World Antibiotic Awareness week highlighted review: Antibiotic use for irreversible pulpitis

Cochrane UK's latest campaign,Tackling antibiotic resistance: evidence for responsible antibiotic use, coincides with World Antibiotic Awareness Week, 13-19 November 2017.

Throughout the week, they're sharing blogs and blogshots to shine a spotlight on Cochrane evidence which supports decision-making in the appropriate use of antibiotics.

This is an opportune moment for sharing Cochrane Oral Health's review on antibiotic use for severe toothache. Please share using the hashtag #AntibioticResistance 

Anirudha Agnihotry, Zbys Fedorowicz, Esther J van Zuuren, Allan G Farman, Jassim Hasan Al-Langawi

Plain language summary: Antibiotic use for severe toothache (irreversible pulpitis)

Review question
Are oral antibiotics effective and safe for treating pain in irreversible pulpitis (inflammation of the nerve inside the tooth/nerve damage)?

Irreversible pulpitis occurs where the dental pulp (tissue inside the tooth which contains the nerve) has been damaged beyond repair. It is characterised by intense pain (toothache), sufficient to wake someone up at night and is considered to be one of the most frequent reasons that patients attend for emergency dental care. Any tooth may be affected, it is not restricted to particular age groups, and it usually occurs as a direct result of dental decay, a cracked tooth or trauma and thus tends to occur more frequently in older patients.

The 'standard of care' for irreversible pulpitis - immediate removal of the pulp from the affected tooth - is now widely accepted and yet in certain parts of the world antibiotics continue to be prescribed.

Study characteristics 
The evidence on which this review is based was current as of 27 January 2016. One study involving 40 people with irreversible pulpitis (nerve damage) was included. There were two groups of 20 people, one group was treated with penicillin 500 mg, the other with placebo (no active ingredient) every six hours over a seven-day period. In addition, all of the participants received painkillers (ibuprofen and paracetamol (acetaminophen) combined with codeine).

Key results 
Antibiotics do not appear to significantly reduce toothache caused by irreversible pulpitis. Furthermore, there was no difference in the total number of ibuprofen or Tylenol tablets used over the study period between both groups. The administration of penicillin does not significantly reduce the pain perception, the percussion (tapping on the tooth) perception or the quantity of pain medication required by people with irreversible pulpitis. There was no reporting on adverse events or reactions.

Quality of the evidence 
This was a study with a small number of participants and the quality of the evidence for the different outcomes was rated as low. There is currently insufficient evidence to be able to decide if antibiotics help for this condition. This review highlights the need for more and better quality studies on the use of antibiotics for irreversible pulpitis.

Read the full review

Citation: Agnihotry A, Fedorowicz Z, van Zuuren EJ, Farman AG, Al-Langawi JH. Antibiotic use for irreversible pulpitis. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD004969. DOI: 10.1002/14651858.CD004969.pub4.