1
|
Aggarwal V, Ahmad T, Singla M, Gupta A, Saatchi M, Hasija M, Meena B, Kumar U. Addition of 2 mg dexamethasone to improve the anesthetic efficacy of 2% lidocaine with 1:80,000 epinephrine administered for inferior alveolar nerve block to patients with symptomatic irreversible pulpitis in the mandibular molars: a randomized double-blind clinical trial. J Dent Anesth Pain Med 2022; 22:305-314. [PMID: 35991360 PMCID: PMC9358268 DOI: 10.17245/jdapm.2022.22.4.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction This clinical trial aimed to evaluate the anesthetic effect of the addition of 2 mg (4 mg/ml) of dexamethasone to 2% lidocaine (plain or with 1:80,000 epinephrine). The solutions were injected for a primary inferior alveolar nerve block (IANB) to provide mandibular anesthesia for the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Methods In a double-blinded setup, 124 patients randomly received either of the following injections: 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, or plain 2% lidocaine mixed with 2 mg dexamethasone, which were injected as a primary IANB. Ten minutes after injection, patients with profound lip numbness underwent electric and thermal pulp sensibility tests. Patients who responded positively to the tests were categorized as "failed" anesthesia and received supplemental anesthesia. The remaining patients underwent endodontic treatment using a rubber dam. Anesthetic success was defined as "no pain or faint/weak/mild pain" during endodontic access preparation and instrumentation (HP visual analog scale score < 55 mm). The effect of the anesthetic solutions on the maximum change in heart rate was also evaluated. The Pearson chi-square test at 5% and 1% significance was used to analyze anesthetic success rates. Results The 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, and plain 2% lidocaine mixed with 2 mg dexamethasone groups had anesthetic success rates of 34%, 59%, and 29%, respectively. The addition of dexamethasone resulted in significantly better results (P < 0.001, χ2 = 9.07, df = 2). Conclusions The addition of dexamethasone to 2% lidocaine with epinephrine, administered as an IANB, can improve the anesthetic success rates during the endodontic management of symptomatic mandibular molars with irreversible pulpitis.
Collapse
Affiliation(s)
- Vivek Aggarwal
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Tanveer Ahmad
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Mamta Singla
- Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, Haryana, India
| | - Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabaad, India
| | - Masoud Saatchi
- Department of Endodontics, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mukesh Hasija
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Babita Meena
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Umesh Kumar
- Division of Conservative Dentistry and Endodontics, Post Graduate Institute of Medical Sciences, Chandigarh, India
| |
Collapse
|
2
|
Fenton C, Lee A. Manage endodontic pain with a combination of analgesics, including non-steroidal anti-inflammatory drugs. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00898-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
3
|
Thompson W, Howe S, Pitkeathley C, Coull C, Teoh L. Outcomes to evaluate care for adults with acute dental pain and infection: a systematic narrative review. BMJ Open 2022; 12:e057934. [PMID: 35190445 PMCID: PMC8860024 DOI: 10.1136/bmjopen-2021-057934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify outcomes reported in peer-reviewed literature for evaluating the care of adults with acute dental pain or infection.DesignSystematic narrative review. SETTING/PARTICIPANTS Primary research studies published in peer-reviewed literature and reporting care for adults with acute dental pain or infection across healthcare settings. Reports not in English language were excluded. STUDY SELECTION Seven databases (CINAHL Plus, Dentistry and Oral Sciences Source, EMBASE, MEDLINE, PsycINFO, Scopus, Web of Science) were searched from inception to December 2020. Risk of bias assessment used the Critical Appraisal Skills Programme checklist for randomised controlled trials and Quality Assessment Tool for Studies of Diverse Design for other study types. OUTCOMES Narrative synthesis included all outcomes of care for adults with acute dental pain or infection. Excluded were outcomes about pain management to facilitate treatment, prophylaxis of postsurgical pain/infection or traumatic injuries. RESULTS Searches identified 19 438 records, and 27 studies (dating from 1993 to 2020) were selected for inclusion. Across dental, pharmacy, hospital emergency and rural clinic settings, the studies were undertaken in high-income (n=20) and low/middle-income (n=7) countries. Two clinical outcome categories were identified: signs and symptoms of pain/infection and complications following treatment (including adverse drug reactions and reattendance for the same problem). Patient-reported outcomes included satisfaction with the care. Data collection methods included patient diaries, interviews and in-person reviews. DISCUSSION A heterogeneous range of study types and qualities were included: one study, published in 1947, was excluded only due to lacking outcome details. Studies from dentistry reported just clinical outcomes; across wider healthcare more outcomes were included. CONCLUSIONS A combination of clinical and patient-reported outcomes are recommended to evaluate care for adults with acute dental pain or infection. Further research is recommended to develop core outcomes aligned with the international consensus on oral health outcomes. PROSPERO REGISTRATION NUMBER CRD42020210183.
Collapse
Affiliation(s)
- Wendy Thompson
- The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Shaun Howe
- Public Dental Service, NHS Shetland, Lerwick, UK
| | | | - Carly Coull
- Oral and Maxillofacial Services, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Teoh
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Abstract
Pain associated with infections of the tooth pulp and periapical tissues is intense and often the most common reason for patients seeking emergency dental care. Effective management of acute dental pain requires a deep understanding of pain mechanisms, which enables accurate diagnosis and definitive treatment. While drugs are only used as an adjunct to definitive dental treatment, a thorough understanding of their mechanism of action and effectiveness enables clinicians to effectively control intra-operative and post-operative pain and prevent persistent pain. This review describes how pain is detected, processed, and perceived. It also provides information on evidence-based strategies on the use of different classes of drugs to effectively manage endodontic pain.
