Irreversible pulpitis or toothache occurs when the soft tissue and nerve inside the tooth (the dental pulp) becomes damaged as a result of decay, trauma or large fillings. The intense pain is caused by inflammation of the dental pulp and the tissue surrounding the root – not by infection. Because this is not an infection, antibiotics do not relieve the pain and should not be used. Treatment for this condition is the removal of the damaged or diseased dental pulp, either through root canal therapy or extraction of the tooth. Inflammatory dental pain is best managed by non-steroidal inflammatory drugs.
Sources:
Agnihotry A. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev. 2016 Feb 17;2:CD004969. PMID: 26886473.
Cope A, et al. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev. 2014 Jun 26;(6):CD010136. PMID: 24967571.
Sutherland S et al. 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. PMID: 12622880.