Dexamethasone + Diclofenac: Is It Safe in Dentistry?

The combination of dexamethasone and diclofenac in dentistry is used to manage postoperative inflammation, pain, and swelling, particularly following oral surgical procedures such as third molar extraction and other interventions involving significant tissue trauma.

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These medications have complementary pharmacological mechanisms: dexamethasone is a corticosteroid that suppresses inflammatory responses, whereas diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that reduces prostaglandin synthesis through cyclooxygenase inhibition.

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Although their combined use may provide effective control of postoperative symptoms, it requires careful clinical assessment because both drugs have potential adverse effects, contraindications, and interactions. Their combination should not be considered a routine prescription for every dental procedure.

✅ Pharmacological mechanisms
The combination involves two different anti-inflammatory pathways.

Drug	Pharmacological Class	Main Mechanism	Clinical Effect
Dexamethasone	Glucocorticoid	Inhibits phospholipase A2 activity indirectly through lipocortin and suppresses inflammatory mediator production.	Reduces inflammatory edema and tissue inflammation.
Diclofenac	Nonsteroidal anti-inflammatory drug (NSAID)	Inhibits COX-1 and COX-2, reducing prostaglandin synthesis.	Provides analgesic and anti-inflammatory effects.

The combination targets different stages of the inflammatory response. However, complementary mechanisms do not necessarily translate into superior clinical outcomes in every dental procedure.

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✅ Clinical applications in dentistry
The combination has primarily been investigated in oral and maxillofacial surgery, particularly in procedures associated with substantial postoperative inflammation.

Potential clinical applications include:
▪️ Surgical extraction of impacted third molars: Management of postoperative pain, facial swelling, and trismus.
▪️ Complex dentoalveolar surgery: Reduction of inflammatory symptoms following extensive tissue manipulation.
▪️ Selected oral surgical procedures: Adjunctive control of postoperative inflammatory responses when clinically justified.

It is important to distinguish postoperative inflammation from infection. Neither medication eliminates the underlying cause of an odontogenic infection, and dexamethasone may mask clinical manifestations of infection.

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✅ Clinical evidence: Does the combination improve postoperative outcomes?
A randomized, open-label pilot clinical trial by Bamgbose et al. (2006) evaluated 150 patients undergoing third-molar extraction. Three protocols were compared:

1. Dexamethasone 8 mg intramuscularly plus diclofenac potassium 50 mg orally.
2. Dexamethasone 8 mg intramuscularly plus acetaminophen 1,000 mg orally.
3. Diclofenac potassium 50 mg orally alone.

The combination of dexamethasone and diclofenac produced a significantly higher proportion of patients reporting no pain compared with the other groups (44% versus 22% and 24%, respectively). It also reduced facial swelling compared with diclofenac monotherapy. However, the study was a pilot trial with an open-label design, and its findings should not be interpreted as definitive evidence of superiority.
Another randomized clinical trial by Lima et al. (2017) compared postoperative dexamethasone with diclofenac following third-molar removal. Dexamethasone produced better outcomes for swelling and trismus, while patients receiving diclofenac required more rescue analgesia. This study compared the medications rather than their combined administration.
These findings suggest that corticosteroids may contribute to postoperative edema control, while NSAIDs provide an important analgesic effect.

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✅ Dosage and administration considerations
There is no universally standardized dexamethasone–diclofenac dosage protocol for dental procedures. The regimen should be individualized according to the surgical procedure, patient characteristics, medical history, and formulation.
The clinical trial by Bamgbose et al. (2006) investigated a specific protocol involving dexamethasone 8 mg intramuscularly and diclofenac potassium 50 mg orally. These doses describe the research protocol and should not be interpreted as a universal prescription.

Important considerations include:
▪️ Use the lowest effective NSAID dose for the shortest appropriate duration.
▪️ Select the corticosteroid route according to the clinical indication and patient circumstances.
▪️ Avoid automatically combining both drugs after uncomplicated dental procedures.
▪️ Reassess patients with persistent or worsening postoperative symptoms rather than extending medication empirically.

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✅ Contraindications, precautions, and adverse effects
Combining a corticosteroid with an NSAID requires particular attention to gastrointestinal safety. Concomitant systemic corticosteroid and NSAID use can increase the risk of gastrointestinal ulceration and bleeding.

Medication	Important Precautions
Diclofenac	Peptic ulcer disease, previous gastrointestinal bleeding, renal impairment, cardiovascular disease, uncontrolled hypertension, NSAID hypersensitivity, and certain stages of pregnancy.
Dexamethasone	Uncontrolled diabetes, active or inadequately controlled infection, immunosuppression, systemic fungal infection, and relevant corticosteroid hypersensitivity.
Combination	Increased gastrointestinal risk, particularly in patients with a history of ulceration, anticoagulant use, or other bleeding risk factors.

Sources: Official prescribing information for diclofenac and dexamethasone

Potential adverse effects

Diclofenac:
▪️ Gastrointestinal irritation, ulceration, and bleeding.
▪️ Renal impairment and fluid retention.
▪️ Increased cardiovascular thrombotic risk.
▪️ Hepatic enzyme elevations and hypersensitivity reactions.

Dexamethasone:
▪️ Transient hyperglycemia.
▪️ Mood changes and sleep disturbances.
▪️ Immunosuppression and increased susceptibility to infection.
▪️ Potential masking of infectious symptoms.

Combined treatment: The most relevant concern is the increased gastrointestinal risk associated with concurrent NSAID and systemic corticosteroid administration. A short treatment course does not eliminate this risk.

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💬 Discussion
The pharmacological rationale for combining dexamethasone and diclofenac is based on their complementary anti-inflammatory mechanisms. Clinical evidence, particularly in third-molar surgery, suggests that this combination can improve certain postoperative outcomes.
However, the available evidence should be interpreted cautiously. The study by Bamgbose et al. (2006) provides encouraging findings, but its pilot design and open-label methodology limit the strength of its conclusions.
An important consideration is the American Dental Association (ADA) clinical practice guideline published in 2024. This guideline recommends NSAIDs, alone or combined with acetaminophen, as first-line pharmacological treatment for postoperative pain following surgical tooth extraction. It also suggests against routinely adding oral, submucosal, or intramuscular corticosteroids to standard analgesic therapy because the available evidence indicates, at most, a trivial reduction in postoperative pain.
The ADA guideline does not specifically evaluate corticosteroids for managing postoperative facial swelling or trismus as separate inflammatory complications. Therefore, its recommendation should not be interpreted as evidence that corticosteroids have no role in selected oral surgical situations.
Overall, dexamethasone plus diclofenac may be considered in selected surgical cases, but routine combined administration is not supported by sufficiently strong evidence.

