Endodontics
Effect of systemic penicillin on pain in untreated irreversible pulpitis*,**

https://doi.org/10.1067/moe.2000.109777Get rights and content

Abstract

Objective: The purpose of this prospective, randomized, double-blind study was to determine the effect of penicillin on pain in untreated teeth diagnosed with irreversible pulpitis. Study Design: Forty emergency patients participated, and each had a clinical diagnosis of an irreversible pulpitis. Patients randomly received a 7-day oral dose (28 capsules, 500 mg each, to be taken every 6 hours) of either penicillin or a placebo control in a double-blind manner. No endodontic treatment was performed. Each patient also received ibuprofen; acetaminophen with codeine (30 mg); and a 7-day diary to record pain, percussion pain, and number and type of pain medication taken. Results: The administration of penicillin did not significantly (P >.05) reduce pain, percussion pain, or the number of analgesic medications taken by patients with untreated irreversible pulpitis. The majority of patients with untreated irreversible pulpitis had significant pain and required analgesics to manage this pain. Conclusion: Penicillin should not be prescribed for untreated irreversible pulpitis because penicillin is ineffective for pain relief. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:636-40)

Section snippets

Patients and methods

Forty adult patients presenting for emergency treatment participated in this study. All patients were in good health as determined by a written health history and oral questioning. Subjects were not taking antibiotics and had not received them within 30 days before participation in the study. This study was approved by The Ohio State University Human Subjects Committee, and written consent was obtained from each patient.

Each patient included in this study had a tooth with a clinical diagnosis

Results

Each group consisted of 20 patients. The distribution of tooth type is found in Table I.

Table II shows the initial values of age, sex, weight, initial pain, and initial percussion pain for the 2 groups.

The pain ratings are summarized in Table III.The SPID between the penicillin and placebo groups was not statistically significant (Table IV, P =.776).As shown in Table III, 100% (40 of 40) of the subjects presented with moderate to severe pain ratings at the baseline. For both groups, the mean

Discussion

The administration of penicillin did not significantly (P >.05) reduce pain, percussion pain, or the number of analgesic medications taken by patients with untreated irreversible pulpitis. Although bacteria are important in the pathogenesis of irreversible pulpitis caused by caries, Massler and Pawlack1 and Torneck2 established that pulps of teeth with irreversible pulpitis and without a clinical pulpal exposure contained no demonstrable bacteria. Early stages of irreversible pulpitis represent

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Supported by research funding from the Endodontic Graduate Student Research Fund and the Steve Goldberg Memorial Fund, The Ohio State University.

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Reprint requests: Al Reader, DDS, MS, Graduate Endodontics, College of Dentistry, PO Box 182357, The Ohio State University, 305 W 12th Ave, Columbus, OH 43218-2357

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