Comparative assessment of efficacy of two different pretreatment single oral doses of betamethasone on inter-appointment and postoperative discomfort: An in vivo clinical evaluation

Systemic Corticosteroid Uses in Endodontics-Part 1: Managing Postoperative Pain

INTRODUCTION

This study aimed to systematically search and review all available literature regarding systemic (oral or locally injected) corticosteroids in endodontics to assess their effect on postoperative pain.

METHODS

A search was conducted using PubMed, Cochrane Library, Embase, Scopus, Dentistry & Oral Science, and ProQuest. Randomized controlled trials enrolling participants undergoing endodontic treatment and assessing the presence of pain and pain scores at 6, 12, and 24 hours postoperatively were included. We synthesize the effect measures using risk ratios (RRs), standardized mean differences (SMDs), and their corresponding 95% confidence intervals (CIs). Meta-analysis was performed using the random-effects inverse variance method. The level of significance was set at P < .05. The certainty of the evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation approach.

RESULTS

A total of 2303 participants from 29 trials were included. Patients who received corticosteroids were significantly less likely to report pain at 6 hours (RR = 2.5; 95% CI, 1.74-3.61; P < .00001), 12 hours (RR = 2.10; 95% CI, 1.53-2.90; P < .00001), and 24 hours (RR = 1.77; 95% CI, 1.38-2.28; P < .00001) postoperatively. Furthermore, they reported lower pain intensity at 6 hours (SMD = - 0.82; 95% CI, -1.17 to -0.48; P < .00001), 12 hours (SMD = - 0.63; 95% CI, -0.75 to -0.51; P < .00001), and 24 hours (SMD = - 0.68; 95% CI, -0.90 to -0.46; P < .00001) postoperatively.

CONCLUSIONS

Moderate certainty evidence indicates that the use of systemic corticosteroids likely results in a moderate to large reduction in postoperative endodontic pain.

Nonclinical research areas of future importance for clinical therapies: Exploring the concepts of nonlinearity in dentistry

Linear system analysis has been dominating medical and dental research, and most of the research achievements in these fields have come from applying a reductionist view of nature. However, biologic systems are fundamentally nonlinear with highly composite dynamics made up of numerous interacting elements and feedback loops, therefore studying them as linear models may not result in an accurate representation of their true features. The authors reviewed and utilized some of the principles of chaos and nonlinearity and extended them to clinical dentistry, from cracked tooth and flare-up after root canal procedures to the outcome of clinical treatments. Utilization of the concepts of chaos and sensitive dependence on initial conditions, and the concepts of self-organization, stigmergy, and fractals may help us to understand some of the puzzles that have not been solved by conventional linear models. The goal of this paper is to present some areas within nonclinical research that we believe will have important roles in the development of future clinical examination methods and therapies.

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

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.

Comparative evaluation of the efficacy of diclofenac sodium administered using different delivery routes in the management of endodontic pain: A randomized controlled clinical trial

Introduction

Pain of endodontic origin is of concern to both the patient and the clinician. Expectation of a painful experience can increase the patient's anxiety levels, making treatment more difficult. Management of endodontic pain is one of the challenging aspects in endodontics.

Objective

To evaluate whether the intraligamentary mode of administration of diclogfenac sodium is effective in abating endodontic pain during interappointment visits.

Aim

The purpose of this clinical trial is to evaluate the analgesic efficacy of diclofenac sodium administered through oral and intraligamentary routes in reducing postendodontic pain.

Materials and Methods

Thirty patients were randomly allocated into three groups. Group A - placebo (Vitamin B12), Group B - diclofenac sodium (intraligamentary), and Group C - diclofenac sodium tablets. The tablets were given 30 min before the start of the procedure, while the intraligamentary injection was administered before commencing the endodontic procedure. The visual analog scale was used to evaluate the pain score at baseline and 6, 12, 24, and 48 h postoperatively.

Results

Prophylactic intraligamentary injection of diclofenac sodium was found to be highly effective in reducing postendodontic pain than the oral route of administration.

Conclusion

In patients with low pain threshold, intraligamentary route of administration is effective in controlling pain of endodontic origin postoperatively.

Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review

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.