✍️ Conclusion
The combination of dexamethasone and diclofenac in dentistry offers a pharmacological approach to managing postoperative inflammation and pain, particularly following third-molar surgery.
Nevertheless, its clinical use requires individualized assessment because the potential benefits must be balanced against gastrointestinal, cardiovascular, renal, and immunological risks.
For most routine dental procedures, NSAIDs remain an evidence-supported first-line option for postoperative pain management. The addition of dexamethasone should be reserved for selected indications rather than considered a standard component of every postoperative prescription.

🎯 Clinical Recommendations
1. Prioritize NSAID-based analgesia according to current dental pain guidelines rather than routinely prescribing dual anti-inflammatory therapy.
2. Consider the combination only when a specific inflammatory indication justifies the additional corticosteroid exposure.
3. Evaluate gastrointestinal, renal, cardiovascular, and metabolic risk factors before prescribing.
4. Do not use corticosteroids to suppress swelling associated with an untreated odontogenic infection; establish appropriate source control and infection management.

📚 References
✔ Bamgbose, B. O., Akinwande, J. A., Adeyemo, W. L., Ladeinde, A. L., Arotiba, G. T., & Ogunlewe, M. O. (2006). Prospective, randomized, open-label, pilot clinical trial comparing the effects of dexamethasone coadministered with diclofenac potassium or acetaminophen and diclofenac potassium monotherapy after third-molar extraction in adults. Current Therapeutic Research, 67(4), 229–240. https://doi.org/10.1016/j.curtheres.2006.07.001
✔ Carrasco-Labra, A., Polk, D. E., Urquhart, O., Aghaloo, T., Claytor, J. W., Jr., Dhar, V., Dionne, R. A., Espinoza, L., Gordon, S. M., Hersh, E. V., Law, A. S., Li, B. S.-K., Schwartz, P. J., Suda, K. J., Turturro, M. A., Wright, M. L., Dawson, T., Miroshnychenko, A., Pahlke, S., ... Moore, P. A. (2024). Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults. The Journal of the American Dental Association, 155(2), 102–117.e9. https://doi.org/10.1016/j.adaj.2023.10.009
✔ Lima, C. A. A., Favarini, V. T., Torres, A. M., da Silva, R. A., & Sato, F. R. L. (2017). Oral dexamethasone decreases postoperative pain, swelling, and trismus more than diclofenac following third molar removal: A randomized controlled clinical trial. Journal of Cranio-Maxillofacial Surgery, 21(3), 321–326. https://doi.org/10.1007/s10006-017-0635-0
✔ U.S. National Library of Medicine. (2026). Diclofenac sodium: Prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/
✔ U.S. National Library of Medicine. (2025). Dexamethasone tablets: Prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/

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Recommendations for Drug Therapy in Pediatric Dentistry

Medication therapy in pediatric dentistry requires individualized decisions based on the child's age, body weight, medical history, developmental stage, and clinical condition.

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Physiological differences between children and adults influence drug absorption, distribution, metabolism, and elimination, making accurate prescribing essential.

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The selection of medications should be guided by the diagnosis, therapeutic objectives, potential adverse effects, and established pediatric dosing recommendations.
This article presents practical, evidence-based medication recommendations for pediatric dental patients, focusing on analgesics, antibiotics, local anesthetics, and medication safety.

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✅ General Recommendations for Medication Prescribing
Before prescribing any medication, the dentist should perform a comprehensive assessment of the patient.
The following recommendations should be incorporated into routine clinical practice:

▪️ Verify the child's current body weight in kilograms: Weight-based calculations are essential for most pediatric medications.
▪️ Review the medical history: Identify allergies, systemic diseases, hepatic or renal impairment, and other relevant conditions.
▪️ Evaluate current medications: Check for potential drug interactions and duplicate active ingredients.
▪️ Establish an accurate diagnosis: Medication selection must address the underlying condition rather than symptoms alone.
▪️ Select an appropriate formulation: Consider the child's age, ability to swallow, cooperation, and available pharmaceutical preparations.
▪️ Determine the appropriate dose and duration: Follow established pediatric dosing references and product-specific recommendations.
▪️ Provide clear caregiver instructions: Specify the dose, administration interval, duration, and potential adverse effects.

Important recommendation: Pediatric doses should never exceed the recommended adult maximum dose. All calculations must account for the drug's concentration and the maximum permitted daily dose.

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✅ Recommendations for Analgesics and Anti-Inflammatory Drugs
Pain management is an essential component of pediatric dental treatment. According to the American Academy of Pediatric Dentistry (AAPD), nonsteroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen, and acetaminophen are first-line pharmacological options for pediatric dental pain.
The following dosage ranges are included in the AAPD medication reference:

Medication	General Pediatric Dosage	Clinical Recommendations
Ibuprofen	4–10 mg/kg/dose every 6–8 hours	Consider for inflammatory dental pain when no contraindications exist.
Acetaminophen (Paracetamol)	10–15 mg/kg/dose every 4–6 hours	Consider when NSAIDs are contraindicated or as an alternative analgesic.

Clinical recommendations:

▪️ Use ibuprofen when its anti-inflammatory properties are clinically beneficial and the patient has no contraindications.
▪️ Avoid ibuprofen in children with significant dehydration, renal impairment, active gastrointestinal bleeding, or other relevant contraindications.
▪️ Consider acetaminophen in patients who cannot receive NSAIDs, taking hepatic function into account.
▪️ Avoid duplicate acetaminophen administration through combination medications.
▪️ Do not routinely alternate or combine analgesics without a clearly established dosing schedule.
▪️ Reserve opioid analgesics for exceptional circumstances, following appropriate specialist assessment and current prescribing restrictions.

Dosage safety: According to the AAPD medication reference, acetaminophen should not exceed 75 mg/kg/day in children younger than 12 years, or 4,000 mg in 24 hours, whichever is lower. Ibuprofen doses should also comply with the applicable maximum single and daily limits.

