Effect of pretreatment medication on postendodontic pain: A double-blind, placebo-controlled study
Ravi Kumar Konagala, Jyothi Mandava, Ravi Kumar Pabbati, A Anupreeta, Roopesh Borugadda, Ravichandra Ravi, Ravi Kumar Konagala, Jyothi Mandava, Ravi Kumar Pabbati, A Anupreeta, Roopesh Borugadda, Ravichandra Ravi
Abstract
Background: Posttreatment endodontic pain has been reported in 25%-40% of all endodontic patients. Effective management of endodontic pain represents a continuing challenge.
Aim: To evaluate and compare the efficacy of preoperative single dose of nonsteroidal anti-inflammatory drug, piroxicam (20 mg), with two types of corticosteroid drugs - dexamethasone (4 mg) or deflazacort (30 mg) - for the prevention and control of postendodontic pain.
Materials and methods: A total of 132 volunteers selected for nonsurgical root canal therapy were randomly divided into the following four groups (n = 30 each) according to preoperative medication given: Group 1, piroxicam (20 mg); Group 2, dexamethasone (4 mg); Group 3, deflazacort (30 mg); and Group 4, placebo. The preoperative medications were administrated 1 h before the start of standard endodontic treatment. Patients were instructed to complete a pain diary using Visual Analog Scale preoperatively and at 6-, 12-, 24-, 48-, and 72-h intervals after root canal instrumentation.
Statistical analysis: The correlation between preoperative endodontic pain to postoperative pain and pair-wise comparison of four groups was evaluated by Kruskal-Wallis analysis of variance test followed by Mann-Whitney U-test.
Results: Compared to the placebo group, piroxicam, dexamethasone, and deflazacort resulted in a statistically significant reduction in postendodontic pain at 6, 12, and 24 h (P < 0.05).
Conclusion: Preoperative single oral dose of piroxicam or dexamethasone or deflazacort is equally effective in controlling postendodontic pain.
Keywords: Dexamethasone; Visual Analog Scale; piroxicam; placebo; root canal treatment.
Conflict of interest statement
There are no conflicts of interest.
References
- Pochapski MT, Santos FA, de Andrade ED, Sydney GB. Effect of pretreatment dexamethasone on postendodontic pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:790–5.
- Ehrmann EH, Messer HH, Clark RM. Flare-ups in endodontics and their relationship to various medicaments. Aust Endod J. 2007;33:119–30.
- Arslan H, Topcuoglu HS, Aladag H. Effectiveness of tenoxicam and ibuprofen for pain prevention following endodontic therapy in comparison to placebo: A randomized double-blind clinical trial. J Oral Sci. 2011;53:157–61.
- Marshall JG, Walton RE. The effect of intramuscular injection of steroid on posttreatment endodontic pain. J Endod. 1984;10:584–8.
- Mehrvarzfar P, Shababi B, Sayyad R, Fallahdoost A, Kheradpir K. Effect of supraperiosteal injection of dexamethasone on postoperative pain. Aust Endod J. 2008;34:25–9.
- Glassman G, Krasner P, Morse DR, Rankow H, Lang J, Furst ML, et al. Aprospective randomized double-blind trial on efficacy of dexamethasone for endodontic interappointment pain in teeth with asymptomatic inflamed pulps. Oral Surg Oral Med Oral Pathol. 1989;67:96–100.
- Liesinger A, Marshall FJ, Marshall JG. Effect of variable doses of dexamethasone on posttreatment endodontic pain. J Endod. 1993;19:35–9.
- Metri M, Hegde S, Bhandi S. Effect of pretreatment diclofenac sodium on postendodontic pain: A randomised controlled trial. J Conserv Dent. 2016;19:7–10.
- Song HH, Choi KS, Kim CW, Kwon YE. Pharmacokinetic profiles of twobranded formulations of piroxicam 20 mg in healthy Korean volunteers by a rapid isocratic HPLC method. J Bioequiv Availab. 2009;1:74–9.
- Nayak S, Acharjya B. Deflazacort versus other glucocorticoids: A comparison. Indian J Dermatol. 2008;53:167–70.
- Pilatti GL, André dos Santos F, Bianchi A, Cavassim R, Tozetto CW. The use of celecoxib and dexamethasone for the prevention and control of postoperative pain after periodontal surgery. J Periodontol. 2006;77:1809–14.
- Jalalzadeh SM, Mamavi A, Shahriari S, Santos FA, Pochapski MT. Effect of pretreatment prednisolone on postendodontic pain: A double-blind parallel-randomized clinical trial. J Endod. 2010;36:978–81.
- Mehrvarzfar P, Abbott PV, Saghiri MA, Delvarani A, Asgar K, Lotfi M, et al. Effects of three oral analgesics on postoperative pain following root canal preparation: A controlled clinical trial. Int Endod J. 2012;45:76–82.
- Attar S, Bowles WR, Baisden MK, Hodges JS, McClanahan SB. Evaluation of pretreatment analgesia and endodontic treatment for postoperative endodontic pain. J Endod. 2008;34:652–5.
- Mokhtari F, Yazdi K, Mahabadi AM, Modaresi SJ, Hamzeheil Z. Effect of premedication with indomethacin and ibuprofen on postoperative endodontic pain: A Clinical trial. Iran Endod J. 2016;11:57–62.
- Marshall JG. Consideration of steroids for endodontic pain. Endocrinol Top. 2002;3:41–5.
- Alexander RE, Throndson RR. A review of preoperative corticosteroid use in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;34:1261–3.
- Hargreaves K, Abbott PV. Drugs for pain management in dentistry. Aust Dent J. 2005;50:S14–22.
- Smith EA, Marshall JG, Selph SS, Barker DR, Sedgley CM. Nonsteroidal anti-inflammatory drugs for managing postoperative endodontic pain in patients who present with preoperative pain: A systematic review and meta-analysis. J Endod. 2017;43:7–15.
- Lin S, Levin L, Emodi O, Abu El-Naaj I, Peled M. Etodolac versus dexamethasone effect in reduction of postoperative symptoms following surgical endodontic treatment: A double-blind study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:814–7.
- Tripathi KD. Essentials of Medical Pharmacology. 7th ed. New Delhi,India: Jaypee; 2013. Corticosteroids; pp. 282–96.
Source: PubMed