Efficacy of A Pre-Operative, Single Dose of Anti-Inflammatory Drugs for The Prevention and Control of Post-Endodontic Pain

Introduction

Effective management of endodontic pain represents a continuing challenge, with up to 40% of endodontic patients reporting post-operative pain of different degrees, which is more intense in the first 48 hours and progressively reduces with time. Several studies have emphasized that a preoperative single oral dose of anti-inflammatory drugs can modulate the release of inflammatory mediators and reduce the occurrence of side effects compared with repeated doses during the postoperative period. Recently researchers conducted a double-blind, placebo-controlled study to evaluate and compare the efficacy of a pre-operative single dose of nonsteroidal anti-inflammatory drug (NSAID) with corticosteroid (steroidal anti-inflammatory drug [SAID]) for the prevention and control of post-endodontic pain.

Patient Profile

Patients of age group between 18 to 50 years (62 men and 70 women) who required nonsurgical endodontic therapy in single or multirooted posterior teeth (premolars and molars) with vital or nonvital pulp and symptomatic teeth with mild-to-moderate pulpalgia.

Method

A total of 132 volunteers selected for nonsurgical root canal therapy were randomly divided into four groups (n=30 each): Group 1, piroxicam (20mg [NSAID]); Group 2, dexamethasone (4mg [SAID]); Group 3, deflazacort (30mg [SAID]); and Group 4, placebo. The pre-operative medications were administrated 1 hour before the start of standard endodontic treatment.

Results

Only 122 patients could complete the study protocol. Intensity and occurrence of pain was decreased in all the four experimental groups at 6, 12, 24, 48, and 72 hours’ intervals after root canal instrumentation but was greatest in Group 2 (dexamethasone), followed by Group 1 (piroxicam) and Group 3 (deflazacort); the least reduction was found in Group 4 (placebo). In the dexamethasone group, the percentage of patients reporting no pain after a 6-hour period was 77%, which increased to 100% after 72 hours.

Overall, dexamethasone resulted in greater reduction in pain followed by piroxicam and deflazacort at between 6 to 72 hours’ intervals after root canal instrumentation. Also, prophylactic administration of 20 mg of piroxicam before initiating root canal treatment was more effective in reducing post-operative pain compared with deflazacort.

Conclusion

Hence, the study demonstrated that administration of a pre-operative, single oral dose of anti-inflammatory drugs such as NSAID or SAID instead of multiple post-operative doses improved patient compliance and reduced side effects from medications.

J Conserv Dent. 2019 Jan-Feb; 22(1): 54–58.