with 1:100,000 epinephrine did not result in significantly decreased pain of infiltrations or significantly decreased pain of the incision and drainage procedure when compared with 2% lidocaine with 1:100,000 epinephrine in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling.
Collapse
Affiliation(s)
- Matthew Balasco
- Division of Endodontics, College of Dentistry, The Ohio State University, Columbus, Ohio
| | | | | | | | | |
Collapse
|
46
|
Ramu C, Padmanabhan TV. Indications of antibiotic prophylaxis in dental practice- review. Asian Pac J Trop Biomed 2012; 2:749-54. [PMID: 23570007 PMCID: PMC3609373 DOI: 10.1016/s2221-1691(12)60222-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 01/22/2012] [Accepted: 03/14/2012] [Indexed: 11/24/2022] Open
Abstract
Antibiotics are frequently used in dental practice. Clinical and bacteriological epidemiological factors determine the indications of antibiotics in dentistry. Antibiotics are used in addition to appropriate treatment to aid the host defences in the elimination of remaining bacteria. It is indicated when there is evidence of clinical sign involvement and spread of infection. Antibiotics are prescribed in dental practice for treating odontoge nic infections, non-odontogenic infections, as prophylaxis against focal and local infection. Special care needs to be addressed to patients with organ transplants, poorly controlled diabetes and pregnancy. Antibiotics should be used only as an adjunct to dental treatment and never alone as the first line of care. The present paper reviews the indications of antibiotics in dental practice.
Collapse
Affiliation(s)
- C Ramu
- *Corresponding author: Dr. C Ramu, MDS, Senior lecturer, Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra University,Porur, Chennai-600116, India. Tel: +919442322777 E-mail:
| | | |
Collapse
|
47
|
Efficacy of Ibuprofen and Ibuprofen/Acetaminophen on Postoperative Pain in Symptomatic Patients with a Pulpal Diagnosis of Necrosis. J Endod 2011; 37:1608-12. [DOI: 10.1016/j.joen.2011.08.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 06/09/2011] [Accepted: 08/30/2011] [Indexed: 11/17/2022]
|
48
|
Pain Prevalence and Severity before, during, and after Root Canal Treatment: A Systematic Review. J Endod 2011; 37:429-38. [DOI: 10.1016/j.joen.2010.12.016] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 11/18/2022]
|
49
|
Tsesis I, Faivishevsky V, Fuss Z, Zukerman O. Flare-ups after Endodontic Treatment: A Meta-analysis of Literature. J Endod 2008; 34:1177-81. [DOI: 10.1016/j.joen.2008.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 07/06/2008] [Accepted: 07/16/2008] [Indexed: 10/21/2022]
|
50
|
Ehrmann EH, Messer HH, Clark RM. Flare-ups in endodontics and their relationship to various medicaments. AUST ENDOD J 2008; 33:119-30. [PMID: 18076580 DOI: 10.1111/j.1747-4477.2007.00087.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this research is to investigate the frequency of endodontic flare-ups using a visual analogue scale. Definitions of flare-ups vary widely as does their reported frequency. A flare-up was defined as an increase of 20 or more points on the visual analogue scale for a given tooth, within the periods of 4 h and 24 h after the initial treatment appointment. The data from a previous study were used to determine the incidence of flare-ups after using three modalities (Ledermix, calcium hydroxide and no medication) to manage patients presenting for relief of pain of endodontic origin. A statistical analysis showed that there were no significant differences in flare-up rates at both the 4-h and 24-h periods between the three modalities. Further research is required using the above definition of a flare-up and standardising treatment protocols.
Collapse
Affiliation(s)
- Ernest H Ehrmann
- School of Dental Science, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.
| | | | | |
Collapse
|