Collapse
Affiliation(s)
- Asma A Khan
- Department of Endodontics, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| |
Collapse
|
5
|
Fazlyab M, Esmaeili Shahmirzadi S, Esnaashari E, Azizi A, Moshari AA. Effect of low-level laser therapy on postoperative pain after single-visit root canal retreatment of mandibular molars: A randomized controlled clinical trial. Int Endod J 2021; 54:2006-2015. [PMID: 34383325 DOI: 10.1111/iej.13608] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 01/20/2023]
Abstract
AIM To compare the effect of low-level laser therapy (LLLT) on postoperative pain after single-visit root canal retreatment on mandibular molars. METHODOLOGY This randomized controlled clinical trial included 36 patients referred to the Department of Endodontics, Islamic Azad University, Tehran, Iran. Healthy patients who required root canal retreatment on symptomatic first or second mandibular molars, with a PAI index score of 2 or 3, preoperative tooth and percussion pain of <56 mm on a 170-mm visual analogue scale (VAS) were included. After local anaesthesia using inferior alveolar nerve block followed by rubber dam isolation and access cavity preparation, the D RaCe retreatment system was used to remove the existing root filling material, and after canal negotiation and gaining patency, working length was determined with an apex locator. Further canal enlargement was carried out with size 35, 0.04 taper, and size 40, 0.04 taper RaCe rotary instruments and then canals were filled using laterally compacted gutta-percha points and AH Plus sealer. The patients were randomly assigned to treatment groups: In the LLLT group, a 980-nm diode laser set at 6.89 W/cm2 energy density, 0.5 W power, and a tip diameter of 10 mm were activated from the buccal side on the mesial and distal root apices for 15 s. In the sham group, the laser handpiece was placed inside the patient's mouth at the same location, but the laser was not activated. Then patients were instructed to record their postoperative pain levels at 4, 8, 12 and 24 h and 2, 3 and 7 days after treatment on separate VAS scales. For data analysis, the independent sample t and the Mann-Whitney U tests were used. Nominal variables were analysed by using the chi-square test. RESULTS In the LLLT group, the most intense pain was reported 24 and 48 h post-treatment [mean (SD) = 0.22 (0.54) for both], whereas in the sham group, the most intense pain level was observed 4 h post-treatment [mean (SD) = 0.78 (0.80)]. At the 4-h interval, pain intensity was significantly lower in the LLLT group (p = .016). CONCLUSIONS Low-level laser therapy reduced postoperative pain after single-visit root canal retreatment of mandibular molars only four hours following the procedure.
Collapse
Affiliation(s)
- Mahta Fazlyab
- Department of Endodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.,Iranian Center For Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ehsan Esnaashari
- Department of Endodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Arash Azizi
- Oral Medicine Department, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Amir Abbas Moshari
- Department of Endodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| |
Collapse
|
6
|
Kaushik M, Mehra N, Sharma R, Moturi K, Podugu UK, George A. Comparing the Efficacy of Twin Mix and Lidocaine for Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis. Anesth Prog 2021; 67:207-213. [PMID: 33393600 DOI: 10.2344/anpr-67-03-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/20/2020] [Indexed: 11/11/2022] Open
Abstract
This randomized, active-controlled, double-blind, prospective clinical trial evaluated the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine versus an admixture of 2% lidocaine with 1:200,000 epinephrine and 1 mL of 4 mg dexamethasone (Twin mix) for inferior alveolar nerve blocks (IANBs) in patients with symptomatic irreversible pulpitis (SIP) of the mandibular molars. Seventy-eight patients with SIP of mandibular molars were randomly allocated to the 2 groups of 39 subjects. All patients were required to have profound lip numbness within 10 minutes of local anesthetic deposition. The efficacy of pulpal anesthesia was confirmed by absence of pain or mild pain (Heft-Parker visual analogue scale ≤54 mm) during access cavity preparation and placement of glide path files. The collected data were subjected to independent t test, chi-square test, and Fisher exact test using SPSS software version 20.0 at a significance level of 0.05. IANB success rates for the lidocaine group and the Twin mix group was 66% and 68% respectively, which was not a statistically significant difference (p > .05). This study demonstrated that the anesthetic efficacy of Twin mix was equivalent to 2% lidocaine for IANBs in teeth with SIP.
