Emergency management of acute apical periodontitis in the permanent dentition: a systematic review of the literature

J Can Dent Assoc. 2003 Mar;69(3):160.


Objective: To perform a systematic literature review and meta-analysis on the effectiveness of interventions used in the emergency management of acute apical periodontitis in the permanent dentition.

Methods: Electronic databases were searched from their inception to 2001. These searches, combined with manual searching, yielded 1,097 citations, of which 92 were relevant. Independent application of inclusion criteria by 2 teams of reviewers yielded 15 eligible randomized controlled trials. Data on population, interventions, outcomes (pain relief or change in intensity of pain as reported by patients or clinicians) and methodological quality were determined by independent duplicate review. Disagreements were resolved by consensus.

Results: Meta-analysis showed that pre-emptive analgesics (nonsteroidal anti-inflammatory drugs [NSAIDs]) in conjunction with pulpectomy provided a significant benefit (weighted mean difference -11.70, 95% confidence interval -22.84 to -0.56). Three interventions did not show significant benefit: systemic antibiotics, intracanal treatment with a steroid-antibiotic combination, and trephination through attached gingiva.

Conclusions: In the management of pain associated with acute apical periodontitis, there is strong evidence to support the use of systemic NSAIDs in conjunction with nonsurgical endodontics. The use of antibiotics is not recommended.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Analgesics / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Dentition, Permanent
  • Emergency Treatment
  • Humans
  • Pain Measurement
  • Periapical Periodontitis / complications
  • Periapical Periodontitis / drug therapy*
  • Periapical Periodontitis / etiology
  • Periapical Periodontitis / surgery*
  • Pulpectomy
  • Randomized Controlled Trials as Topic
  • Steroids
  • Tooth, Nonvital / complications
  • Toothache / drug therapy*
  • Toothache / etiology
  • Toothache / surgery*


  • Analgesics
  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Steroids