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✅ Recommendations for Antibiotic Use in Pediatric Dentistry
Systemic antibiotics should be prescribed only when a bacterial infection warrants antimicrobial treatment. They must be considered an adjunct to definitive dental management rather than a replacement for treatment of the infection source.

Commonly considered antibiotics include:

Antibiotic	Clinical Application	Prescribing Recommendation
Amoxicillin	Selected odontogenic infections with systemic involvement	Common empirical first-line option when indicated and no relevant allergy exists.
Amoxicillin-Clavulanate	Selected infections requiring broader antimicrobial coverage	Consider when the clinical presentation and previous treatment justify broader coverage.
Metronidazole	Selected infections involving anaerobic microorganisms	Consider as an adjunct when clinically indicated.
Azithromycin	Selected patients with penicillin allergy	Evaluate allergy history, resistance patterns, and individual risks.

Clinical recommendations:

▪️ Do not prescribe antibiotics for uncomplicated pulpitis, apical periodontitis, or localized intraoral swelling when definitive dental treatment is sufficient and there is no systemic involvement.
▪️ Consider systemic antibiotics when there is progressive infection, facial swelling, fever, or other evidence of systemic involvement.
▪️ Prioritize source control through appropriate procedures, including pulp therapy, drainage, or extraction when indicated.
▪️ Verify the nature and severity of reported penicillin allergies before selecting an alternative.
▪️ Avoid unnecessary broad-spectrum antibiotics.
▪️ Reassess patients who fail to improve and evaluate whether additional intervention or referral is required.

Urgent recommendation: Patients presenting with progressive facial swelling, fever, trismus, dysphagia, respiratory difficulty, or suspected deep-space infection require immediate assessment and appropriate emergency management.

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✅ Recommendations for Local Anesthetic Use
Local anesthesia is essential for controlling procedural pain and facilitating safe, effective dental treatment in children.

Commonly used local anesthetics include:
▪️ Lidocaine 2% with epinephrine: Frequently used for infiltration and nerve block anesthesia.
▪️ Mepivacaine: Available with or without vasoconstrictor, depending on the clinical indication.
▪️ Articaine 4%: An option for selected pediatric patients, subject to age restrictions and manufacturer recommendations.

Clinical recommendations:
1. Select the anesthetic according to the child's age, weight, medical history, developmental status, and planned procedure.
2. Calculate the maximum recommended dose in mg/kg before administration.
3. Use the lowest effective dose to achieve adequate anesthesia.
4. Consider the cumulative dose when multiple injections or topical anesthetics are administered.
5. Document the anesthetic agent, concentration, total dose, injection technique, and anatomical site.
6. Provide postoperative instructions to prevent accidental biting or injury to anesthetized soft tissues.

Special precaution: Benzocaine should not be used in children younger than two years because of the risk of methemoglobinemia. Articaine product labeling generally does not recommend its use in children younger than four years.

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✅ Recommendations for Other Medications in Pediatric Dentistry
Other pharmacological agents may be necessary depending on the diagnosis and the patient's individual circumstances.

Medication Group	Clinical Indication	Prescribing Recommendation
Antifungals	Oral candidiasis	Confirm the diagnosis and select an appropriate formulation and treatment duration.
Antivirals	Selected viral infections, including herpes simplex	Consider the timing of treatment, clinical severity, and patient risk factors.
Corticosteroids	Selected inflammatory or immune-mediated conditions	Prescribe only when clearly indicated and consider potential systemic effects.
Sedative Medications	Selected patients requiring pharmacological behavior guidance	Follow established pediatric sedation protocols and monitoring requirements.

Sedation recommendation: Sedative medications should never be administered without appropriate professional supervision. Patient assessment, airway evaluation, fasting considerations when applicable, physiological monitoring, emergency preparedness, and recovery criteria must follow established pediatric sedation guidelines.

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✅ Recommendations to Prevent Medication Errors
Medication errors are an important preventable risk in pediatric dental practice. Particular attention should be given to dose calculations, drug concentrations, administration intervals, and caregiver instructions.

Common Prescribing Error	Recommended Preventive Measure
Prescribing without confirming current weight	Obtain and document weight in kilograms.
Confusing mg with mL	Calculate the dose in mg and convert using the exact product concentration.
Exceeding maximum daily doses	Verify individual doses and cumulative daily limits.
Prescribing antibiotics unnecessarily	Confirm the clinical indication before initiating treatment.
Ignoring potential drug interactions	Review medical history and current medications.
Providing unclear instructions	Give caregivers written administration instructions.

💬 Discussion
The pharmacological management of pediatric dental patients requires a balance between therapeutic effectiveness and patient safety. Appropriate medication selection depends on accurate diagnosis, developmental characteristics, body weight, medical history, and potential contraindications.
A fundamental consideration is the distinction between symptomatic treatment and definitive dental management. Analgesics can reduce pain but do not eliminate the underlying cause of pulpal or periapical disease. Similarly, antibiotics should not replace appropriate procedures such as pulpotomy, pulpectomy, drainage, or extraction when clinically indicated.
Current AAPD recommendations emphasize appropriate analgesic selection, antimicrobial stewardship, careful local anesthetic administration, and standardized safety measures during pediatric sedation.
These principles reinforce the importance of individualized prescribing rather than applying the same medication regimen to all pediatric patients.

🎯 Clinical Recommendations
For practical implementation, the following recommendations should be incorporated into routine pediatric dental practice:

▪️ Prioritize diagnosis before prescription: Identify the underlying cause of pain or infection before selecting medication.
▪️ Verify every weight-based calculation: Use the child's current weight and an updated pediatric drug reference.
▪️ Check the formulation concentration: Ensure that the prescribed volume corresponds accurately to the intended dose in milligrams.
▪️ Individualize treatment: Consider allergies, systemic conditions, concurrent medications, and contraindications.
▪️ Establish follow-up criteria: Reassess persistent pain, progressive swelling, or unexpected adverse reactions.
▪️ Document prescribing decisions: Record the indication, medication, dose, administration interval, and duration.
▪️ Educate caregivers: Provide clear written instructions and explain warning signs that require immediate evaluation.