Collapse
Affiliation(s)
- Mamta Kaushik
- Professor and Head, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, India
| | - Neha Mehra
- Reader, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, India
| | | | - Kishore Moturi
- Professor and Head, Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, India
| | - Uday Kumar Podugu
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, India
| | - Alvin George
- Ex-PG student, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, India
| |
Collapse
|
7
|
Souza LN, de Arruda JAA. What are the benefits of intraosseous injection of dexamethasone in mandibular third molar surgeries? Int J Oral Maxillofac Surg 2020; 50:139-140. [PMID: 32499081 DOI: 10.1016/j.ijom.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- L N Souza
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - J A A de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
8
|
Powcharoen W. In response to Letter to the Editor entitled "What are the benefits of intraosseous injection of dexamethasone in mandibular third molar surgeries?". Int J Oral Maxillofac Surg 2020; 50:140. [PMID: 32493687 DOI: 10.1016/j.ijom.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- W Powcharoen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
| |
Collapse
|
9
|
Effect of calcium hydroxide mixed with lidocaine hydrochloride on postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis: a preliminary randomized controlled prospective clinical trial. Clin Oral Investig 2020; 25:203-210. [PMID: 32462277 DOI: 10.1007/s00784-020-03354-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the effect of calcium hydroxide mixed with lidocaine HCl on postoperative spontaneous pain. MATERIALS AND METHODS Sixty patients having irreversible pulpitis and symptomatic apical periodontitis with a preoperative spontaneous pain and percussion pain which was more than 50 on a visual analogue scale (100 mm VAS) were included in this study. After the preparation of the root canals, the patients were randomly distributed into two groups according to the calcium hydroxide vehicle, control group (mixed with saline) and calcium hydroxide mixed with lidocaine HCl (n = 30). Postoperative spontaneous pain scores were recorded by a VAS every day for a week. Data were analysed using one-way analysis of variance, chi-squared test and Mann-Whitney U tests (p = 0.05). RESULTS The calcium hydroxide mixed with lidocaine HCl group resulted in significantly less pain compared with the calcium hydroxide mixed with saline group during days 1 to 4 (p < 0.05). There were no significant differences between the groups in terms of postoperative percussion pain levels (p > 0.05). CONCLUSION Within the limitations of this study, it can be concluded that the calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis. CLINICAL RELEVANCE The calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis. CLINICAL REGISTRATION NUMBER TCTR20181121003.
Collapse
|
10
|
Comparison of intraosseous and submucosal dexamethasone injection in mandibular third molar surgery: a split-mouth randomized clinical trial. Int J Oral Maxillofac Surg 2020; 49:529-535. [DOI: 10.1016/j.ijom.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/03/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022]
|
11
|
Effect of Pulpotomy Procedures With Mineral Trioxide Aggregate and Dexamethasone on Post-endodontic Pain in Patients with Irreversible Pulpitis: A Randomized Clinical Trial. Eur Endod J 2020; 4:69-74. [PMID: 32161890 PMCID: PMC7006548 DOI: 10.14744/eej.2019.91885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: Endodontic post-treatment pain continues to be one of the main problems encountered by dental professionals. Therefore, pain control during and after endodontic treatment is one of the most important issues in endodontics. The purpose of this clinical trial was to compare postoperative pain relief achieved with dexamethasone (DEX) and mineral trioxide aggregate (MTA) used as pulp coverage after pulpotomy in human molars with irreversible pulpitis. Methods: This prospective double-blind study was conducted on 54 patients complaining of dental pain due to irreversible pulpitis. The standard pulpotomy procedure was performed by the same dentist in all patients. At the time of the cotton pellet placement, patients were randomly divided into three groups: those in whom a sterile dry cotton (DC) pellet was used, patients treated with a cotton pellet soaked in MTA, and those who were treated with a cotton pellet soaked in DEX. After completion of the treatment, patients received rescue medication every 6 hours for the first day. Postoperative pain was assessed at 6-hour intervals for 24 hours, and then every day until day 7 using a visual analog scale. Results: In general, patients treated with MTA suffered the lowest levels of pain at all time intervals. Post-pulpotomy pain was significantly reduced at 18 and 24 hours and from days 2 to 7 post-treatment in the MTA group. DEX lowered the pain level more than the DC pellet. However, the differences observed in the mean pain scores of the DEX and DC pellet groups at all-time intervals were not statistically significant. Conclusion: Pulpotomy procedures can reduce pain related irreversible pulpitis. Pulpotomy with MTA-soaked cotton pellet significantly reduces pain intensity in patients with irreversible pulpitis.
Collapse
|
12
|
Ibuprofen and Acetaminophen Versus Intranasal Ketorolac (Sprix) in an Untreated Endodontic Pain Model: A Randomized, Double-blind Investigation. J Endod 2019; 45:94-98. [PMID: 30711184 DOI: 10.1016/j.joen.2018.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Previously, ketorolac was available for primary use only via intravenous and intramuscular routes. Its availability in intranasal form offers an alternative route of administration that patients can self-administer. The purpose of this study was to compare the efficacy of intranasal ketorolac (Sprix; Egalet US Inc, Wayne, PA) with a combination of ibuprofen/acetaminophen in an acute pain model of untreated endodontic patients experiencing moderate to severe pain and symptomatic apical periodontitis. METHODS Seventy patients experiencing moderate to severe pain, a pulpal diagnosis of symptomatic irreversible pulpitis or necrosis, and a periapical diagnosis of symptomatic apical periodontitis participated. Patients were randomly divided into 2 groups and received either 31.5 mg intranasal ketorolac and placebo capsules or 1000 mg acetaminophen/600 mg ibuprofen capsules and a mock nasal spray. Patients recorded perceived pain scores on a visual analog scale every 15 minutes from drug administration up to 240 minutes. The time to 50% pain relief, the first sign of pain relief, and meaningful pain relief were recorded, and the data were analyzed. RESULTS A decline in reported pain was observed until 120 minutes after dosing, after which reported pain remained relatively constant. There was no significant difference between the 2 groups for the time to 50% pain relief, the first sign of pain relief, or meaningful pain relief. CONCLUSIONS The effectiveness of intranasal ketorolac was not significantly different from that of a 1000 mg acetaminophen/600 mg ibuprofen combination. Intranasal ketorolac provides a nonnarcotic alternative and an additional route of medication administration to practicing clinicians.
