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Journal of the American Dental... Dec 2019Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is... (Meta-Analysis)
Meta-Analysis
Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: Systematic review and meta-analysis-a report of the American Dental Association.
BACKGROUND
Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use.
TYPE OF STUDIES REVIEWED
The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.
RESULTS
The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence).
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.
Topics: Abscess; Adult; American Dental Association; Anti-Bacterial Agents; Humans; Periapical Periodontitis; Pulpitis; Randomized Controlled Trials as Topic; United States
PubMed: 31761029
DOI: 10.1016/j.adaj.2019.09.011 -
Journal of the American Dental... Nov 2019An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and...
Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association.
BACKGROUND
An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults.
TYPES OF STUDIES REVIEWED
The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework.
RESULTS
The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high.
CONCLUSION AND PRACTICAL IMPLICATIONS
Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.
Topics: Adult; American Dental Association; Anti-Bacterial Agents; Evidence-Based Dentistry; Humans; Periapical Abscess; Toothache
PubMed: 31668170
DOI: 10.1016/j.adaj.2019.08.020 -
International Endodontic Journal Oct 2023The diagnosis of the status of the inflamed pulp is essential in clinical diagnosis and treatment provision. There are a limited number of well-designed and... (Review)
Review
BACKGROUND
The diagnosis of the status of the inflamed pulp is essential in clinical diagnosis and treatment provision. There are a limited number of well-designed and well-executed clinical trials on the diagnosis of the true status of the pulp.
OBJECTIVES
Three PICO questions were formulated and agreed a priori by the European Society of Endodontology to evaluate the clinical tests for sensibility testing, determination of biomarkers and pulp bleeding with regard to their suitability to correctly diagnose the condition of the pulp tissue for the development of S3-Level guidelines.
METHODS
A literature search was conducted using PubMed, Clarivate Analytics' Web of Science, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials from inception to 21 January 2022. Additionally, a hand search was performed, and the contents of the major subject journals were also examined. Eligibility criteria followed the proposed PICO questions. Two independent reviewers were involved in study selection, data extraction and appraising the included studies; disagreements were resolved by a third reviewer. The risk of bias was assessed by the QUADAS-2 tool for diagnostic accuracy studies, the Newcastle-Ottawa scale for noncomparative, nonrandomized studies and the Newcastle-Ottawa Quality Assessment scale adapted for cross-sectional studies.
RESULTS
In total, 28 studies out of 29 publications were considered eligible and were included in the review. Twelve studies were identified to investigate the diagnostic accuracy of the pulp vitality. Ten studies fulfilled the criteria to evaluate the diagnostic accuracy of the pulpal conditions, while 6 studies investigating the expression of biomarkers were eligible. Three studies addressing the prognostic factors and therapeutic interventions relating to pulpal status were included.
DISCUSSION
The core problem in pulp diagnostics is that a reliable reference standard is lacking under clinical conditions. Based on limited evidence, the most promising current approach seems to define a combination of different clinical tests and symptoms, probably in future including molecular diagnosis ("diagnostic package") will be required to ascertain the best possible strategy to clinically diagnose true pulpal conditions.
CONCLUSIONS
The effectiveness of diagnosing pulpitis is low due to limited scientific evidence regarding the accuracy and reproducibility of diagnostic tests. There is a lack of evidence to determine the true status of the pulp or to identify prognostic indicators allowing for a reliable pre-operative estimation of the outcome of vital pulp treatment.
REGISTRATION
PROSPERO database (CRD42021265366).