✍️ Conclusion
Appropriate medication prescribing in pediatric dentistry requires evidence-based decisions, accurate dosage calculations, and careful consideration of each child's clinical characteristics.
Analgesics should be selected according to the nature of the pain, antibiotics reserved for infections requiring systemic antimicrobial therapy, and local anesthetics administered according to established pediatric safety recommendations.
Ultimately, applying these medication recommendations in pediatric dentistry helps minimize prescribing errors, reduce adverse drug reactions, and improve the quality and safety of dental care for children.

📚 References
✔ American Academy of Pediatric Dentistry. (2025). Useful medications for oral conditions. In The reference manual of pediatric dentistry (pp. 669–677). American Academy of Pediatric Dentistry.
✔ American Academy of Pediatric Dentistry. (2026). Acute pain management for pediatric dental patients. In The reference manual of pediatric dentistry. American Academy of Pediatric Dentistry.
✔ American Academy of Pediatric Dentistry. (2026). Use of antibiotic therapy for pediatric dental patients. In The reference manual of pediatric dentistry. American Academy of Pediatric Dentistry.
✔ American Academy of Pediatric Dentistry. (2025). Use of local anesthesia for pediatric dental patients. In The reference manual of pediatric dentistry (pp. 407–414). American Academy of Pediatric Dentistry.
✔ American Academy of Pediatrics, & American Academy of Pediatric Dentistry. (2025). Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatric Dentistry, 47(6), E100–E128.

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Pharmacotherapy in Pediatric Dentistry: A Clinical Guide

Pharmacotherapy in pediatric dentistry involves the appropriate selection, dosing, administration, and monitoring of medications used to manage pain, infection, inflammation, and procedural anxiety in children.

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Weight-based dosing, accurate medication calculations, and evidence-based indications are essential to minimize adverse drug reactions and prevent medication errors. Antibiotics should be reserved for appropriate indications, while definitive dental treatment remains central to managing odontogenic disease.

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✅ Principles of Pediatric Drug Prescribing
Before prescribing, clinicians should assess:

▪️ Body weight in kilograms: Calculate the dose using the recommended mg/kg regimen and verify the maximum single and daily doses.
▪️ Age and medical history: Consider allergies, renal or hepatic impairment, concurrent medications, and relevant contraindications.
▪️ Formulation and concentration: Confirm the concentration of liquid medications and the appropriate measuring device.
▪️ Route and duration: Choose the appropriate formulation and shortest evidence-supported treatment duration.
▪️ Caregiver instructions: Provide clear written directions, dosing intervals, maximum daily doses, and storage precautions.

A calculated weight-based dose must never exceed the recommended maximum for the child's age, weight, indication, or formulation. Doses should be verified against an authoritative pediatric drug reference and local prescribing guidance.

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✅ Common Medications in Pediatric Dentistry
The following table summarizes commonly used medication classes and their principal indications. Actual prescribing decisions depend on the individual patient and current clinical guidelines.

Medication class	Clinical use	Key safety consideration
NSAIDs (e.g., ibuprofen)	Acute dental pain and postoperative inflammation	Assess dehydration, renal disease, gastrointestinal risk, and contraindications.
Acetaminophen (paracetamol)	Pain when NSAIDs are unsuitable or as an adjunct when indicated	Prevent duplicate products and excessive total daily doses; consider hepatic disease.
Antibiotics (e.g., amoxicillin)	Selected bacterial odontogenic infections with systemic involvement or spreading infection	Check allergy history, indication, dose, local guidance, and antimicrobial stewardship.
Local anesthetics (e.g., lidocaine)	Procedural pain control	Calculate the total dose by weight and document the agent, concentration, and amount administered.
Sedative agents	Selected patients requiring pharmacologic behavior guidance	Require appropriate training, patient selection, monitoring, rescue capability, and recovery protocols.

Sources: American Academy of Pediatric Dentistry (AAPD) guidance on analgesia, local anesthesia, antibiotics, and sedation.

✅ Analgesics for Acute Dental Pain
Nonsteroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen when appropriate, are first-line options for many cases of acute dental pain in children. Acetaminophen (paracetamol) may be used when NSAIDs are contraindicated or combined with an NSAID when pain control is inadequate and the combination is clinically appropriate.
The 2023 evidence-based guideline from the American Dental Association and collaborating institutions supports NSAIDs alone or combined with acetaminophen for temporary toothache management and after dental extractions in children. The certainty of evidence was very low, so treatment should be individualized.

Clinical considerations:
▪️ Use an accurate weight-based dose and verify the maximum dose and interval.
▪️ Avoid ibuprofen or other NSAIDs when contraindicated, including in relevant renal conditions or significant dehydration.
▪️ Prevent accidental acetaminophen overdose by checking combination products and total daily intake.
▪️ Avoid codeine and tramadol in children younger than 12 years for pain management, consistent with FDA restrictions and the cited dental pain guideline.

Analgesics provide symptom control; they do not replace treatment of the underlying dental disease.

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✅ Antibiotics in Pediatric Dentistry
Antibiotics are not routinely indicated for toothache, uncomplicated pulpitis, or a localized infection that can be managed with definitive dental treatment in an otherwise healthy child. Pulpotomy, pulpectomy, drainage, or extraction should be considered according to the diagnosis and restorability of the tooth.
Systemic antibiotics may be indicated when infection spreads beyond the local site, systemic manifestations develop, or specific medical circumstances warrant treatment. Facial swelling accompanied by fever, progressive swelling, trismus, dysphagia, or respiratory difficulty requires urgent assessment; airway or breathing compromise is an emergency.
Amoxicillin is commonly used when an antibiotic is indicated, but selection must account for allergy history, clinical severity, previous antibiotic exposure, local resistance patterns, and applicable guidelines. Antibiotic prophylaxis is a separate decision reserved for selected patients at increased risk of specific complications.

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✅ Local Anesthesia and Sedation
Local anesthesia is fundamental to pain control during pediatric dental procedures. The agent and dose should be selected according to the child's weight, medical history, developmental status, procedure, and any concurrently administered medications.
The AAPD recommends using the lowest effective total dose, documenting the anesthetic administered, and providing postoperative instructions to reduce accidental lip, cheek, or tongue biting. Benzocaine is contraindicated in children younger than 2 years because of the risk of methemoglobinemia.
Sedation is not a substitute for adequate analgesia. When pharmacologic behavior guidance is necessary, pediatric sedation requires presedation evaluation, appropriate monitoring, personnel trained to rescue a child from a deeper-than-intended level of sedation, emergency equipment, and monitored recovery.