Collapse
|
13
|
Yavari HR, Jafari F, Jamloo H, Hallaj-Nezhadi S, Jafari S. The Effect of Submucosal Injection of Corticosteroids on Pain Perception and Quality of Life after Root Canal Treatment of Teeth with Irreversible Pulpitis: A Randomized Clinical Trial. J Endod 2019; 45:477-482. [PMID: 30910353 DOI: 10.1016/j.joen.2019.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 12/26/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of the present investigation was to study the effect of local infiltration of corticosteroids on postoperative pain and quality of life (QOL) in teeth with irreversible pulpitis after 1-visit endodontic treatment. METHODS In this double-blind randomized clinical trial, 242 healthy patients with irreversible pulpitis undergoing 1-visit endodontic treatment were included. Forty-five patients were lost during the follow-up, and the remaining 197 patients were followed for 7 days (67 patients in the placebo group, 66 in the long-acting betamethasone group, and 64 in the dexamethasone group). The patients marked their level of pain and QOL before treatment and at 6-, 12-, 24-, 48-, and 72-hour and 7-day postoperative intervals using a questionnaire. Freidman and Kruskal-Wallis tests were used for statistical analysis. P ≤ .05 was considered significant. RESULTS The pain was more severe in the placebo group compared with the other groups at all time intervals. A significant increase was observed in pain severity after 12 hours in all 3 groups. In general, the pain was less severe in the dexamethasone group compared with the betamethasone group at 6-, 12-, and 24-hour intervals. The pain severity was similar in both groups at 48 hours, and it was less severe in the long-acting betamethasone group compared with the dexamethasone group after 72 hours and 7 days. There were no significant differences in the betamethasone and dexamethasone groups in pain intensity between males and females. Moreover, overall pain perception was higher in the mandible than in the maxilla. There was an inverse and significant relationship between pain severity and QOL. CONCLUSIONS Infiltration of long-acting betamethasone and dexamethasone resulted in decreased postoperative pain experience. Dexamethasone was more effective in alleviating pain within the first 24-hour period after treatment. Infiltration of long-acting betamethasone and dexamethasone exhibited the same efficacy in 48 hours. The efficacy of long-acting betamethasone in pain relief lasted for 7 days. The QOL in the 2 groups receiving corticosteroids was higher than that in the placebo group.
Collapse
Affiliation(s)
- Hamid Reza Yavari
- Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farnaz Jafari
- Department of Endodontics, Dental School, Tabriz Branch, Islamic Azad University, Tabriz, Iran.
| | - Helen Jamloo
- Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayeh Hallaj-Nezhadi
- Drug Applied Research Center, Faculty of Pharmacology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanaz Jafari
- Department of Orthodontics, Faculty of Dentistry, Ilam University of Medical Sciences, Ilam, Iran
| |
Collapse
|
14
|
Fuller M, Younkin K, Drum M, Reader A, Nusstein J, Fowler S. Postoperative Pain Management with Oral Methylprednisolone in Symptomatic Patients with a Pulpal Diagnosis of Necrosis: A Prospective Randomized, Double-blind Study. J Endod 2018; 44:1457-1461. [DOI: 10.1016/j.joen.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/20/2018] [Accepted: 06/05/2018] [Indexed: 11/27/2022]
|
15
|
Suneelkumar C, Subha A, Gogala D. Effect of Preoperative Corticosteroids in Patients with Symptomatic Pulpitis on Postoperative Pain after Single-visit Root Canal Treatment: A Systematic Review and Meta-analysis. J Endod 2018; 44:1347-1354. [DOI: 10.1016/j.joen.2018.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 01/08/2023]
|
16
|
Shamszadeh S, Shirvani A, Eghbal MJ, Asgary S. Efficacy of Corticosteroids on Postoperative Endodontic Pain: A Systematic Review and Meta-analysis. J Endod 2018; 44:1057-1065. [DOI: 10.1016/j.joen.2018.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 11/17/2022]
|
17
|
Gundogdu EC, Arslan H. Effects of Various Cryotherapy Applications on Postoperative Pain in Molar Teeth with Symptomatic Apical Periodontitis: A Preliminary Randomized Prospective Clinical Trial. J Endod 2018; 44:349-354. [PMID: 29398090 DOI: 10.1016/j.joen.2017.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The purpose of the study was to evaluate the effects of intracanal, intraoral, and extraoral cryotherapy on postoperative pain in molar teeth with symptomatic apical periodontitis. METHODS A total of 100 patients were randomly distributed into 4 groups: control (without cryotherapy application), intracanal cryotherapy application, intraoral cryotherapy application, and extraoral cryotherapy application. The postoperative pain of the patients was recorded at the first, third, fifth, and seventh days. The data were statistically analyzed by using linear regression, χ2, one-way analysis of variance, Tukey post hoc, and Kruskal-Wallis H tests (P = .05). RESULTS There were no statistically significant differences among the groups in terms of demographic data (P > .05). The preoperative pain levels and preoperative visual analogue scale (VAS) scores of pain on percussion were similar among the groups (P > .05). The linear regression analysis demonstrated that group variable had the most significant effect on postoperative pain at day 1 (P < .001) among the other variables (group, age, gender, tooth number, preoperative pain levels, and VAS scores of pain on percussion). When compared with the control group, all the cryotherapy groups exhibited less percussion pain and less postoperative pain at the first, third, fifth, and seventh days (P < .05). CONCLUSIONS Within the study limitations, all the cryotherapy applications (intracanal, intraoral, and extraoral) resulted in lower postoperative pain levels and lower VAS scores of pain on percussion versus those of the control group.
