Are antibiotics effective for endodontic pain? An evidence-based review

Antibiotics are frequently prescribed to aid in the treatment of endodontic pain. Over the past 25years, several surveys of general dentists and endodontists have been conducted that illustrate a persistent pattern of prescribing antibiotics in conjunction with endodontic treatment (1–5). However, despite concurrent advances in our understanding of the biology of inflammatory and infectious processes, and the increased awareness of the side-effects of antibiotics, most notably the emergence of resistant bacterial strains, there seems to be little change observed in the practice of prescribing antibiotics. This review focuses on the effects of antibiotic medications for reducing postendodontic symptoms, primarily pain. This paper is not intended to be a review of endodontic microbiology, and the general pharmacology of antibiotics. The reader is referred to a number of excellent recent reviews on this topic (6– 10). Rather, the clinical studies to be reviewed focus on the efficacy of antibiotics, mostly in conjunction with non-surgical endodontic treatment, for treating postoperative signs and symptoms of endodontic pathosis. Endodontic pain is the result of an inflammatory process, which is most commonly related to microbial irritation but which may also be related to mechanical or chemical factors. A variety of chemical mediators such as arachidonic acid metabolites, cytokines,