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💬 Discussion
The evidence supports a patient-centered, indication-based approach to pediatric pharmacotherapy. Analgesics, antibiotics, local anesthetics, and sedative agents serve distinct clinical purposes and should not be used interchangeably.
Current guidance emphasizes nonopioid analgesics for acute dental pain, judicious antibiotic prescribing, conservative local anesthetic dosing, and strict safety protocols for sedation. Nevertheless, medication recommendations must be interpreted in the context of the child's medical status, clinical diagnosis, and local regulations.
An important limitation is that evidence supporting individual drug regimens varies in certainty. Furthermore, guidelines developed in one country may differ from local formularies or regulatory requirements. Clinical judgment and verification against current pediatric prescribing references remain essential.

✍️ Conclusion
Pharmacotherapy in pediatric dentistry requires accurate weight-based dosing, careful medication selection, and systematic monitoring for adverse effects. NSAIDs and acetaminophen are central to acute pain management, while antibiotics should be restricted to appropriate indications. Safe local anesthesia and sedation depend on patient assessment, dose control, professional training, and emergency preparedness.
Pharmacological treatment should complement, rather than replace, definitive dental care and preventive strategies.

🎯 Clinical Recommendations
▪️ Standardize prescribing: Use a weight-based calculation and independently verify the dose, concentration, dosing interval, and maximum daily amount before issuing a prescription.
▪️ Document clinical justification: Record the indication, relevant contraindications, allergy assessment, and rationale for antibiotics or sedative medication.
▪️ Establish a safety-net plan: Give caregivers written instructions on administration, expected effects, adverse reactions, and when urgent reassessment is necessary.
▪️ Escalate high-risk cases: Seek medical consultation or specialist support when significant comorbidities, complex drug interactions, or advanced infection complicate treatment.

📚 References
✔ American Academy of Pediatric Dentistry. (2025). Useful medications for oral conditions. In The reference manual of pediatric dentistry (2025–2026 ed., pp. 669–677). https://www.aapd.org/research/oral-health-policies--recommendations/useful-medications-for-oral-conditions/
✔ American Academy of Pediatric Dentistry. (2025). Use of local anesthesia for pediatric dental patients. In The reference manual of pediatric dentistry (2025–2026 ed., pp. 407–414). https://www.aapd.org/media/Policies_Guidelines/BP_LocalAnesthesia.pdf
✔ American Academy of Pediatric Dentistry. (2026). Use of antibiotic therapy for pediatric dental patients. The Reference Manual of Pediatric Dentistry, 2026–2027. https://www.aapd.org/research/oral-health-policies--recommendations/use-of-antibiotic-therapy-for-pediatric-dental-patients/
✔ American Academy of Pediatric Dentistry. (2026). Antibiotic prophylaxis for dental patients at risk for infection. The Reference Manual of Pediatric Dentistry, 2026–2027. https://www.aapd.org/research/oral-health-policies--recommendations/antibiotic-prophylaxis-for-dental-patients-at-risk-for-infection/
✔ American Academy of Pediatric Dentistry, & American Academy of Pediatrics. (2025). Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatric Dentistry, 47(6), E100–E128. https://www.aapd.org/globalassets/media/policies_guidelines/bp_monitoringsedation25.pdf
✔ Carrasco-Labra, A., Polk, D. E., Urquhart, O., Aghaloo, T., Claytor, J. W., Dhar, V., et al. (2023). Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in children: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh School of Dental Medicine, and the Center for Integrative Global Oral Health at the University of Pennsylvania. Journal of the American Dental Association. https://pmc.ncbi.nlm.nih.gov/articles/PMC10910586/

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Dexamethasone in Endodontics: Benefits Beyond Injections.

Intracanal dexamethasone is an emerging topic of interest in endodontics because of its potential to modulate inflammation and reduce post-instrumentation pain.

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Unlike systemic corticosteroid therapy, local application aims to deliver an anti-inflammatory agent directly into the root canal system.

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Dexamethasone has been investigated as an intracanal solution and as a component of calcium hydroxide-based medicaments. Related corticosteroid-containing pastes also provide a clinical context for understanding the potential benefits and limitations of local anti-inflammatory therapy.
However, these formulations are not interchangeable, and evidence supporting one preparation cannot automatically be extrapolated to another.

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✅ Why Use Dexamethasone as an Intracanal Medicament?
Dexamethasone is a potent glucocorticoid that suppresses inflammatory mediator production and modulates the host inflammatory response.

In endodontics, its proposed benefits include:
▪️ Reduction of postoperative pain associated with periapical inflammation.
▪️ Modulation of inflammatory responses following instrumentation.
▪️ Potential improvement in patient comfort during interappointment periods.

Importantly, dexamethasone is not an antimicrobial substitute for sodium hypochlorite irrigation, adequate chemomechanical preparation, or other established infection-control procedures.

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✅ Intracanal Dexamethasone: Solutions and Paste Formulations
Two approaches deserve particular attention: direct intracanal application of a corticosteroid solution and incorporation of dexamethasone into an intracanal paste.

Formulation	Potential Purpose	Main Limitation
Intracanal dexamethasone solution	Potential local anti-inflammatory action and postoperative pain control.	Limited clinical evidence and variation in application protocols.
Calcium hydroxide–dexamethasone paste	Combines the intended antimicrobial action of calcium hydroxide with corticosteroid-mediated inflammation control.	Optimal formulation, compatibility, dosage, and clinical indications remain uncertain.
Corticosteroid–antibiotic paste	Combines anti-inflammatory activity with antimicrobial activity, depending on the ingredients.	Antibiotic-specific risks, potential discoloration, allergies, and antimicrobial stewardship concerns.

Clinical note: Ledermix is a corticosteroid–antibiotic paste containing triamcinolone acetonide and demeclocycline, not dexamethasone. Evidence for one formulation should not be extrapolated directly to another.

