Pharmacotherapy in Endodontics

master's thesis

• Title (croatian): Farmakoterapija u endodonciji
• Author: Jelena Kiš
• Mentor: Eva Klarić Sever (mentor)
• Committee member: Eva Klarić Sever (predsjednik povjerenstva)
• Committee member: Božana Lončar Brzak (član povjerenstva)
• Committee member: Samir Čimić (član povjerenstva)
• Granter: University of Zagreb; School of Dental Medicine; (Department of Endodontics and Restorative Dentistry); Zagreb
• Defense date and country: 2023-07-10, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine; Endodonics and Restorative Dentistry

Abstract

During endodontic therapy, effective management of infection and pain is essential. Research suggests that 20% of patients experience pain after endodontic procedures. Based on recent meta-analyses, a combination of ibuprofen and paracetamol is the most effective approach for relieving postoperative endodontic pain. It is recommended to administer the first dose of analgesics before the loss of local anesthesia and to follow a scheduled dosing regimen rather than taking medication as needed. In cases of severe postoperative pain, alternative drug classes are considered. In endodontic infections, the objectives of treatment are to eliminate pathogenic microorganisms, bacterial toxins, and necrotic tissue from the contaminated root canal system, which creates an environment that supports healing. This is achieved through mechanical debridement and chemical disinfection of the root canals, as well as establishing proper drainage from both soft and hard tissues. Antibiotics are indicated as adjuvant therapy in endodontics in specific cases, such as presence of systemic symptoms and diffuse spread of infection. According to current studies, prescription durations of 2 to 3 days, until symptom resolution, are as effective as longer courses. Prolonged exposure to antibiotics can lead to the development of antibiotic resistance and side effects because of the reduction of normal gastrointestinal microbiota. Amoxicillin, possibly combined with metronidazole, is the preferred antibiotic against odontogenic microorganisms. When treating patients, it is important to prioritize individualized management of pain and infections. This involves carefully assessing the effectiveness and safety of analgesics and antibiotics.

Abstract (croatian)

Tijekom endodontske terapije, esencijalno je učinkovito liječenje infekcije i boli. Istraživanja pokazuju da 20% pacijenata osjeća bol nakon endodontskih zahvata. Na temelju nedavnih meta-analiza, kombinacija ibuprofena i paracetamola je najučinkovitiji pristup za ublažavanje postoperativne endodontske boli. Preporuča se primijeniti prvu dozu analgetika prije gubitka efekta lokalne anestezije i slijediti planirani režim doziranja umjesto uzimanja lijekova po potrebi. Kod jake postoperativne boli, u razmatranje dolaze druge skupine analgetika. Kod endodontskih infekcija, ciljevi liječenja su eliminirati patogene mikroorganizme, bakterijske toksine i nekrotično tkivo iz kontaminiranog sustava korijenskih kanala, čime se stvaraju uvijeti koji promoviraju cijeljenje. To se postiže mehaničkom instrumentacijom i kemijskom dezinfekcijom korijenskih kanala, kao i uspostavom pravilne drenaže iz mekih i tvrdih tkiva. Antibiotici su indicirani kao pomoćna terapija u endodonciji u specifičnim slučajevima kao što su prisutnost sistemskih simptoma i difuznoga širenja infekcije. Prema trenutnim istraživanjima, propisivanja antibiotske terapije u trajanju od 2 do 3 dana, odnosno do povlačenja simptoma, jednako je učinkovito kao i duža terapija (7-10 dana). Produljena konzumacija antibiotika može dovesti do razvoja rezistencije na antibiotike i nuspojava zbog smanjenja fiziološke gastrointestinalne mikroflore. Amoksicilin, po potrebi u kombinaciji s metronidazolom, je preferirani antibiotik protiv odontogenih mikroorganizama. Pri liječenju bolesnika važno je dati prioritet individualiziranom liječenju boli i infekcija. To uključuje pažljivo procjenjivanje učinkovitosti i sigurnosti analgetika i antibiotika.

• Keywords: pain; odontogenic infection; analgesics; antibiotics; endodontics
• Keywords (croatian): bol; odontogena infekcija; analgetici; antibiotici; endodoncija
• Language: english
• URN:NBN: urn:nbn:hr:127:169919
• Study programme: Title: Integrated undergraduate and graduate university study of Dental Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-07-05 14:27:35