Clinical guideline for drugs management in endodontic therapy

1. DRUGS MANAGEMENT IN
ENDONDONTIC THERAPY
KIM HOSPITAL
LA NGOC HOAI LONG, DDS

2. DRUGS
1. ANTIBIOTICS.
2. ANAGESICS
3. STEROIDS

3. 1. ANTIBIOTICS

4. Antibiotics are not effective for teeth with
Irreversible Pulpitis
 ANTIBIOTIC do not reduce pain
A Cochrane systematic review finds no evidence to
support the use of antibiotics for pain relief in
irreversible pulpitis.
Keenan JV1, Farman AG, Fedorowicz Z, Newton JT.

5. Antibiotics Indications
1. Systemic involvement ( Fever, Cellulitis,
Lymphadenopathy)
2. Medical compromised /
Complex patient
Antibiotic are unnecessary for pain and localized swelling

6. Apical lesions of pulpal origin generated
by
THE IMMUNE SYSTEM
In most situations, this inflammatory process successfully eliminates bacteria emerging from the apical foramen
and prevents their spread to the periapical tissue.
AAE collegues for Excellence Winter 2002

7. ZONES OF FISH

10. Antibiotic Decision Making.
 First choice: Penicillin 500mg qid
If no respond in 72 hours then use
• Clindamycin 300mg qid
• Add Metronidazole 500mg qid
• Penicillin + Betalactamase ( Augmentin 625 mg tid)
 If patient is allergy to penicillin
 First drug of choice: Clindamycin 300mg qid
 If no respond in 72 hours then use
 Azithromycin 250mg qi
NOTE: Prescribe at least for 5-7 days to prevent antibiotic resistance.

11. 2. Analgesics
 The pain relief afforded by endodontic treatment is effective but rarely immediate
and compete.
 Post treatment pain is usually mild in nature rarely lasts longer than 72h and
usually well managed with NSAIDs agent or Acetaminophen.
 Up to 80% patients report preoperative pain, continute to experience some level of
pain following endodontic procedure.
Consideration of steroid for endodontic pain
Article in Endodontic Topics 3(1):41 - 51 · November 2002

12. Analgesics decision making
650-1000mg Acetaminophen q6h
Acetaminophen with Codein q6h
Acetaminophen with Hydrocodone q6h
Acetaminophen with Oxyconden q6h
Mild
Severe

13. NSAIDS
 Drug choice due to inflammatory etiology of
dental pain
 Contraindications for
 Pregnancy.
 Ulcers
 Kidney disease.
 Ulcerative colitis

15. ACETAMINOPHEN
 Drug of choice when NSAIDs are contraindicated.

16. STEROID
 Steroid have widespread on many organs system but these effects are typical only
seen at supra-physiological doses given over long-time period.
Normally over 2 weeks.
Consideration of steroids for endodontic pain
Marshall, J. Gordon.
Endodontic Topics, Volume 3, Number 1, November 2002, pp. 41-51(11)

17. When should I prescribe Steroids
 600-800 mg Ibuprofen + 500mg Acetaminophen = Non-effective.
 Persistant pain lasts longer than normal
 Vital or Necrotic pulp

18. Contraindications for Steroid
 Systemic Fungal Infection
 Immune Deficiency

19. How should it be prescribed/doses
 48mg Methylprednisolone/ day for 3 days
 10-12mg Dexamethasone/ day for 3 days.