Collapse
Affiliation(s)
- Eyup Candas Gundogdu
- Department of Endodontics, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Hakan Arslan
- Department of Endodontics, Faculty of Dentistry, Ataturk University, Erzurum, Turkey.
| |
Collapse
|
18
|
Arslan H, Doğanay E, Karataş E, Ünlü MA, Ahmed HMA. Effect of Low-level Laser Therapy on Postoperative Pain after Root Canal Retreatment: A Preliminary Placebo-controlled, Triple-blind, Randomized Clinical Trial. J Endod 2017; 43:1765-1769. [DOI: 10.1016/j.joen.2017.06.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/10/2017] [Accepted: 06/18/2017] [Indexed: 01/27/2023]
|
19
|
Effect of the Simultaneous Working Length Control during Root Canal Preparation on Postoperative Pain. J Endod 2017; 43:1422-1427. [DOI: 10.1016/j.joen.2017.04.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/27/2017] [Accepted: 04/29/2017] [Indexed: 11/18/2022]
|
20
|
Kérourédan O, Jallon L, Perez P, Germain C, Péli JF, Oriez D, Fricain JC, Arrivé E, Devillard R. Efficacy of orally administered prednisolone versus partial endodontic treatment on pain reduction in emergency care of acute irreversible pulpitis of mandibular molars: study protocol for a randomized controlled trial. Trials 2017; 18:141. [PMID: 28351379 PMCID: PMC5371272 DOI: 10.1186/s13063-017-1883-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/07/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Irreversible pulpitis is a highly painful inflammatory condition of the dental pulp which represents a common dental emergency. Recommended care is partial endodontic treatment. The dental literature reports major difficulties in achieving adequate analgesia to perform this emergency treatment, especially in the case of mandibular molars. In current practice, short-course, orally administered corticotherapy is used for the management of oral pain of inflammatory origin. The efficacy of intraosseous local steroid injections for irreversible pulpitis in mandibular molars has already been demonstrated but resulted in local comorbidities. Oral administration of short-course prednisolone is simple and safe but its efficacy to manage pain caused by irreversible pulpitis has not yet been demonstrated. This trial aims to evaluate the noninferiority of short-course, orally administered corticotherapy versus partial endodontic treatment for the emergency care of irreversible pulpitis in mandibular molars. METHODS/DESIGN This study is a noninferiority, open-label, randomized controlled clinical trial conducted at the Bordeaux University Hospital. One hundred and twenty subjects will be randomized in two 1:1 parallel arms: the intervention arm will receive one oral dose of prednisolone (1 mg/kg) during the emergency visit, followed by one morning dose each day for 3 days and the reference arm will receive partial endodontic treatment. Both groups will receive planned complete endodontic treatment 72 h after enrollment. The primary outcome is the proportion of patients with pain intensity below 5 on a Numeric Scale 24 h after the emergency visit. Secondary outcomes include comfort during care, the number of injected anesthetic cartridges when performing complete endodontic treatment, the number of antalgic drugs and the number of patients coming back for consultation after 72 h. DISCUSSION This randomized trial will assess the ability of short-term corticotherapy to reduce pain in irreversible pulpitis as a simple and rapid alternative to partial endodontic treatment and to enable planning of endodontic treatment in optimal analgesic conditions. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02629042 . Registered on 7 December 2015. (Version n°1.1 28 July 2015).
Collapse
Affiliation(s)
- Olivia Kérourédan
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- INSERM, Bioingénierie Tissulaire, U1026, 33076 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Léonard Jallon
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Paul Perez
- CHU de Bordeaux, USMR, Pôle Santé publique, 33076 Bordeaux, France
| | | | - Jean-François Péli
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Dominique Oriez
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Jean-Christophe Fricain
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- INSERM, Bioingénierie Tissulaire, U1026, 33076 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Elise Arrivé
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
- INSERM, ISPED, Centre INSERM U-897-Epidemiologie-Biostatistique, Bordeaux Cedex, 33076 France
| | - Raphaël Devillard
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- INSERM, Bioingénierie Tissulaire, U1026, 33076 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| |
Collapse
|
21
|
Iranmanesh F, Parirokh M, Haghdoost AA, Abbott PV. Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review. IRANIAN ENDODONTIC JOURNAL 2017; 12:123-130. [PMID: 28496516 PMCID: PMC5421265 DOI: 10.22037/iej.2017.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/02/2017] [Accepted: 03/04/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Post-operative pain and flare-up may occur in up to 58% of patients following root canal treatment. The aim was to conduct a systematic review and a possible meta-analysis to determine the effect of glucocorticosteroid (GCS) on pain following root canal treatment. METHODS AND MATERIALS Scopus, MEDLINE and CENTRAL databases were searched up to 30th January 2017 with broad key words. In addition, the reference lists in eligible papers and text books were hand-searched. Assessment of the eligibility of papers and data extraction were performed by two independent reviewers. RESULTS Of 9891 articles, 18 were recruited as eligible papers. Most of these papers showed pain reducing effect of GCS on post-endodontic pain. Because of wide heterogeneity among the recruited papers, it was not possible to perform meta-analysis. CONCLUSION Based on the results of this systematic review, there is a vast heterogeneity amongst articles regarding the use of GCS and their effect on post-operative pain after endodontic treatment. Further investigations with similar methods and materials are needed before meta-analysis on the effect of GCS on post-operative pain following root canal treatment can be performed.