Topics: Humans; Pulpitis; Cross-Sectional Studies; Reproducibility of Results; Dental Pulp; Dental Pulp Diseases; Biomarkers
PubMed: 35536159
DOI: 10.1111/iej.13762 -
Journal of Education and Health... 2023Medicinal plants and herbal drugs are being used increasingly as part of primary health care in most parts of the world. As important adjunctive and alternative... (Review)
Review
Medicinal plants and herbal drugs are being used increasingly as part of primary health care in most parts of the world. As important adjunctive and alternative treatments for oral health care, herbal products' use may continue to increase and become more widespread. The objective of this study is to present a comprehensive systematic review of the current published literature on the effectiveness of medicinal plants and herbal products employed to improve oral health in adolescents with a health promotion approach. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The keywords "herbal medicine," "herbal extract," "herbal supplements," "plant extract," "natural drug," "pulpitis," "dental caries," "oral viral diseases," and "abscess" were used in combination with the Boolean operators OR and AND. PubMed, Embase, Scopus, and Web of Science were searched. Quality assessment of the included studies was performed using the Cochrane Handbook for Systematic Reviews of Interventions. The search yielded 49 original research studies. A total of 22 studies had low or unclear risk bias. The geographical distribution of included studies was primarily concentrated on western countries. Overall, studies reported herbal product users' age, ranging from young adults aged 18 years to elderly people aged 75 years or older. Most studies reported multiple compounds, including herbal drugs and herbal extracts. Chamomile and Aloe vera were the most frequently reported herbal compounds. The most commonly described herbal products to treat oral diseases were gels, mouth rinses, and pastes. The studies included a range of people with oral diseases, including periodontal and gingival diseases, recurrent aphthous stomatitis, oral lichen planus, and oral candidiasis. Herbal product interventions were found to be effective and safe alternatives for oral health care. One of the most important goals of the World Health Organization (until 2015) is the oral health index, so it is important that dental services be followed up more seriously. Considering the problems in reaching this goal of the World Health Organization in our country, herbal products have the ability to improve clinical oral health outcomes in adolescents. Limited adverse side effects indicate the overall safety of these treatments for a wide range of oral diseases. Therefore, the use of medicinal plants as well as alternative medicine is one of the useful methods in achieving this important goal of public health.
PubMed: 38023092
DOI: 10.4103/jehp.jehp_1297_22 -
Journal of Endodontics May 2021Proresolving lipid mediators are specialized molecules (SPMs) involved in the active resolution of the inflammatory process by regulating tissue homeostasis. The aim of... (Review)
Review
INTRODUCTION
Proresolving lipid mediators are specialized molecules (SPMs) involved in the active resolution of the inflammatory process by regulating tissue homeostasis. The aim of this study was to investigate the scientific literature to assess the potential of SPMs as an adjunct in the treatment of endodontic infection.
METHODS
Three electronic databases (PubMed, Web of Science, and Scopus) were searched from their inception until February 2020 (PROSPERO CRD42020164743). Supplemental research was performed by screening the references of the relevant studies eligible for inclusion. A quality assessment of animal studies was performed using the Animal Research: Reporting of In Vivo Experiments guidelines, whereas the Systematic Review Centre for Laboratory animal Experimentation Risk of Bias tool was used to assess the risk of bias.
RESULTS
A total of 3295 records were screened, and 8 articles meeting the criteria were included for this qualitative review. The eligible studies showed a high to moderate overall quality and a low to moderate risk of bias. SPMs positively affected the development of pulpitis and apical periodontitis in experimental animal models. The early treatment of pulpitis with the topical application of SPMs was beneficial to control inflammation within 24 hours from contamination. In addition, SPMs delivered within the root canals after disinfection were found effective in promoting periapical healing.
CONCLUSIONS
Our findings suggest that SPMs may play a role in the inception and treatment of pulpal-periapical diseases, and they should be considered for future research for developing new therapeutics as an adjunct to endodontic treatment.
Topics: Animals; Dental Care; Endodontics; Humans; Inflammation; Periapical Periodontitis; Pulpitis
PubMed: 33548330
DOI: 10.1016/j.joen.2021.01.008 -
International Endodontic Journal Oct 2023Inflammatory biomarkers are potentially useful targets for pulpal diagnostic tests that can identify pulp status and predict vital pulp treatment (VPT) outcome, however,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Inflammatory biomarkers are potentially useful targets for pulpal diagnostic tests that can identify pulp status and predict vital pulp treatment (VPT) outcome, however, their accuracy is unknown.
OBJECTIVES
(1) Calculate sensitivity, specificity and diagnostic odds ratio (DOR) of previously investigated pulpitic biomarkers; (2) Determine if biomarker levels discriminate between clinical diagnoses of pulpitis based on the presence or absence of spontaneous pain (3) Evaluate if biomarker level can predict VPT outcome.
METHODS
Searches: PubMed/MEDLINE, Ovid SP, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Embase, Web of Science and Scopus in May 2023.
INCLUSION
prospective and retrospective observational studies and randomized trials. Participants were humans with vital permanent teeth and a well-defined pulpal diagnosis.
EXCLUSION
deciduous teeth, in vitro and animal studies. Risk of bias was assessed with modified-Downs and Black quality assessment checklist. Meta-analysis was performed using bivariate random effect model in Meta-DiSc 2.0 and RevMan and the quality of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.
