Role of Prophylactic Antibiotics in the Management of Postoperative Endodontic Pain

Abstract

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.

Effect of Amoxicillin with Clavulanic Acid Antibiotic Premedication on Pre-Treatment and Post-Endodontic Pain in Teeth with Irreversible Pulpitis: A Randomized. Controlled Trial

“…The percentage of patients who needed 2 analgesic tablets in experimental group was 0% where in the control group the percentage was 23.81%, which revealed that the experimental group had less degree of pain than control group. These results coincided with the recent publication of the randomized controlled trial of similar methodological steps and outcomes detected by Alsomadi L and Al Habahbeh R [19] where they concluded that antibiotic premedication (amoxicillin and clavulanic acid) resulted in less number of analgesic tablets consumed in experimental group 24, 32, 40, and 48 hours post-treatment with less pain recorded on pain scale used. This concludes that amoxicillin with clavulanic acid premedication had an impact on degree of postoperative pain.…”

“…The major cause of pain is thought to be the release of inflammatory mediators that activates sensory nociceptors surrounding the tooth. The resultant stimulation of both central and peripheral mechanisms is referred to as hypergesia and defined as increase in magnitude of painful stimuli [5]. Given that the mechanisms involved are occurring at the periphery, an anti-inflammatory agent should be used to control pain.…”

Evaluation of post-obturation pain in single-visit endodontic treatment after pre-medication with oral anti-inflammatory and antibiotics. An in-vivo study

“…Hence, for day 7, the ascending order of pain was Group-3= Group-2= Group-1< Group-4. Alsomadi and Habahbeh (24) concluded that antibiotic pre-medication (amoxicillin and clavulanic acid) resulted in less number of analgesic tablets consumed in experimental group after 24, 32, 40, and 48 h post-treatment with less pain recorded on pain scale. He concluded that amoxicillin with clavulanic acid pre-medication had an impact on degree of post-operative pain.…”

Comparing the effect of Placebo and Prophylactic Antibiotics on asymptomatic Necrotic teeth.

“…This study and related trial suggest that it is not justified to prescribe antibiotics prophylactically in those conditions and it may also result in the possible undesirable side effects for the patient. 4,13,18 The dentist may face legal action for prescribing antibiotics for non-beneficial situation which places a patient at risk for any unwanted reaction of the drug. Particularly, in case of penicillin, which results in anaphylactic reactions, which resulted in a yearly morality of approximately 400 to 800 patients and also has a higher incidence of morbidity.…”

“…Mores and co-workers concluded that prophylactic antibiotics significantly reduced the flare-up. 13,14 Udoye found that antibiotics were less effective than analgesic in reducing inter appointment emergencies. 6 Walton and Chiappnelli concluded that post treatment symptoms of flare-up were not affected by prophylactic administration of antibiotics.…”