Collapse
Affiliation(s)
- Foad Iranmanesh
- Department ofEndodontics, Dental School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran;
| | - Masoud Parirokh
- Endodontology Research Center, Dental School, Kerman University of Medical Sciences, Kerman, Iran;
| | - Ali Akbar Haghdoost
- Research Center for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran;
| | - Paul V. Abbott
- Dental School, University of Western Australia, Perth, Australia
| |
Collapse
|
22
|
Bultema K, Fowler S, Drum M, Reader A, Nusstein J, Beck M. Pain Reduction in Untreated Symptomatic Irreversible Pulpitis Using Liposomal Bupivacaine (Exparel): A Prospective, Randomized, Double-blind Trial. J Endod 2016; 42:1707-1712. [PMID: 27769675 DOI: 10.1016/j.joen.2016.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In the treatment of patients with symptomatic irreversible pulpitis, endodontic debridement is a predictable method to relieve pain. However, there are clinical situations in which emergency care cannot be provided immediately. An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible pulpitis. Some medical studies have shown potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA) to prolong pain relief and reduce opioid use postoperatively. The Food and Drug Administration has approved Exparel only for infiltrations; therefore, the purpose of this study was to compare an infiltration of liposomal bupivacaine versus bupivacaine for pain control in untreated, symptomatic irreversible pulpitis. METHODS Ninety-five emergency patients received 2% lidocaine with 1:100,000 epinephrine via infiltration or an inferior alveolar nerve block to relieve their initial presenting pain. Patients then randomly received either 4 mL liposomal bupivacaine (13.3 mg/mL) or 4 mL 0.5% bupivacaine with 1:200,000 epinephrine by infiltration. Patients received a diary for the day of the appointment and 3 days postinjection to record soft tissue numbness, pain levels, and analgesic (non-narcotic and narcotic) use. RESULTS No significant differences (P < .05) were found between the 2 anesthetic formulations for pain or the use of pain medications. A statistically higher level of soft tissue numbness was found on days 1 to 3 for the liposomal bupivacaine group. CONCLUSIONS Although liposomal bupivacaine had some effect on soft tissue anesthesia, it did not reduce pain to manageable clinical levels in patients presenting with untreated, symptomatic irreversible pulpitis.
Collapse
Affiliation(s)
- Kristy Bultema
- Division of Endodontics, Private Practice Limited to Endodontics, Beavercreek, Ohio
| | - Sara Fowler
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Division of Endodontics, The Ohio State University, Columbus, Ohio.
| | - John Nusstein
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Mike Beck
- Division of Biosciences, The Ohio State University, Columbus, Ohio
| |
Collapse
|
23
|
Randomized Clinical Trial of Intraosseous Methylprednisolone Injection for Acute Pulpitis Pain. J Endod 2016; 42:2-7. [DOI: 10.1016/j.joen.2015.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 11/20/2022]
|
24
|
Effect of Ibuprofen on Masking Endodontic Diagnosis. J Endod 2014; 40:1058-62. [DOI: 10.1016/j.joen.2014.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/14/2014] [Accepted: 05/09/2014] [Indexed: 11/17/2022]
|
25
|
Boopathi T, Sebeena M, Sivakumar K, Harikaran J, Karthick K, Raj A. Supplemental pulpal anesthesia for mandibular teeth. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2013; 5:S103-8. [PMID: 23946560 PMCID: PMC3722689 DOI: 10.4103/0975-7406.113307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/04/2013] [Accepted: 05/04/2013] [Indexed: 11/26/2022] Open
Abstract
Clinical pulpal anesthesia is dependent on the interaction of three major factors. (1) the dentist (2) the patient and (3) local anesthesia. Many patients fear endodontic treatment due to a concern about pain. Although pain treatment is well managed in many endodontic patients, there exists a group of patients who do not receive adequate local anesthesia. The purpose of this review article is to discuss the possible reasons for pulpal anesthetic failures and also to focus on the measures for developing effective approaches for the same.
