A primary care-based study on the treatment of pulpitis using a corticosteroid/antibiotic dressing

Objective: To investigate, clinically, the efficacy of a steroid/antibiotic dressing on teeth diagnosed with reversible pulpitis. Study design: Retrospective clinical audit in a primary care setting over 12 years. Materials and methods: Patients diagnosed as suffering from reversible pulpitis were selected for this study. Following caries control, a thin layer of a steroid/antibiotic dressing was placed on the cavity floor and covered with a zinc oxide-eugenol cement as a temporary filling. The patients were reviewed 3 weeks later or earlier if symptoms were intolerable. If after 3 weeks the tooth was symptom-free, the steroid/antibiotic dressing was partially removed (leaving approximately 2 mm on the cavity floor) and the tooth was restored definitively. If the tooth was not symptom-free at review, a decision was made, depending on severity, to either re-dress the tooth with the corticosteroid/ antibiotic compound or commence root canal treatment; teeth in the latter group were then excluded from the study. All subsequent reviews and interventions required for the teeth remaining in the study were recorded accordingly. Results: The average age of the patients in this study was 54 years and 55% were females. A total of 454 teeth were treated, of which 435 (96%) needed two and 19 (4%) needed three treatment visits. Subsequent interventions included root canal treatment for 43 (10%) teeth, extraction for 21 (5%) teeth and 14 (3%) teeth were re-dressed more than once. The median survival time of the teeth was 6 years. Conclusions: This study showed that root canal treatment may not necessarily be the first line of treatment for teeth diagnosed with reversible pulpitis, even with borderline cases. Most of the teeth treated with the steroid/antibiotic dressing settled and very few were lost over a 12-year period. Palabras clave: cohort, Ledermix, longitudinal study, primary care, pulpitis