Prostaglandins: their possible role in the pathogenesis of pulpal and periapical diseases, part 2

Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A placebo-controlled clinical study

BACKGROUND

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to compare the effect of the administration of preoperative ibuprofen, ketorolac, combination of etodolac with paracetamol and combination of aceclofenac with paracetamol versus placebo for the potential increased effectiveness of the inferior alveolar nerve block [IANB] anesthesia.

MATERIALS AND METHODS

A total of 100 endodontic emergency patients in moderate to severe pain diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, either a drug or placebo 30 minutes before the administration of a conventional IANB. Cold testing was done before administration of anesthesia to determine level of pain using Heft-Parker Visual Analogue Scale (VAS) score. Success was defined as no pain or pain (VAS) on access or initial instrumentation.

RESULTS

Overall success was 54% for all the groups. Success was highest (70%) for the ketorolac group, 55% for both ibuprofen group and combination of aceclofenac with paracetamol group, 50% for combination of etodolac with paracetamol group, and 40% for the placebo group.

CONCLUSIONS

Under the conditions of this study, the use of preoperative medication did improve the anesthetic efficacy of IANB for the treatment of teeth diagnosed with irreversible pulpitis but not significantly.

Gender differences in analgesia for endodontic pain

The purpose of this prospective clinical trial was to investigate the analgesic efficacy of three oral medication groups on postoperative endodontic pain in male and female dental patients, with an emphasis on analgesic differences between the sexes. Forty-three patients were administered ibuprofen 600 mg, placebo, or pentazocine 50 mg/0.5 mg naloxone in a randomized, double-blinded manner. Beginning immediately after endodontic treatment, patients took the assigned medication every 6 hours for 24 hours and recorded their degree of discomfort on a 100-mm visual analog scale. Statistical analysis of the data showed that ibuprofen 600 mg provided statistically significantly greater analgesia than placebo at 6 and 12 hours (P = 0.0014 and 0.0024), and pentazocine/naloxone provided statistically significantly greater analgesia than placebo at 12 hours (P = 0.0084). Sex-dependent differences were noted within the pentazocine/naloxone group, which showed significantly greater analgesia in females compared with males (P = 0.007).

Prostaglandin E2 and treatment outcome in pulp therapy of primary molars with carious exposures

OBJECTIVES

Prostaglandin E2 (PGE2) has been suggested as an indicator of irreversible pulpitis in permanent teeth [1]. There is scant information on the role of chemical mediators in primary molar pulp inflammation. The aim of this preliminary study was to investigate the levels of PGE2 in blood harvested from root pulp stumps following coronal pulp amputation in vital primary molar teeth with carious exposures.

METHODS

Seventy-nine cariously exposed primary molars underwent treatment by one of two vital pulp therapy techniques. Blood was harvested from 38 teeth and volume and concentration of PGE2 ([PGE2]) determined [2]. Treatment outcome was assessed from both clinical and radiographic evidence.

RESULTS

PGE2 was detected in all samples, with a wide concentration range (1-2641 ng/mL). The distribution was skewed, requiring log transformation. The difference in the mean (log) [PGE2] for radiological success (3.12, SD 1.60 and failure (4.62, SD 1.80) was significant, t = 2.05, P = 0.047. The difference in the mean (log) [PGE2] for clinical success (3.24, SD 1.65) and failure (5.44, SD 1.43 was near-significant, t = 1.84, P = 0.074.

CONCLUSION

[PGE2] correlated positively with radiological outcome following vital pulp therapy.

Evaluation of the combination of flurbiprofen and tramadol for management of endodontic pain

Effective management of endodontic pain represents a continuing challenge. In this study, we evaluated the efficacy of flurbiprofen and a novel centrally acting analgesic, tramadol, alone and in combination, for reducing pain in endodontic emergency patients. Patients (n = 49) were administered a local anesthetic and underwent pulpectomy. They were then administered, on a double-blind basis, either: (i) placebo (one capsule to start and then every 6 h); (ii) flurbiprofen (100 mg loading dose and then 50 mg every 6 h); (iii) tramadol (100 mg loading dose and then 100 mg every 6 h); or (iv) the combination of flurbiprofen and tramadol (as above). Pulpectomy combined with placebo medication resulted in a 50% reduction in pain by 24 h (p < 0.01). Patients treated with flurbiprofen and tramadol reported less pain, compared with placebo treatment at 6 and 24 h (p < 0.01 for both). These results suggest that a nonsteroidal anti-inflammatory drug/opiate combination, together with endodontic therapy, may be useful in the management of endodontic pain.