✅ What Does the Clinical Evidence Show?
A randomized clinical trial by Ghanbarzadegan et al. (2019) evaluated intracanal medicaments in 90 necrotic molars and premolars. The investigators compared calcium hydroxide mixed with saline, calcium hydroxide mixed with 2% chlorhexidine, and calcium hydroxide mixed with dexamethasone.
The calcium hydroxide–dexamethasone group demonstrated lower pain scores than the calcium hydroxide–saline group during the first 24–72 hours. Differences were no longer statistically significant at 96 hours. These findings suggest a possible short-term analgesic benefit, but they do not establish universal superiority or define an optimal formulation.
A separate randomized trial published in 2024 investigated dexamethasone as a final intracanal rinse in patients with symptomatic irreversible pulpitis. The investigators reported better postoperative pain relief than with saline. However, this study evaluated a rinse, not a paste, and its findings should not be treated as direct evidence for sustained intracanal medication.
The broader evidence remains limited by differences in study design, patient selection, formulations, and outcome measurements. Intracanal dexamethasone is promising, but the evidence is insufficient to support routine use in every root canal treatment.

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✅ Safety and Clinical Limitations
Local administration does not eliminate the possibility of adverse effects. Relevant considerations include:

▪️ Potential local immunomodulation and effects on tissue healing.
▪️ Possible systemic exposure, depending on the preparation and amount used.
▪️ Formulation compatibility, stability, and removability.
▪️ The risk of suppressing inflammatory symptoms without adequately controlling infection.

When antibiotics are included in a paste, clinicians must also consider allergies, antimicrobial stewardship, and formulation-specific adverse effects.
Calcium hydroxide remains an established intracanal medicament when an interappointment dressing is indicated. Adding dexamethasone should not be assumed to improve disinfection or long-term healing without stronger comparative evidence.

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💬 Discussion
The clinical interest in intracanal dexamethasone reflects an important distinction in endodontic pharmacology: controlling inflammation is not the same as controlling infection. A corticosteroid may reduce inflammatory symptoms, while successful treatment still depends on adequate microbial control and an effective coronal seal.
Combining dexamethasone with calcium hydroxide is scientifically interesting because the components have different intended functions. Nevertheless, the clinical performance of a combination depends on its formulation, concentration, chemical compatibility, and biological effects. Evidence from a small number of clinical trials cannot establish the safety or effectiveness of all compounded preparations.
The 2024 expert consensus on irrigation and intracanal medication emphasizes that intracanal medicaments are adjuncts to, rather than replacements for, thorough preparation and irrigation. Further randomized clinical trials should evaluate standardized formulations, adverse effects, postoperative pain, and long-term periapical healing.

✍️ Conclusion
Intracanal dexamethasone represents a potential adjunct for managing inflammation and postoperative pain in endodontics. Preliminary clinical evidence supports further investigation of calcium hydroxide–dexamethasone combinations and local corticosteroid application.
However, differences between solutions, compounded pastes, and commercially available corticosteroid–antibiotic preparations must be respected. Until stronger evidence establishes standardized protocols and long-term outcomes, intracanal dexamethasone should be regarded as a promising but insufficiently validated approach rather than a routine replacement for established endodontic medicaments.

🎯 Clinical Recommendations
▪️ Consider intracanal corticosteroid evidence critically and distinguish findings for dexamethasone from those for other glucocorticoids.
▪️ Do not assume that adding dexamethasone to calcium hydroxide improves antimicrobial efficacy or long-term healing.
▪️ Avoid unvalidated compounded formulations when compatibility, stability, dosage, and tissue safety have not been established.
▪️ Prioritize definitive infection control, appropriate case selection, and a durable coronal seal.

📚 References
✔ Ghanbarzadegan, A., Ajami, M., & Aminsobhani, M. (2019). The effect of different combinations of calcium hydroxide as intra-canal medicament on endodontic pain: A randomized clinical trial study. Iranian Endodontic Journal, 14(1), 1–6. https://doi.org/10.22037/iej.v14i1.22815
✔ Moskow, A., Morse, D. R., Krasner, P., & Furst, M. L. (1984). Intracanal use of a corticosteroid solution as an endodontic anodyne. Oral Surgery, Oral Medicine, and Oral Pathology, 58(5), 600–604. https://doi.org/10.1016/0030-4220(84)90086-0
✔ Negm, M. M. (2001). Intracanal use of a corticosteroid-antibiotic compound for the management of posttreatment endodontic pain. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 92(4), 435–439. https://doi.org/10.1067/moe.2001.115975
✔ Zou, X., Zheng, X., Liang, Y., Zhang, C., Fan, B., Liang, J., Ling, J., Bian, Z., Yu, Q., Hou, B., Chen, Z., Wei, X., Qiu, L., Chen, W., He, W., Xu, X., Meng, L., Chen, Z., Chen, L., ... Yue, L. (2024). Expert consensus on irrigation and intracanal medication in root canal therapy. International Journal of Oral Science, 16, Article 23. https://doi.org/10.1038/s41368-024-00280-5

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Antimicrobial Therapy in Pediatric Dentistry: A Clinical Guide

Antimicrobial therapy in pediatric dentistry plays an important role in managing selected odontogenic infections and preventing complications in children at increased risk of infective endocarditis.

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However, antibiotics are not a substitute for definitive dental treatment, and their inappropriate use contributes to antimicrobial resistance, adverse drug reactions, and unnecessary exposure.

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Clinical decisions should consider the child's age, body weight, medical history, infection severity, and the availability of source control through procedures such as pulpotomy, pulpectomy, drainage, or extraction.
This guide summarizes key evidence-based principles for the rational use of antimicrobial agents in pediatric dental practice.

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✅ Indications for antimicrobial therapy
Systemic antibiotics are generally indicated when an odontogenic infection is accompanied by systemic involvement or spreading infection, or when specific medical circumstances justify their use. Localized dental disease should primarily receive definitive dental treatment.

▪️ Systemic involvement: fever, malaise, progressive facial swelling, lymphadenopathy associated with spreading infection, or cellulitis.
▪️ Spreading or severe infection: infections involving facial spaces, rapidly progressing swelling, or signs of systemic deterioration.
▪️ Selected high-risk medical conditions: antimicrobial prophylaxis may be required for specific cardiac conditions or other circumstances identified in current guidelines.

By contrast, irreversible pulpitis, symptomatic apical periodontitis, and a localized draining sinus tract do not routinely require systemic antibiotics in otherwise healthy children when appropriate dental treatment can be provided. The American Academy of Pediatric Dentistry (AAPD) emphasizes distinguishing localized disease from acute facial swelling and systemic infection.

