Corticosteroids have been combined with antibiotics for intradental application in the management of pulp and periapical diseases. The corticosteroid component is included as almost all pulp and periapical diseases are inflammatory in nature. The antibiotic is used as these diseases are usually caused by the presence of bacteria within the tooth, pulp or root canal system.
There are two forms of corticosteroid-antibiotic compounds that are commercially available and that can be used intradentally—a water-soluble paste, and a hard-setting cement.
The choice of which form to use depends on the condition being treated and where the material is to be placed.
The corticosteroid-antibiotic pastes are used as an intracanal medication (within the root canal system of a tooth) during endodontic treatment. The paste can be used as an initial medication for rapid and reliable relief of pain when treating irreversible pulpitis. It is also used as an intracanal medication to reduce the periapical inflammation (acute or chronic apical periodontitis)—and hence the pain—that is often associated with irreversible pulpitis and always associated with an infected root canal system. The pastes are also used as intracanal medication in the prevention and management of several forms of root resorption (eg internal inflammatory resorption, external apical inflammatory resorption, external lateral inflammatory resorption). An additional effect of the intracanal use of corticosteroids is a reduction in the amount of external replacement resorption that occurs following tooth avulsion and intrusive luxation injuries, as corticosteroids inhibit the action of clastic cells.
The cement form of corticosteroid-antibiotic mixtures is used within the crown of a tooth as part of a cavity lining or base, as an indirect pulp cap, as a direct pulp cap, or as a pulpotomy agent prior to restoration of cavities in teeth that have reversible pulpitis (ie reversible inflammation of the pulp). Commercial preparations typically also contain various other substances (eg calcium hydroxide, zinc oxide, eugenol). The cement is presented as a powder and liquid which are mixed to form a paste that is placed on the dentine or exposed pulp; it then sets to form the hard cement.
©Therapeutic Guidelines Limited (dtg1, January 2007)