Pain in children’s milk teeth caused by extensive decay: we examine the best ways to treat the dental pulp

Tooth decay is one of the most common diseases in children. Tooth decay in the primary or milk teeth tends to progress rapidly, and it often reaches the pulp. Dental pulp consists of nerves, tiny blood vessels and connective tissue that make up the centre of a tooth. Symptoms of this extensive tooth decay include pain, swelling and abnormal tooth movement.

Dentists often have to perform one of three pulp treatment techniques to resolve the problem:

  1. Direct pulp capping: where a healing agent is placed directly over the exposed pulp. The most common materials used for direct pulp capping are calcium hydroxide, mineral trioxide aggregate, formocresol or an adhesive resin, placed directly over the tooth’s nerve.
  2. Pulpotomy: removal of a portion of the pulp. After a pulpotomy, one of four materials is generally used to fill the cavity: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate.
  3. Pulpectomy: removal of all of the pulp in the pulp chamber and root canal of a tooth. After a pulpectomy, a material is put into the space created by pulp removal.

This review looks at the three techniques, and the effectiveness of different materials (known as medicaments) for pulp capping, pulpotomy and pulpectomy. Continue reading

Do the drugs work? Cochrane evidence on antibiotics in dentistry

799px-Medication_amoxycillin_capsule13-17 November is World Antibiotic Awareness Week. The World Health Organization (WHO) has said that antibiotic resistance is:  “one of the biggest threats to global health, food security, and development today”. Antibiotics are used to prevent and treat bacterial infections, but if over-used they can cause bacteria to change and become resistant. This makes infections more difficult to treat, and results in longer hospital stays, higher medical costs and increased mortality (World Health Organization, 2017).

Antibiotics are still commonly used in dentistry, Cope et al (2014) estimate that 8-10% of antibiotics used in primary care are prescribed by dentists in some parts of the world. Their effectiveness has been explored by several Cochrane Oral Health reviews over the years, looking at some of the scenarios where they might be prescribed. Today we have a look back over the evidence… Continue reading

Antibiotic use for severe toothache


799px-Medication_amoxycillin_capsuleIrreversible pulpitis occurs where the dental pulp (tissue inside the tooth which contains the nerve) has been damaged beyond repair. It is characterised by intense pain (toothache), sufficient to wake someone up at night and is considered to be one of the most frequent reasons that patients attend for emergency dental care. Any tooth may be affected, it is not restricted to particular age groups, and it usually occurs as a direct result of dental decay, a cracked tooth or trauma and thus tends to occur more frequently in older patients. The ‘standard of care’ for irreversible pulpitis – immediate removal of the pulp from the affected tooth – is now widely accepted and yet in certain parts of the world antibiotics continue to be prescribed. Continue reading

Should antibiotics be prescribed for toothache caused by infection of the tooth root?


Photo copyright The Global Panorama, under Creative Commons Licence

Dental pain is a common problem and can be caused when the nerve in the tooth dies due to tooth decay or trauma. The tissue around the end of the tooth root then becomes inflamed and this can lead to pain which gets worse on biting. Without treatment, bacteria can infect the dead tooth and cause a dental abscess, which can lead to swelling and infection, and could be life-threatening. The recommended treatment of this form of toothache is the removal of the dead nerve from the tooth and the associated bacteria. This is usually done by dental extraction or root canal treatment. Oral antibiotics are often also prescribed routinely by some dentists, but concerns about antibiotic resistance are growing. Research is needed to demonstrate whether there is evidence that prescribing antibiotics in these circumstances reduces infection. Continue reading

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. Continue reading