In the United Kingdom (UK), acute dental pain is a major problem affecting 9% of the adult population each year. Globally, the problem may be even more significant, with reports ranging from 12% to 24% annually. The most frequently encountered urgent dental condition is reported to be symptomatic irreversible pulpitis , contributing to up to one in three presentations. Furthermore, symptomatic irreversible pulpitis has been found to have the greatest impact on oral health-related quality of life (OHRQoL) and is the most painful of all urgent dental presentations.
Despite the prevalence of this condition and its significant impact on patients, there is no consensus on optimal emergency management. Two recent studies conducted in the United Kingdom investigated the treatment of symptomatic irreversible pulpitis and identified that 57% to 62% and 77% to 85% of physicians intended to perform an emergency pulpotomy or pulpectomy , respectively. Both approaches have been shown to be equally effective in reducing pain. In multirooted teeth, an “emergency” pulpotomy has been considered more appropriate and predictable than pulpectomy due to the challenges of complete pulp removal and root canal disinfection.
Guidelines have emphasized the need for an “enhanced” treatment protocol with magnification and strict asepsis. However, emergency pulpotomy is performed within the limitations of providing urgent dental care in primary dental care. Such refinement may not be achievable, particularly in systems such as the UK´s National Health Service (NHS), with an average duration of urgent dental care appointments of 20 minutes. The challenges of performing a definitive pulpotomy within the time constraints of an emergency appointment may be compounded by anesthetic difficulties, limited training of primary care physicians in case selection and treatment procedures, and access to materials and magnification. Therefore, a definitive pulpotomy in a single visit may be considered aspirational in many settings, reinforcing the need for effective approaches to emergency management in primary care.
This study investigated the effectiveness of antibiotic/corticosteroid (AAC) dressings in pain management in patients with symptomatic irreversible pulpitis after pulpotomy or pulpectomy in primary dental care.
Methodology
Eighty-three patients with symptomatic irreversible pulpitis who received pulpotomy or pulpectomy with or without AAC were recruited.
Preoperative data on pain, analgesic use, and impact on quality of life were collected.
Postoperative follow-up was performed for 7 days, recording pain, perceived improvement, medication use, and ability to work.
A binary composite score was created to evaluate treatment success based on several criteria.
Results
Overall treatment success was 57%, with 25% of patients requiring additional treatment due to persistent pain.
No significant differences in treatment success were found between the groups with and without AAC.
Patients who received antibiotics/corticosteroids (AAC) reported greater perceived improvement compared to those who did not receive it.
Conclusions
- Evidence on improved outcomes with the use of antibiotics/corticosteroids (AACs) in the management of symptomatic irreversible pulpitis is limited.
- More research is needed to determine whether these medications offer superior pain relief to simply removing inflamed pulp tissue.
Implications for dental practice
Pulpotomy and pulpectomy are effective treatments for symptomatic irreversible pulpitis, but do not always achieve complete pain relief.
The use of antibiotics/corticosteroids (AAC) may offer a perceived improvement in patient well-being, but does not appear to have a significant impact on pain, medication use, or the need for further treatment.
It is important to consider the risk of antibiotic resistance and environmental impact when using AAC.
Alternative pain management strategies should be explored in patients with symptomatic irreversible pulpitis.
- The study was conducted in primary dental care, which may increase the generalizability of the results.
- Additional research with a larger sample size is needed to confirm the findings.
- It is important to individualize treatment based on the needs of each patient.
In summary, this study suggests that the use of antibiotics/corticosteroids (AAC) in the management of symptomatic irreversible pulpitis may not be as beneficial as previously thought. Dentists should carefully consider the risks and benefits of this practice before prescribing it to their patients.