RESULTS
Fifty-six studies were selected, reporting >70 individual biomolecules investigating pulpal health and disease at the gene and protein level. Most studies were of low and fair quality. Among the biomolecules investigated, IL-8 and IL-6 demonstrated a level of diagnostic accuracy with high sensitivity, specificity and DOR to discriminate between healthy pulps and those exhibiting spontaneous pain suggestive of IRP (low-certainty evidence). However, none was shown to have high DOR and the ability to discriminate between pulpitic states (very low certainty evidence). Limited data suggests high levels of matrix metalloproteinase 9 correlate with poorer outcomes of full pulpotomy.
DISCUSSION
The inability of identified molecular inflammatory markers to discriminate between dental pulps with spontaneous and non-spontaneous pain should shift the focus to improved study quality or the pursuit of other molecules potentially associated with healing and repair.
CONCLUSIONS
Low-quality evidence suggests IL-8 and IL-6 demonstrated level of diagnostic accuracy to discriminate between healthy pulps and those exhibiting spontaneous pain. There is a need for standardized biomarker diagnostic and prognostic studies focusing on solutions that can accurately determine the degree of pulp inflammation.
REGISTRATION
PROSPERO CRD42021259305.
Topics: Humans; Pulpitis; Interleukin-6; Prospective Studies; Interleukin-8; Retrospective Studies; Biomarkers; Pain
PubMed: 37392154
DOI: 10.1111/iej.13950 -
The Journal of Evidence-based Dental... Dec 2022To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth with deep caries lesions, does the use of resin-modified calcium silicate-containing composites improve the radiological success and prevent irreversible pulpitis and pulpal necrosis compared with other pulp-capping agents?
MATERIALS AND METHODS
The following databases were screened until September 2021: PubMed, Web of Science, Scielo, Scopus, Embase, and The Cochrane Library. Randomized clinical trials reporting the clinical evaluation of a resin-modified calcium silicate material as an agent for pulp therapy were included. Meta-analysis was performed using the Rev Manager v5.4.1 software. The risk difference and 95% confidence interval of the dichotomous outcome (restoration failure or success) were calculated for comparison.
RESULTS
Ten studies were considered for qualitative analysis and meta-analysis. Studies evaluating the performance of light-cured calcium silicate-based cement from 1 month to a maximum follow-up period of 36 months and comparing it with the performance of CaOH, mineral trioxide aggregate, or Biodentine were included. In the global analysis for direct pulp capping at 6-month follow-up, no statistical differences were observed between the experimental group using the light-cured calcium silicate-based cement and control group (P = .28). However, at 12-month follow-up, global analysis favored the control group (P < .001). For indirect pulp capping, at 6- and 24-month follow-ups, no statistically significant differences were observed between the experimental and control groups (P = .88; P = .21).
CONCLUSIONS
Light-cured calcium silicate-based cement showed a limited clinical performance as a direct pulp capping agent, especially when evaluated in the long term. However, using it as an indirect pulp capping agent may be a reliable and easy-to-use option for restoring teeth with deep caries.
CLINICAL SIGNIFICANCE
This systematic review provides evidence that supports the use of light-cured calcium silicate-based cement as an indirect pulp capping agent.
Topics: Humans; Pulp Capping and Pulpectomy Agents; Dental Pulp Capping; Silicate Cement; Glass Ionomer Cements; Dental Cements; Composite Resins
PubMed: 36494107
DOI: 10.1016/j.jebdp.2022.101776 -
Journal of the American Dental... Jan 2023Local anesthesia is essential for pain control in dentistry. The authors assessed the comparative effect of local anesthetics on acute dental pain after tooth extraction... (Review)
Review
BACKGROUND
Local anesthesia is essential for pain control in dentistry. The authors assessed the comparative effect of local anesthetics on acute dental pain after tooth extraction and in patients with symptomatic irreversible pulpitis.
TYPES OF STUDIES REVIEWED
The authors searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the US Clinical Trials registry through November 21, 2020. The authors included randomized controlled trials (RCTs) comparing long- vs short-acting injectable anesthetics to reduce pain after tooth extraction (systematic review 1) and evaluated the effect of topical anesthetics in patients with symptomatic pulpitis (systematic review 2). Pairs of reviewers screened articles, abstracted data, and assessed risk of bias using a modified version of the Cochrane risk of bias 2.0 tool. The authors assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Fourteen RCTs comparing long- vs short-acting local anesthetics suggest that bupivacaine may decrease the use of rescue analgesia and may not result in additional adverse effects (low certainty evidence). Bupivacaine probably reduces the amount of analgesic consumption compared with lidocaine with epinephrine (mean difference, -1.91 doses; 95% CI, -3.35 to -0.46; moderate certainty) and mepivacaine (mean difference, -1.58 doses; 95% CI, -2.21 to -0.95; moderate certainty). Five RCTs suggest that both benzocaine 10% and 20% may increase the number of people experiencing pain reduction compared with placebo when managing acute irreversible pulpitis (low certainty).