Collapse
Affiliation(s)
- Thangavel Boopathi
- Department of Conservative Dentistry, K. S. R. Institute of Dental Science and Research, Namakkal District, Tamil Nadu, India
| | - Mathew Sebeena
- Department of Conservative Dentistry, K. S. R. Institute of Dental Science and Research, Namakkal District, Tamil Nadu, India
| | - Kailasam Sivakumar
- Department of Conservative Dentistry, K. S. R. Institute of Dental Science and Research, Namakkal District, Tamil Nadu, India
| | - Jayakodi Harikaran
- Department of Conservative Dentistry, K. S. R. Institute of Dental Science and Research, Namakkal District, Tamil Nadu, India
| | - Kumaravadivel Karthick
- Department of Conservative Dentistry, K. S. R. Institute of Dental Science and Research, Namakkal District, Tamil Nadu, India
| | - Aruna Raj
- Department of Conservative Dentistry, Government Dental College, Chennai, Tamil Nadu, India
| |
Collapse
|
26
|
Pain Prevalence and Severity before, during, and after Root Canal Treatment: A Systematic Review. J Endod 2011; 37:429-38. [DOI: 10.1016/j.joen.2010.12.016] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 11/18/2022]
|
27
|
Asgary S, Eghbal MJ. The effect of pulpotomy using a Calcium-Enriched Mixture cement versus one-visit root canal therapy on postoperative pain relief in irreversible pulpitis: a randomized clinical trial. Odontology 2010; 98:126-33. [DOI: 10.1007/s10266-010-0127-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 02/24/2010] [Indexed: 11/29/2022]
|
28
|
Nusstein JM, Reader A, Drum M. Local anesthesia strategies for the patient with a "hot" tooth. Dent Clin North Am 2010; 54:237-247. [PMID: 20433976 DOI: 10.1016/j.cden.2009.12.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Attaining local anesthesia for the treatment of teeth diagnosed with irreversible pulpitis ("hot" tooth) can be a challenge. This article looks at the strategies a dentist can use to help achieve adequate pulpal anesthesia for the patient, thereby eliminating or reducing treatment pain.
Collapse
Affiliation(s)
- John M Nusstein
- Division of Endodontics, The Ohio State University College of Dentistry, 305 West 12th Avenue, Room 3058, Columbus, OH 43210, USA.
| | | | | |
Collapse
|
29
|
Mehrvarzfar P, Shababi B, Sayyad R, Fallahdoost A, Kheradpir (LK. Effect of supraperiosteal injection of dexamethasone on postoperative pain. AUST ENDOD J 2008; 34:25-9. [DOI: 10.1111/j.1747-4477.2007.00076.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
Ianiro SR, Jeansonne BG, McNeal SF, Eleazer PD. The Effect of Preoperative Acetaminophen or a Combination of Acetaminophen and Ibuprofen on the Success of Inferior Alveolar Nerve Block for Teeth with Irreversible Pulpitis. J Endod 2007; 33:11-4. [PMID: 17185119 DOI: 10.1016/j.joen.2006.09.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 08/30/2006] [Accepted: 09/06/2006] [Indexed: 12/01/2022]
Abstract
This study compared preoperative administration of acetaminophen or a combination of acetaminophen and ibuprofen versus placebo for potential increased effectiveness of inferior alveolar nerve (IAN) block anesthesia. There were 40 patients with irreversible pulpitis randomly assigned to a drug or placebo group. Thirty minutes after ingestion of medication, an IAN block was administered. A cold test was done 15 minutes after the block, and if the patients had no sensitivity, endodontic therapy was initiated. If the patient had no pain on access, the IAN was recorded as successful. If the patient had sensitivity to cold or to the access procedure, it was recorded as a failure. Overall success was 60% for all three groups. Success was 71.4% for the acetaminophen group, 75.9% for the acetaminophen and ibuprofen group, and 46.2% for the placebo group. There was no significant difference between the groups; however, there was a trend toward higher success in the medication groups.
Collapse
Affiliation(s)
- Staci R Ianiro
- Department of Endodontics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | |
Collapse
|
31
|
Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic Efficacy of Articaine for Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis. J Endod 2004; 30:568-71. [PMID: 15273637 DOI: 10.1097/01.don.0000125317.21892.8f] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.
Collapse
Affiliation(s)
- Elizabeth Claffey
- Department of Oral Surgery, Oral Pathology, and Anesthesiology, The Ohio State University, Columbus, OH 43218, USA
| | | | | | | | | |
Collapse
|
32
|
Kennedy S, Reader A, Nusstein J, Beck M, Weaver J. The Significance of Needle Deflection in Success of the Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis. J Endod 2003; 29:630-3. [PMID: 14606783 DOI: 10.1097/00004770-200310000-00004] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this prospective, randomized, blinded study was to compare the anesthetic efficacy of the conventional inferior alveolar nerve block, administered with the needle bevel oriented away from the mandibular ramus, to the bidirectional-needle-rotation technique, administered using the computer-assisted Wand II anesthesia system, in patients diagnosed with irreversible pulpitis. Sixty-four emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a blinded manner, 2.8 ml of 2% lidocaine with 1:100,000 epinephrine using either a conventional inferior alveolar nerve block or a bidirectional-needle-rotational technique using the Wand II injection system. The conventional inferior alveolar nerve block was administered with the needle bevel oriented away from the mandibular ramus so the needle would deflect inward toward the mandibular foramen. The bidirectional-needle-rotation technique was administered by rotating the Wand handpiece assembly in a clockwise-counterclockwise movement (like an endodontic hand file) to minimize needle deflection. Endodontic access was begun 17 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (VAS recordings) on endodontic access or initial instrumentation. The results of this study showed no significant differences (p > 0.05) between the success rates of the two techniques. The conventional inferior alveolar nerve block, with the needle bevel oriented away from the mandibular ramus, had a 50% success rate. The bidirectional-needle-rotation technique with the Wand II had a 56% success rate. Neither technique resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.