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✅ Common antimicrobial agents in pediatric dentistry
The selection of an antimicrobial agent should reflect the suspected pathogens, infection severity, allergy history, previous antibiotic exposure, and applicable local guidance.

Agent	Clinical role
Amoxicillin	Common first-line option for indicated odontogenic infections.
Amoxicillin–clavulanate	May be considered for selected infections requiring broader coverage or when initial therapy fails after reassessment.
Azithromycin	An alternative in selected patients with penicillin allergy, depending on allergy phenotype and local resistance.
Metronidazole	May be used as an adjunct in selected infections requiring additional anaerobic coverage.
Clindamycin	Use cautiously because of its association with Clostridioides difficile infection; safer suitable alternatives should be considered.

These agents are not interchangeable, and the table is not a prescribing protocol. Antibiotic selection should follow current pediatric guidance, local susceptibility patterns, and individual patient assessment. Routine broad-spectrum therapy is not justified when a narrower agent is appropriate.

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✅ Pediatric dosing and safety considerations
Unlike adult prescribing, pediatric antimicrobial therapy generally requires weight-based dosing, with attention to maximum recommended doses and the specific indication.

▪️ Calculate the dose using the child's current weight (kg) and the recommended mg/kg per dose or mg/kg/day, as specified by the applicable guideline.
▪️ Check the maximum single and daily dose, formulation concentration, dosing interval, and duration.
▪️ Document the nature and severity of any reported drug allergy; distinguish genuine immediate hypersensitivity from nonallergic adverse effects.
▪️ Review renal or hepatic impairment, relevant drug interactions, previous antibiotic exposure, and the child's ability to take the prescribed formulation.
▪️ Explain administration, adherence, adverse effects, and the need for reassessment if symptoms persist or worsen.

Do not extrapolate adult doses directly to children. Exact prescriptions must be individualized according to age, weight, clinical diagnosis, and current pediatric prescribing recommendations.

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✅ Antibiotic prophylaxis in pediatric dental patients
Antibiotic prophylaxis is reserved for selected high-risk patients, particularly those with specific cardiac conditions associated with adverse outcomes from infective endocarditis. It is not routinely indicated for healthy children undergoing ordinary dental procedures.
The 2026 AAPD guidance recommends evaluating the patient's underlying condition and the planned procedure, particularly whether it involves gingival manipulation, the periapical region, or perforation of oral mucosa. Consultation with the child's physician may be appropriate when risk classification is uncertain.
Prophylaxis should follow current AAPD and American Heart Association recommendations, including the appropriate agent, weight-based dose, and timing. It should not be confused with a therapeutic antibiotic course for an established infection.

💬 Discussion
The principal challenge in antimicrobial therapy in pediatric dentistry is balancing infection control against the consequences of unnecessary antibiotic exposure. Because many pulpal and periapical conditions are driven by infection within a tooth or a localized collection of pus, definitive dental treatment remains essential.
The AAPD's pediatric-specific recommendations support judicious prescribing, while the ADA's evidence-based guideline provides complementary evidence against routine antibiotics for most pulpal and periapical conditions in immunocompetent adults. The ADA recommendations should not be transferred uncritically to children; pediatric decisions should be grounded primarily in pediatric guidance and clinical assessment.
Another important consideration is antimicrobial resistance. Unnecessary prescriptions expose children to adverse effects without reliably resolving the underlying dental cause. Conversely, delaying treatment in a child with rapidly spreading infection or systemic compromise can result in serious complications. Prompt diagnosis, source control, appropriate antimicrobial selection, and timely reassessment are therefore complementary components of care.

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✍️ Conclusion
Rational antimicrobial prescribing in pediatric dentistry requires accurate diagnosis, appropriate source control, and individualized risk assessment. Antibiotics should be prescribed when clinically indicated, rather than routinely for dental pain or localized pulpal disease. Weight-based dosing, allergy assessment, awareness of antimicrobial resistance, and timely follow-up are essential to safe and effective treatment.

🎯 Clinical Recommendations
1. Prioritize source control: provide definitive dental treatment or drainage whenever indicated; antibiotics alone are insufficient for most odontogenic infections.
2. Recognize urgent presentations: rapidly progressive facial swelling, trismus, dysphagia, respiratory difficulty, or systemic deterioration warrants urgent evaluation and escalation of care.
3. Prescribe selectively: choose the narrowest appropriate agent and use a guideline-concordant pediatric regimen.
4. Reassess treatment response: persistent or worsening symptoms require reevaluation of the diagnosis, adequacy of drainage, adherence, and the need for referral or a change in management.

📚 References
✔ American Academy of Pediatric Dentistry. (2025). Use of antibiotic therapy for pediatric dental patients. In The Reference Manual of Pediatric Dentistry (pp. 559–563). American Academy of Pediatric Dentistry. Official guideline.
✔ American Academy of Pediatric Dentistry. (2026). Antibiotic prophylaxis for dental patients at risk for infection. In The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry. Official guideline.
✔ Lockhart, P. B., Tampi, M. P., Abt, E., Aminoshariae, A., Durkin, M. J., Fouad, A. F., Gopal, P., Hatten, B. W., Kennedy, E., Lang, M. S., Patton, L. L., Paumier, T., Suda, K. J., Pilcher, L., Urquhart, O., O'Brien, K. K., & Carrasco-Labra, A. (2019). Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. The Journal of the American Dental Association, 150(11), 906–921.e12. https://doi.org/10.1016/j.adaj.2019.08.020
✔ American Dental Association. (n.d.). Antibiotic stewardship. Official clinical resource.

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Pulpal Emergencies: Clinical and Pharmacological Management

Pulpal emergencies require prompt diagnosis, effective pain control, and definitive dental treatment. Common presentations include reversible pulpitis, symptomatic irreversible pulpitis, pulp necrosis, and associated apical inflammation or abscess.

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Pharmacological management is primarily intended to provide temporary pain relief and control spreading infection when indicated.

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According to the American Dental Association (ADA), nonsteroidal anti-inflammatory drugs (NSAIDs), alone or combined with acetaminophen, are first-line options for temporary management of acute dental pain. Medication does not replace definitive treatment, such as pulpotomy, pulpectomy, root canal treatment, or extraction when indicated.