PRACTICAL IMPLICATIONS
Bupivacaine may be superior to lidocaine with epinephrine and mepivacaine with regard to time to and amount of analgesic consumption. Benzocaine may be superior to placebo in reducing pain for 20 through 30 minutes after application.
Topics: Humans; Acute Pain; Anesthesia, Local; Anesthetics, Local; Benzocaine; Bupivacaine; Epinephrine; Lidocaine; Mepivacaine; Pulpitis
PubMed: 36608963
DOI: 10.1016/j.adaj.2022.10.014 -
Journal of the American Dental... May 2023The authors assessed the clinical effectiveness of analgesics to manage acute pain after dental extractions and pain associated with irreversible pulpitis in children. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The authors assessed the clinical effectiveness of analgesics to manage acute pain after dental extractions and pain associated with irreversible pulpitis in children.
TYPES OF STUDIES REVIEWED
The authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US Clinical Trials registry from inception through November 2020. They included randomized controlled trials comparing any pharmacologic interventions with each other and a placebo in pediatric participants undergoing dental extractions or experiencing irreversible pulpitis. After duplicate screening and data abstraction, the authors conducted random-effects meta-analyses. They assessed risk of bias using the Cochrane Risk of Bias 2.0 tool and certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
The authors included 6 randomized controlled trials reporting 8 comparisons. Ibuprofen may reduce pain intensity compared with acetaminophen (mean difference [MD], 0.27 points; 95% CI, -0.13 to 0.68; low certainty) and a placebo (MD, -0.19 points; 95% CI, -0.58 to 0.21; low certainty). Acetaminophen may reduce pain intensity compared with a placebo (MD, -0.13 points; 95% CI, -0.52 to 0.26; low certainty). Acetaminophen and ibuprofen combined probably reduce pain intensity compared with acetaminophen alone (MD, -0.75 points; 95% CI, -1.22 to -0.27; moderate certainty) and ibuprofen alone (MD, -0.01 points; 95% CI, -0.53 to 0.51; moderate certainty). There was very low certainty evidence regarding adverse effects.
PRACTICAL IMPLICATIONS
Several pharmacologic interventions alone or in combination may provide a beneficial effect when managing acute dental pain in children. There is a paucity of evidence regarding the use of analgesics to manage irreversible pulpitis.
Topics: Child; Humans; Acetaminophen; Ibuprofen; Analgesics, Non-Narcotic; Acute Pain; Pulpitis; Analgesics
PubMed: 37105668
DOI: 10.1016/j.adaj.2023.02.013 -
Journal of Clinical and Experimental... Jul 2022This review and meta-analysis investigates the outcome of direct pulp capping in teeth diagnosed as irreversible pulpitis. (Review)
Review
BACKGROUND
This review and meta-analysis investigates the outcome of direct pulp capping in teeth diagnosed as irreversible pulpitis.
MATERIAL AND METHODS
This systematic review includes experimental and descriptive clinical studies according to the PRISMA criteria, using PubMed and Scopus as database. We have included studies that performed direct pulp capping on human permanent teeth previously diagnosed with irreversible pulpitis and that carried out a subsequent follow-up. The outcome of interest was the clinical success of direct pulp capping.
RESULTS
A total of four studies met the inclusion criteria for this review, however only three of these could be included in the meta-analysis. These three studies represent a total sample of 62 teeth with irreversible pulpitis treated with direct pulp capping that showed an overall success rate of 0.953 (CI=0.900-1.005; <0.001; I²=0). Additionally, the success rates of vital pulp therapies were compared, all of them being greater than 75%; and the success rates of the materials used were analyzed, giving values above 80% in all cases. The risk of bias of the included articles was established using the ROBINS-I tool, showing that two of the articles had a moderate risk of bias and the remaining two had a very high risk of bias.
CONCLUSIONS
Based on the results of this review, direct pulp capping should be clinically included as a successful technique for the treatment of irreversible pulpitis. However, a larger number of studies with more rigorous methodologies are necessary to confirm the efficacy of this technique. Irreversible pulpitis, direct pulp capping (DPC), vital pulp therapy (VPT), indirect pulp capping (IPC), partial pulpotomy, total pulpotomy.
PubMed: 35912026
DOI: 10.4317/jced.59668