Collapse
|
33
|
Nusstein JM, Beck M. Comparison of preoperative pain and medication use in emergency patients presenting with irreversible pulpitis or teeth with necrotic pulps. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 96:207-14. [PMID: 12931095 DOI: 10.1016/s1079-2104(02)91732-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This retrospective study compared differences in preoperative pain and medication use in patients with moderate to severe pain who sought emergency endodontic care for teeth with irreversible pulpitis and for symptomatic teeth with necrotic pulps. STUDY DESIGN A total of 323 patients seeking emergency endodontic treatment completed questionnaires regarding their biographical information, pain, pain history, and medications. Teeth were tested for vitality, mobility, percussion, and palpation pain. Lymphadenopathy was also evaluated. RESULTS Patients with irreversible pulpitis waited significantly (P <.05) longer before seeking emergency care (9 days vs 4 days) than patients with symptomatic teeth with necrotic pulps. No differences (P >.05) were found between the groups in terms of analgesic or antibiotic use and pain relief from preoperative narcotic medications. Nonnarcotic analgesics were reported to significantly reduce pain more often in patients with symptomatic teeth with necrotic pulps. There were sex differences in the group of patients with irreversible pulpitis: More women than men were taking analgesic medications and, in the group having symptomatic teeth with necrotic pulps, more men than women reported pain relief from their analgesic medications. CONCLUSION Patients with irreversible pulpitis wait longer to seek emergency treatment. A majority (81%-83%) of emergency patients with moderate to severe pain will have taken some type of medication(s) to help control their pain, and more women than men with irreversible pulpitis will take an analgesic. By taking their preoperative medication(s), this group of patients will get relief 62% to 65% of the time; furthermore, more men than women with symptomatic teeth with necrotic pulps will experience pain relief.
Collapse
Affiliation(s)
- John M Nusstein
- Advanced Endodontics, College of Dentistry, The Ohio State University, Columbus 43218-2357, USA.
| | | |
Collapse
|
34
|
Isett J, Reader A, Gallatin E, Beck M, Padgett D. Effect of an intraosseous injection of depo-medrol on pulpal concentrations of PGE2 and IL-8 in untreated irreversible pulpitis. J Endod 2003; 29:268-71. [PMID: 12701778 DOI: 10.1097/00004770-200304000-00010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this prospective, randomized, double-blind study was to evaluate the pulpal concentrations of prostaglandin E2 (PGE2) and interleukin-8 (IL-8) in untreated teeth with irreversible pulpitis after the administration of an intraosseous injection of Depo-Medrol. Forty emergency patients with a clinical diagnosis of irreversible pulpitis experiencing moderate to severe pain participated. After receiving local anesthesia, patients randomly received, in a double-blind manner, an intraosseous injection of either 1 ml of Depo-Medrol (40 mg) (20 patients) or 1 ml of sterile saline placebo (control) (20 patients). No endodontic treatment was initiated. At 1 or 3 days after the intraosseous injection, the teeth were extracted and the pulpal tissue harvested. Prostaglandin E2 and interleukin-8 concentrations were determined by enzyme immunoassay. Results demonstrated a significantly (p < 0.05) lower concentration of prostaglandin E2 compared to the saline group at day 1. There were no significant (p > 0.05) differences between the two groups at day 3. The pulpal concentrations of prostaglandin E2 were reduced at 1 day after the intraosseous injection of Depo-Medrol.
Collapse
Affiliation(s)
- James Isett
- The Ohio State University, Columbus 43218, USA
| | | | | | | | | |
Collapse
|
35
|
|
36
|
|
37
|
Abstracts. Br Dent J 2001. [DOI: 10.1038/sj.bdj.4800956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
38
|
Nagle D, Reader A, Beck M, Weaver J. Effect of systemic penicillin on pain in untreated irreversible pulpitis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:636-40. [PMID: 11077389 DOI: 10.1067/moe.2000.109777] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this prospective, randomized, double-blind study was to determine the effect of penicillin on pain in untreated teeth diagnosed with irreversible pulpitis. STUDY DESIGN Forty emergency patients participated, and each had a clinical diagnosis of an irreversible pulpitis. Patients randomly received a 7-day oral dose (28 capsules, 500 mg each, to be taken every 6 hours) of either penicillin or a placebo control in a double-blind manner. No endodontic treatment was performed. Each patient also received ibuprofen; acetaminophen with codeine (30 mg); and a 7-day diary to record pain, percussion pain, and number and type of pain medication taken. RESULTS The administration of penicillin did not significantly (P >.05) reduce pain, percussion pain, or the number of analgesic medications taken by patients with untreated irreversible pulpitis. The majority of patients with untreated irreversible pulpitis had significant pain and required analgesics to manage this pain. CONCLUSION Penicillin should not be prescribed for untreated irreversible pulpitis because penicillin is ineffective for pain relief.
Collapse
Affiliation(s)
- D Nagle
- The Ohio State University, Columbus 43218-2357, USA
| | | | | | | |
Collapse
|