Investigating acute management of irreversible pulpitis: a survey of general dental practitioners in North East England


Objective To investigate current strategies of acute management of irreversible pulpitis by general dental practitioners.

Design A postal survey was sent to a representative sample based on postal code to 180 dentists registered with the General Dental Council in the North East of England. The questionnaire identified general dental practitioners' strategies for the diagnosis and acute management of irreversible pulpitis.

Results One hundred and three questionnaires were returned. Irreversible pulpitis was primarily diagnosed from patients' signs and symptoms. There was a high confidence in anaesthetising a tooth with irreversible pulpitis. Treatment was undertaken with either pulpotomy (with a view to single or multi-stage orthograde root canal treatment) or full extirpation in just over half of respondents (51%). Seventy-one percent of respondents reported using different intrapulpal medicaments. Antibiotics were 'frequently' prescribed in cases of irreversible pulpitis by 25% of respondents. For endodontic procedures, dental dam usage was generally low and used 'occasionally' or 'never' by 40% of respondents.

Conclusions Antibiotics were being inappropriately prescribed in the management of irreversible pulpitis, transgressing from NICE guidelines on antibiotic usage. Rubber dam use is not universal during the initial management of pulpitis, or during the definitive endodontic procedure, impacting upon the safety and predicility of outcome. Respondents often placed medicaments into the pulp, in spite of a lack of evidence for their efficacy.

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Gemmell, A., Stone, S. & Edwards, D. Investigating acute management of irreversible pulpitis: a survey of general dental practitioners in North East England. Br Dent J 228, 521–526 (2020).

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