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The use of medicaments in the management of symptomatic irreversible pulpitis: a community-based cohort study

Lookup NU author(s): David Edwards, Sabrina Rasaiah, Dr Simon StoneORCiD, Professor Justin DurhamORCiD, Professor John Whitworth



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Aim: To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom. Methodology: All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients’ numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For seven days post operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post-hoc Tukey’s multiple comparisons test for continuous data and chi-squared or Fisher´s exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: i. patients did not return for treatment due to pain by day seven; ii. at day three there was a 33% (or 2-points) reduction in NRS pain score; iii. there was a change score of +3 in global rating; iv. the patient was no-longer using analgesia and able to return to work. Results Eighty-five participants were recruited, with 83 completing follow-up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p=0.645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p=0.015). Conclusions: This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue. Funding This study was funded by the European Society of Endodontology Young Investigator Grant (2020). Conflict of interest None to declare.

Publication metadata

Author(s): Edwards D, Rasaiah S, Kirkevang L, Vaeth M, Stone S, Durham J, Whitworth J

Publication type: Article

Publication status: Published

Journal: International Endodontic Journal

Year: 2024

Volume: 57

Issue: 4

Pages: 416-430

Print publication date: 01/04/2024

Online publication date: 12/01/2024

Acceptance date: 02/01/2024

Date deposited: 12/01/2024

ISSN (print): 0143-2885

ISSN (electronic): 1365-2591

Publisher: Wiley-Blackwell Publishing Ltd


DOI: 10.1111/iej.14020


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Funder referenceFunder name
European Society of Endodontology Young Investigator Grant (2020)