Valacyclovir in Pain Management of Acute Apical Abscesses

Inclusion Criteria: * Patient must be ≥ 18-year-old * Patient must be systemically healthy; American Society of Anesthesiologists (ASA) Class I or II * Patient must exhibit clinical evidence of pulp necrosis and acute apical abscess * Patient must present with radiographic * signs of apical disease either by * periapical radiography or cone-beam * computed tomography * Patient consented to receive conventional pulpal debridement, incision and drainage at the end of the study * Persistent pain of moderate or higher level (\>4) was the main inclusion criterion. Pain assessed as follows: 0 defined as no pain, 1-3 as mild pain, 4-6 as moderate pain, and 7-10 as severe pain Exclusion Criteria: * Smokers (more than 10 cigarettes per day) * External or internal tooth resorption * Marginal periodontitis * Pregnant or nursing mothers (hormonal factors may influence the periapical condition) * Documented allergic or adverse reactions to amoxicillin or valacyclovir * Teeth with unusual anatomy or inaccurate clinical diagnosis on the day of treatment (i.e., partially necrotic pulp) * Patients currently taking antibiotics or antiviral medications