Efficacy of Prophylactic use of Antibiotics to Avoid Flare up During Root Canal Treatment of Nonvital Teeth: A Randomized Clinical Trial

Management of Endodontic Flare-Up in the Presence of Periapical Radiolucency: Case Report and Overview

Flare-ups following root canal therapy (RCT) are of significant concern in dentistry. They are characterized by the occurrence of pain or swelling during or even after a root canal procedure. They affect a considerable proportion of cases, up to 16% and occasionally even 50%, and they often necessitate unscheduled appointments. Whenever a flare-up occurs within hours or days following RCT, it demands emergency treatment. Flare-ups can be attributed to multiple factors, including mechanical, chemical, and microbial causes. Identifying these factors beforehand and utilizing the expertise of clinicians can help better manage patients after the procedure and assure a long-term successful outcome. It has been observed that retreatment cases with periapical periodontitis treated in a single appointment have higher flare-up rates. Despite the prevalence and the impact of flare-ups, the endodontic community has yet to adopt scientifically validated and approved preventive measures to manage and prevent flare-ups. Hence, in this case report, the ethical letter was approved (TUCDREC/250923). It provides insight into the management of an interappointment flare-up with an overview.

The effect of antibiotic use on endodontic post-operative pain and flare-up rate: a systematic review with meta-analysis

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.

The Influence of Sodium Hypochlorite and Chlorhexidine on Postoperative Pain in Necrotic Teeth: A Systematic Review

Objective:

The purpose of this systematic review was to provide the answer to the question: Can sodium hypochlorite and chlorhexidine influence postoperative pain after the endodontic treatment in necrotic teeth?

Methods:

The PROSPERO registration number is CRD42018096433 and was conducted following the PRISMA statements. The MeSH and free terms were used to search for articles published in the electronic databases (PubMed, Web of Science, Scopus, Cochrane Library, and Virtual Health Library), in the gray literature, and by a manual search. The reviewers selected the studies considering predetermined eligibility criteria, performed data extraction, and evaluated the risk of bias. Only clinical trials comparing the effect of sodium hypochlorite and chlorhexidine on postoperative pain in teeth of adult patients with necrotic pulps were included.

Results:

Five studies were qualified for the systematic review. Two studies were considered a low risk of bias. The results showed no statistically significant difference regarding postoperative pain in the groups. Only 1 study reported a statistically significant difference in the sixth postoperative hour, and the pain was associated with the sodium hypochlorite group.

Conclusion:

There was no influence of auxiliary chemical substance (NaOCl and CHX) on postoperative pain used in endodontic treatment in the teeth with pulp necrosis. However, one study observed a significant difference in the sixth postoperative hour, associated with the sodium hypochlorite group.

Antibiotic abuse during endodontic treatment: A contributing factor to antibiotic resistance

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.

Role of Prophylactic Antibiotics in the Management of Postoperative Endodontic Pain

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.