Antibiotics for Simple Dental Pain?
Gottlieb M, Khishfe B. “Are antibiotics necessary for dental pain without overt infection.” Ann Emerg Med. 2017 Jan;69(1):128-130.
Dental pain is a common complaint seen in the emergency department and frequently results in prescriptions for antibiotics as well as analgesics. Is there any evidence that the addition of an antibiotic to pain medication in non-infected dental pain adds benefit?
Review of 2 small randomized controlled trials. The authors did a Pubmed search for studies that specifically looked at antibiotics in non-infected dental pain. They found two articles that addressed the question. The first was a double blind, placebo controlled RCT by Nagle et al. that looked at 40 patients with irreversible pulpitis that presented to an emergency dental clinic. Subjects got randomized to get either penicillin + analgesics (ibuprofen and acetaminophen/codeine) or placebo + analgesics. All patients had a follow up appointment 7 days after enrollment. The second study was another double blind, placebo controlled RCT by Runyon et al. that looked at 134 patients that presented to an emergency department with dental pain. They were evaluated for any sign of infection (fever, intra or extraoral swelling, purulence, trismus, pregnancy, immunocompromise, recent antibiotic use (<30d)). Patients were randomized to get either penicillin + analgesics (ibuprofen + hydrocodone/acetaminophen) or placebo + analgesics. Patients were followed up 5-7 days after enrollment.
The first study found no difference in pain scores or analgesic use between the two groups. The second study found no significant difference between the two groups in terms of development of infection (10% placebo vs. 9% penicillin), pain score (43.5 placebo vs. 42 penicillin) or use of analgesics.
Penicillin probably does not affect short term pain or risk of infection in dental pain patients without signs of infection.