✅ Clinical assessment and initial management

▪️ History: Assess pain onset, duration, spontaneous or nocturnal pain, thermal sensitivity, swelling, fever, allergies, current medications, and relevant medical conditions.
▪️ Examination: Perform pulp sensibility tests, percussion, palpation, periodontal assessment, and appropriate radiographic evaluation.
▪️ Diagnosis: Differentiate reversible pulpitis, symptomatic irreversible pulpitis, pulp necrosis, symptomatic apical periodontitis, and acute apical abscess.
▪️ Emergency intervention: Prioritize appropriate local anesthesia and definitive treatment. Drainage is indicated when an accessible abscess requires it.

Facial swelling that progresses rapidly, difficulty swallowing or breathing, floor-of-mouth swelling, or systemic toxicity requires urgent hospital evaluation because of the risk of deep-space infection or airway compromise.

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✅ Pharmacological management: adult doses
The following regimens are reference options for immunocompetent adults requiring temporary pain control. Selection must account for medical history, contraindications, concomitant medications, and local prescribing guidance.

Table 1. Analgesics for acute pulpal pain

Medication	Adult dose	Clinical considerations
Ibuprofen	400 mg every 6 hours as needed	First-line NSAID; avoid in active peptic ulcer, significant renal disease, or relevant NSAID hypersensitivity.
Naproxen sodium	440 mg initially, then 220 mg every 8–12 hours as needed	Alternative NSAID; consider gastrointestinal, renal, and cardiovascular risks.
Acetaminophen (paracetamol)	500–1,000 mg every 6–8 hours as needed	Alternative when NSAIDs are unsuitable; reduce or avoid as appropriate in liver disease and account for all combination products.
Ibuprofen + acetaminophen	Ibuprofen 400 mg + acetaminophen 500 mg per dose	Combination may improve analgesia when both medications are appropriate.

Dosing safety: Use the lowest effective dose for the shortest necessary period. Do not combine ibuprofen with naproxen or another NSAID. The ADA guideline lists maximum daily doses of 2,400 mg for ibuprofen, 1,100 mg for naproxen sodium, and 4,000 mg for acetaminophen; these are guideline ceilings, not targets. Lower limits may be appropriate, especially for acetaminophen.

Local anesthesia
Local anesthetic administration can provide immediate relief while definitive treatment is arranged or performed. Lidocaine 2% with epinephrine 1:100,000 is a commonly used option. Select the agent and dose according to the patient's medical status, product labeling, weight where relevant, and maximum recommended dose. In cases of severe irreversible pulpitis, supplemental anesthesia may be required.

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✅ Antibiotics: indications and adult regimens
Antibiotics are not routinely indicated for pulpitis, including symptomatic irreversible pulpitis, even when pain is severe. They do not eliminate the inflamed pulp or replace endodontic treatment.
Systemic antibiotics may be indicated when an odontogenic infection has systemic involvement, such as fever or malaise, or when there is spreading infection. The need for immediate referral or hospital care must be assessed independently of the prescription.

Table 2. Antibiotic options when indicated

Antibiotic	Adult regimen	Important notes
Amoxicillin	500 mg every 8 hours	ADA first-line option when antibiotics are indicated.
Penicillin V potassium	500 mg every 6 hours	Alternative first-line option under ADA guidance.
Clindamycin	300 mg orally every 6 hours for 3–7 days, when indicated	Use cautiously due to the risk of Clostridioides difficile infection, including potentially life-threatening colitis. Consider safer alternatives when appropriate.

The ADA guideline specifies a 3–7-day course for these regimens when indicated, reassessment within 3 days, and discontinuation 24 hours after symptoms resolve. Confirm allergy history and applicable local guidelines before prescribing. Avoid selecting alternatives such as clindamycin without careful consideration of adverse effects, including Clostridioides difficile infection.

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💬 Discussion
Pharmacological management of pulpal emergencies should be guided by the clinical diagnosis rather than pain intensity alone. The evidence supports NSAIDs, with or without acetaminophen, as first-line temporary analgesia, while routine opioid prescribing is discouraged.
Antibiotic overprescribing remains a relevant concern in endodontic emergencies. In immunocompetent adults, antibiotics offer limited benefit for most conditions confined to the pulp and periapical tissues when definitive dental treatment is available. Treatment delay should therefore be minimized, and patients with systemic involvement or progressive infection require prompt reassessment.

✍️ Conclusion
Effective management of pulpal emergencies depends on accurate diagnosis, appropriate analgesia, and timely definitive dental treatment. Antibiotics should be reserved for appropriate clinical indications, and patients with signs of spreading infection must receive urgent evaluation. A prescription alone is insufficient to resolve the underlying pulpal disease.

🎯 Clinical Recommendations
▪️ Prioritize definitive treatment: Remove the source of pulpal disease through appropriate vital pulp therapy, endodontic treatment, drainage, or extraction.
▪️ Individualize analgesia: Consider medical history, contraindications, drug interactions, and cumulative daily doses before prescribing.
▪️ Avoid unnecessary antibiotics: Severe pulpal pain alone is not an indication for systemic antimicrobial therapy.
▪️ Establish a clear follow-up plan: Reassess deterioration promptly and ensure definitive treatment is completed without unnecessary delay.

📚 References
✔ Carrasco-Labra, A., Polk, D. E., Urquhart, O., Aghaloo, T., Claytor, J. W., Dhar, V., et al. (2024). Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania. The Journal of the American Dental Association, 155(2), 102–117.e9. https://doi.org/10.1016/j.adaj.2023.10.009
✔ Lockhart, P. B., Tampi, M. P., Abt, E., Aminoshariae, A., Durkin, M. J., Fouad, A. F., Gopal, P., Hatten, B. W., Kennedy, E., Lang, M. S., Patton, L. L., Paumier, T., Suda, K. J., Pilcher, L., Urquhart, O., O’Brien, K. K., & Carrasco-Labra, A. (2019). Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling: A report from the American Dental Association. The Journal of the American Dental Association, 150(11), 906–921.e12. https://doi.org/10.1016/j.adaj.2019.08.020
✔ American Association of Endodontists. (n.d.). Emergency treatment. https://www.aae.org/specialty/topic/emergency-treatment/

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