Title Antibiotics Are An Ineffective Treatment For Preoperative Pain Relief
Clinical Question In patients experiencing spontaneous moderate to severe pain from irreversible pulpitis, does the administration of penicillin reduce patient discomfort pre-operatively compared to no penicillin administration?
Clinical Bottom Line Penicillin is not an effective treatment for preoperative pain relief. In a randomized control trial, 40 patients were separated into two groups of twenty. One received penicillin and the other received a placebo. Pain measures were recorded across seven days and no significant difference was found between the two groups.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
11077389Nagle/2000Patients with moderate to severe pain (n=40)Randomized Control Trial
Key resultsThe authors found that penicillin is ineffective at reducing preoperative pain in patients suffering from moderate to severe levels of pain due to irreversible pulpitis. The subjects were separated into two groups (n=20) and were either given penicillin or a placebo with instructions to take 500 mg four times a day. Additionally, they were given traditional pain medication (ibuprofen and acetaminophen with codeine) if further pain relief was needed. Pain measures along with the number and type of traditional pain medications taken were recorded daily for 7 days. There was no statistical difference in either the pain measures or the amount of analgesics taken between the penicillin and placebo groups.
Evidence Search “Penicillin” AND “Pain” AND “Pulpitis” limits: RTC
Comments on
The Evidence
This study was a randomized, double-blind, control trial.
Applicability This applies to all dentists who are considering treating patients with irreversible pulpitis with antibiotics in an effort to reduce pain.
Specialty (Endodontics) (General Dentistry)
Keywords Antibiotics, Analgesic, Pain, Pulpitis
ID# 2244
Date of submission 04/12/2012
E-mail rowansk@livemail.uthscsa.edu
Author Spencer Rowan
Co-author(s) e-mail
Faculty mentor Kenneth M. Hargreaves, DDS, PhD
Faculty mentor e-mail Hargreaves@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
by JeffTaylor, Madeline Hart (San Antonio, TX) on 11/28/2017
A PubMed database search in November 2017, Hoskin et al. 2016 (PMID: 22767119) and Agnihotry et al.2016 (PMID: 26886473). Both are systematic reviews and report no statistical significance in efficacy over time of post- operative healing in analgesics with placebo to analgesics with antibiotics. All of the studies cited; those in the original evidence and the more recent, utilized Ibuprofen uptake as the determining variable for increased or decreased pain. Both SR were considered to have low bias and due to the limited number of patients included overall, recommend more RCT, low bias studies for further investigation.