Efficacy of penicillin for dental pain without overt infection.
OBJECTIVE
Dental pain is a common presenting symptom in the acute care setting. Even in the absence of overt infection, many physicians routinely prescribe antibiotics such as penicillin. The authors sought to test the hypothesis that penicillin is not necessary or beneficial in the treatment of undifferentiated dental pain without overt infection.


METHODS
This prospective, randomized, double-blind, placebo-controlled trial was conducted at an urban teaching hospital with approximately 105,000 emergency department visits per year. A convenience sample of adult emergency department patients presenting with dental pain and no clinically overt infection was randomized to receive penicillin or placebo. A structured evaluation was performed at enrollment and again at a 5- to 7-day follow-up visit. The main outcome measure was evidence of overt dental infection at the 5- to 7-day follow-up visit.


RESULTS
A total of 195 patients were enrolled. Ninety-eight (50%) were randomized to treatment with penicillin. A total of 125 patients (64%) were followed up. Outcome data were identified for nine additional study patients, who returned to the dental clinic or emergency department outside of the scheduled follow-up period and were included in the final analysis. Overall, 13 of 134 patients (9%) developed signs of infection: six of 64 (9%) from the penicillin group and seven of 70 (10%) from the placebo group (p = 0.90). There was no significant difference between the penicillin and placebo groups in baseline characteristics, medication compliance, or visual analog scale pain scores at enrollment.


CONCLUSIONS
These data support the hypothesis that penicillin is neither necessary nor beneficial in the treatment of undifferentiated dental pain in the absence of overt infection.
Runyon
Michael S
MS
Department of Emergency Medicine, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC 28232-2861, USA. michael.runyon@carolinashealthcare.org
Brennan
Michael T
MT
Batts
Jayne J
JJ
Glaser
Theodore E
TE
Fox
Philip C
PC
Norton
H James
HJ
Kent
M Louise
ML
Cox
Timothy L
TL
Lockhart
Peter B
PB
D000328:Adult; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D003729:Dental Care / Q000379:methods / Q000706:statistics & numerical data; D004311:Double-Blind Method; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement; D010406:Penicillins / Q000627:therapeutic use*; D011446:Prospective Studies; D014098:Toothache / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D010406:Penicillins