DRUGS MANAGEMENT IN ENDONDONTIC THERAPY

KIM HOSPITALLA NGOC HOAI LONG, DDS

DRUGS

1. ANTIBIOTICS.2. ANAGESICS3. STEROIDS

1. ANTIBIOTICS

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.

Antibiotics Indications1. Systemic involvement ( Fever, Cellulitis, Lymphadenopathy)2. Medical compromised / Complex patient

Antibiotic are unnecessary for pain and localized swelling

Apical lesions of pulpal origin generated by

THE IMMUNE SYSTEMIn 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

ZONES OF FISH

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.

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 painArticle in Endodontic Topics 3(1):41 - 51 · November 2002

Analgesics decision making

650-1000mg Acetaminophen q6h

Acetaminophen with Codein q6h

Acetaminophen with Hydrocodone q6h

Acetaminophen with Oxyconden q6h

Mild

Severe

NSAIDS

Drug choice due to inflammatory etiology of dental pain

Contraindications for Pregnancy. Ulcers Kidney disease. Ulcerative colitis

ACETAMINOPHEN

Drug of choice when NSAIDs are contraindicated.

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 painMarshall, J. Gordon.

 Endodontic Topics, Volume 3, Number 1, November 2002, pp. 41-51(11)

When should I prescribe Steroids

600-800 mg Ibuprofen + 500mg Acetaminophen = Non-effective. Persistant pain lasts longer than normal Vital or Necrotic pulp

Contraindications for Steroid

Systemic Fungal Infection Immune Deficiency

How should it be prescribed/doses

48mg Methylprednisolone/ day for 3 days 10-12mg Dexamethasone/ day for 3 days.