Development of a method to detect and quantify prostaglandin E2 in pulpal blood from cariously exposed, vital primary molar teeth

AIM

The aim of this in vitro study was to detect and quantify an established marker of inflammation, prostaglandin E2 (PGE2), in blood samples harvested from radicular pulp stumps after coronal pulp amputation.

METHODOLOGY

Harvesting was achieved by a paper strip 'dip-stick' method and the volume of each sample estimated before storage at -80 degrees C. A competitive, plate-based enzyme immunoassay technique (EIA) was developed for detection and quantification of the inflammatory mediator assumed to be present in blood samples. Since this technique had not previously been used to assess pulp blood, steps in the development of harvesting, storage, extraction and validation of this sensitive assay are described.

RESULTS

Thirty-nine single-blood samples were assayed and yielded detectable amounts of PGE2 ranging from 1.0 to 2641 ng mL-1.

CONCLUSIONS

The results of this investigation indicate that the inflammatory mediator, PGE2 can be detected and quantified in small blood samples from pulp stumps. Further development may derive quantitative tests for determining the condition of pulp tissue in primary molar pulp treatment.

Evaluation of periapical injection of Ketorolac for management of endodontic pain

Effective pain management of the endodontic emergency patient is often a problem. Ketorolac tromethamine is the first nonsteroidal anti-inflammatory drug available for intramuscular injection in the United States. Although its analgesic efficacy is comparable with opiates after intramuscular injection, to date no study has evaluated its efficacy after intraoral periapical injection. Fifty-two endodontic emergency patients were injected (injection routes = intraoral infiltration/intramuscular deltoid) on a double-blind basis with either: (i) placebo/placebo, (ii) 30 mg ketorolac/placebo, (iii) placebo/30 mg ketorolac, or (iv) 2% mepivicaine with 1:20 K levonordefrin/placebo. Infiltration injection of ketorolac at on oral site produced significant analgesic effects, particularly in treating pain of mandibular origin. These results suggest that intraoral injection of ketorolac may prove to be a useful adjunct in the management of endodontic pain patients. Further studies are required to replicate these findings and to develop optimal treatment combinations.

Mediators of acute and chronic periradicular lesions

Multiple mechanisms are involved in the pathologic changes associated with formation of acute and chronic periradicular lesions. Mechanical injury to the periradicular tissues can cause activation of several pathways of inflammation and release of nonspecific mediators. Continuous irritation of periradicular tissues can cause activation of several pathways of inflammation and release of nonspecific mediators. Continuous egress of antigens from a pathologically involved root canal can also result in one or a combination of the various types of immunologic reactions. A number of these reactions participate in the destruction of periradicular tissues. Because of complex interactions between the various components of these systems, the dominance of any one pathway or substance may be difficult to establish.

Leukotrienes: their possible role in pulpal and periapical diseases

Leukotrienes play an important role in inflammation and its sequelae such as pain, swelling, and bone resorption. This review covers, their history, structure, synthesis, metabolism, biological effects, inhibitors, antagonists, and their possible role in pathogenesis of pulpal and periapical disease.

Complement activation as a possible in vitro indication of the inflammatory potential of endodontic materials

Samples of four brands of gutta-percha and the nine ingredients that make up one brand were studied in vitro to observe their interaction with the serum complement system, thus allowing for assessment of their possible inflammatory potential. Crossed immunoelectrophoresis of the third complement component was used as an indicator of complement activation. The four different brands of gutta-percha showed comparable complement activation as determined by C3 conversion. When the ingredients of one brand of gutta-percha were examined for complement-activating properties, major activities were associated with gutta-percha compound, agerite stalite-antioxidant, and titanium oxide food grade. The significance of the possible inflammatory potential of gutta-percha and its ingredients, as it relates to endodontic therapy, is discussed.

A review of the incidence of pain after an operation treatment visit: Part I

This review presented some typically encountered painful sequellae from routine restorative dental treatment. A brief description of the importance of Tomes' processes and free nerve endings were mentioned also. This review should serve as a background for a clinical study concerning posttreatment pain that will be described in a later article.