Antibiotic use for irreversible pulpitis

  • Review
  • Intervention

Authors


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 minority of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.

Objectives

To provide reliable evidence regarding the effects of prescribing systemic antibiotics for irreversible pulpitis by comparing clinical outcomes expressed as pain relief.

Search methods

We searched the Cochrane Oral Health Group Trials Register (to 2nd February 2009); CENTRAL (The Cochrane Library 2009, Issue 1); MEDLINE (1966 to January 2009); and EMBASE (1980 to February 2009). There were no language restrictions.

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. Pooling of data was not possible and a descriptive summary is presented.

Main results

One trial involving 40 participants was included. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the 7-day study period. The between-group differences in sum pain intensity differences (SPID) for the penicillin group were (6.0±10.5), and for placebo (6.0±9.5) P = 0.776. The sum pain percussion intensity differences (SPPID) for the penicillin group were (3.5±7.5) and placebo (2.0±7.0) P = 0.290, with differences as assessed by the Mann-Whitney-Wilcoxon test considered to be statistically significant at P < 0.05. There was no significant difference in the mean total number of ibuprofen tablets (P = 0.839) and Tylenol tablets (P = 0.325), in either group over the study period. The administration of penicillin over placebo did not appear to significantly reduce the quantity of analgesic medication taken (P > 0.05) for irreversible pulpitis.

Authors' conclusions

This review which was based on one methodologically sound but low powered small sample trial provides some evidence that there is no significant difference in pain relief for patients with untreated irreversible pulpitis who did or did not receive antibiotics in addition to analgesics.

摘要

背景

不可逆牙髓炎之抗生素使用

不可逆牙髓炎伴隨著急性,且強烈的疼痛.是患者尋求牙科緊急治療最常見的原因.除了拔除牙齒之外,最常用來解除疼痛的方式為牙齒鑽孔後,清除發炎的牙髓(神經),並清潔根管.然而,有少數牙醫師仍利用給予抗生素來解除因不可逆牙髓炎所引起的疼痛.

目標

本篇回顧的目標是給予系統性抗生素解除因不可逆牙髓炎所引起之疼痛,並藉由比較其臨床功效,以提供一個可信賴的證據。

搜尋策略

我們搜尋了一下的資料庫: Cochrane Oral Health Group Trials Register and Pain, Palliative Care and Supportive (PaPaS) Care Group Trials Register 至 2004年9月6號; the Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library Issue 3 2004; MEDLINE (1966年至2004年9月6號); EMBASE (1980年至2004年第36周).

選擇標準

本篇回顧包含了一篇隨機對照試驗(randomised controlled trial),其比較了利用抗生素與止痛藥,安慰劑與止痛藥來解除因不可逆牙髓炎引起之急性疼痛.

資料收集與分析

在此回顧的文獻中, 因為只收納了一篇試驗, 所以不可能蒐集眾多研究之資料, 且已呈現一個描述性的結論。

主要結論

有一篇包含四十個參與者的試驗被收錄. 在長達七天的實驗裡面,在實驗組與安慰劑組別裡面對於疼痛評分有非常相近的程度.在Sum pain intensity differences (SPID)之組間差距在penicillin 組為(6.0&plusmn;10.5), 在安慰劑組為(6.0&plusmn;9.5) P值為0.776. 在sum pain percussion intensity differences (SPPID), penicillin group 為(3.5&plusmn;7.5),在安慰劑組為(2.0&plusmn;7.0) P值0.290.差異的評估使用MannWhitneyWilcoxon test, P值小於0.05 被認為有統計上顯著差異. 在總量上ibuprofen 藥片(p = 0.839)以及Tylenol 藥片(P = 0.325) 在實驗過程當中並無顯注之差異.在不可逆牙髓炎, penicillin的使用比較起安慰劑,對於減少止痛藥的使用上(P>0.05)並無顯著的降低.

作者結論

此篇回顧在方法邏輯上是完整的,但是對於未治療之不可逆牙髓炎在接受或不接受抗生素治療以至於進一步的止痛藥使用上,樣本數較不具有足夠能力來提供證明是否有顯著的差異.

翻譯人

本摘要由臺灣大學附設醫院王偉全翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

抗生素似乎對於不可逆牙髓炎引起之疼痛無顯著效果. 不可逆牙髓炎,發生原因為牙髓(神經)已遭受可修復程度以上之破壞,且特徵為劇烈的疼痛,被認為是一種患者來尋求緊急牙科治療最常見的原因.此篇回顧,包含了一個試驗(40位參與者),提供了少量證據,對於penicillin的服用並無法明顯降低不可逆牙髓炎引起的疼痛感,敲痛感,以及患者對於止痛藥的需求.

Plain language summary

Antibiotic use for irreversible pulpitis

Antibiotics do not appear to significantly reduce toothache caused by irreversible pulpitis.
Irreversible pulpitis, where the dental pulp (nerve) has been damaged beyond repair is characterised by intense pain and considered to be one of the most frequent reasons that patients attend for emergency dental care.
This review, which included one trial (40 participants), found that there is a small amount of evidence to suggest that the administration of penicillin does not significantly reduce the pain perception, the percussion perception or the quantity of pain medication required by patients with irreversible pulpitis.

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