Antibiotic use for severe toothache

Antibiotics - irreIrreversible pulpitis occurs where the tissue inside the tooth which contains the nerve (tooth pulp) has been damaged beyond repair. It is characterised by severe toothache, and is one of the main reasons for emergency dental care. Any tooth can be affected, and it usually occurs because of dental decay, a cracked tooth or trauma to the tooth. The standard care is to remove the pulp from the affected tooth, however in some parts of the world antibiotics continue to be prescribed.

What was the research?

A systematic review of the evidence to find out whether oral antibiotics are effective and safe for treating pain in irreversible pulpitis.

Who conducted the research?

The research was conducted by a team led by Zbys Fedorowicz of the Cochrane Collaboration’s Bahrain Branch, on behalf of the Cochrane Oral Health Group. Esther J van Zuuren, Allan G Farman, Anirudha Agnihotry and Jassim Hasan Al-Langawi were also on the team.

What evidence was included in the review?

Data was extracted from one randomised controlled trial. A total of 40 people participated in the trial, and were randomly assigned to penicillin or a placebo. In addition, all of the participants received painkillers.

What did the evidence say?

The only study eligible for inclusion showed that antibiotics did not appear to significantly reduce toothache caused by irreversible pulpitis. Furthermore, there was no difference in the amount of painkillers used by the two groups.

How good was the evidence?

This was a study with a small number of participants and the quality of the evidence was rated as low.

What are the implications for dentists and the general public?

There is insufficient evidence to determine whether antibiotics reduce pain for dental patients with irreversible pulpitis. This review found that the prescribing of antibiotics should not be seen as a substitute for the standard care option of immediate removal of the dental pulp.

What should researchers look at in the future?

As only one randomized controlled trial was found that was suitable for inclusion, more may be needed. However, due to concerns over antibiotic resistance, it may be more appropriate for future trials to concentrate on pain control.


Fedorowicz Z, van Zuuren EJ, Farman AG, Agnihotry A, Al-Langawi JH. Antibiotic use for irreversible pulpitis. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD004969. DOI: 10.1002/14651858.CD004969.pub3.

2 thoughts on “Antibiotic use for severe toothache

  1. Depending on the severity of your infection, antibiotics might be used in tandem with pulp removal to ensure the infection doesn’t spread to the jaw bone.

    • This review did not address the situation when people have severe infections, and it was not intended to do so. It was looking at standard care, and whether there was a case for antibiotics to be prescribed as part of that. The review found no evidence to suggest this was effective in significantly reducing toothache. Due to the problem of antibiotic resistance, prescription of antibiotics as a substitute for pulpectomy cannot be recommended on the basis of this review.

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