Abstract
Question: Does systemic penicillin improve pain control in people who have irreversible pulpitis?
Objective To determine the effect of penicillin on pain in untreated teeth diagnosed as having irreversible pulpitis.
Design Double-blind randomised controlled trial.
Intervention Forty emergency patients who had a clinical diagnosis of an irreversible pulpitis randomly received a 7-day oral dose (500 mg every 6 h) of either penicillin or placebo in a double-blind manner. No endodontic treatment was performed until 7 days later. Each patient also received ibuprofen and acetaminophen with codeine (30 mg). All patients completed the trial (0% drop-out). Patients were advised to use acetaminophen with codeine only if ibuprofen did not relieve pain.
Outcome measures Patient-assessed pain, percussion pain, and number and type of pain medication taken. At 7 days teeth were pulp-tested and the presence or absence of vital tissue confirmed by clinicians on endodontic access.
Results Penicillin did not significantly (P>0.05) reduce pain, percussion pain or the number of analgesics taken by patients who had untreated irreversible pulpitis. The majority of patients with untreated irreversible pulpitis had significant pain and required analgesics to manage this pain. Three quarters of the teeth tested in the penicillin group, and 80% of the teeth tested in placebo group, were vital. None of the teeth was cariously exposed clinically.
Conclusions Penicillin should not be prescribed for untreated irreversible pulpitis because penicillin is ineffective for pain relief. Many teeth with untreated irreversible pulpitis remain symptomatic for at least a week.
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Oguntebi, BR, Deschepper, EJ, Taylor, TS, White, CL and Pink, FE Postoperative pain incidence related to the type of emergency treatment of symptomatic pulpitis. Oral Surg Oral Med Oral Pathol 1992) 73: 479–843.
Fouad, AF, Rivera, EM and Walton, RE Penicillin as a supplement in resolving the localized acute apical abscess. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996) 81: 590–595.
Haldi, J and John, K Sulfanilamide penicillin in the pulp fluid of the dog following administration of these compounds. J Dent Res 1965) 44: 1386–1388.
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Address for reprints: Al Reader, Graduate Endodontics College of Dentistry, PO Box 182357, Ohio State University, 305W 12th Avenue, Columbus OH 43218-2337, USA.
Nagle D, Reader A, Beck M, Weaver J. Effect of systemic penicillin on pain in untreated irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90:636–640
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Lumley, P. Penicillin does not provide effective pain relief for untreated irreversible pulpitis. Evid Based Dent 3, 72 (2002). https://doi.org/10.1038/sj.ebd.6400114
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DOI: https://doi.org/10.1038/sj.ebd.6400114