EFFECTIVENESS OF VARIOUS MEDICATIONS ON POST OPERATIVE PAIN OF VITAL TEETH AFTER ROOT CANAL THERAPY
Main Article Content
Keywords
Postoperative pain, Root canal therapy, Betamethasone, Ibuprofen, Indomethacin
Abstract
Background: Postoperative pain is a common concern after root canal therapy, particularly in vital teeth, due to inflammation and periapical irritation. Despite improvements in endodontic procedures, effective pain management remains a critical aspect of patient care. Various pharmacologic agents are used to control postoperative discomfort, with differing degrees of success.
Aim: To compare the effectiveness of Betamethasone, Indomethacin, and Ibuprofen in reducing postoperative pain following root canal treatment in vital teeth.
Material and Methods: A randomized, double-blind, placebo-controlled clinical trial was conducted on 80 patients undergoing root canal therapy on vital teeth. Participants were randomly assigned into four groups (n = 20): Placebo, Indomethacin (25 mg), Betamethasone (0.5 mg), and Ibuprofen (400 mg). Medications were administered orally 30 minutes before the procedure. Pain levels were recorded using a Visual Analog Scale (VAS) at 6, 12, 24, and 48 hours post-treatment. Data were analyzed using SPSS version 26.0 with repeated measures ANOVA and post hoc tests.
Results: All three active medications significantly reduced postoperative pain compared to placebo at all time intervals (p < 0.001). Betamethasone consistently showed the lowest mean pain scores across all time points, followed by Ibuprofen and Indomethacin. By 48 hours, moderate to severe pain (VAS ≥ 4) was absent in the Betamethasone group, while 25.00% of placebo patients continued to experience significant pain. Adverse effects were minimal and not statistically significant among groups.
Conclusion: Preoperative administration of Betamethasone, Ibuprofen, and Indomethacin significantly reduced postoperative pain after root canal therapy, with Betamethasone demonstrating the highest efficacy and excellent tolerability. These findings support the use of corticosteroids, particularly Betamethasone, as an effective premedication strategy for managing post-endodontic pain.
References
2. Iqbal A. The Factors Responsible for Endodontic Treatment Failure in the Permanent Dentitions of the Patients Reported to the College of Dentistry, the University of Aljouf, Kingdom of Saudi Arabia. J Clin Diagn Res. 2016;10(5):146–8.
3. Gotler M, Bar-Gil B, Ashkenazi M. Postoperative Pain after Root Canal Treatment: A Prospective Cohort Study. Int J Dent. 2012;2012:310467.
4. Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. Int Endod J. 2008;41(2):91–9.
5. Iranmanesh F, Parirokh M, Haghdoost AA, Abbott PV. Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review. Iran Endod J. 2017;12(2):123–30.
6. Amato M, Pantaleo G, Abtellatif D, Blasi A, Gagliani M, Iandolo A. An in vitro evaluation of the degree of pulp tissue dissolution through different root canal irrigation protocols. J Conserv Dent. 2018;21(2):175–9.
7. Jayakodi H, Kailasam S, Kumaravadivel K, Thangavelu B, Mathew S. Clinical and pharmacological management of endodontic flare-up. J Pharm Bioall Sci. 2012;4(Suppl 2):S294–8.
8. Siqueira JF Jr. Microbial causes of endodontic flare-ups. Int Endod J. 2003;36(7):453–63.
9. Löst C. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006;39(12):921–30.
10. Whitten BH, Gardiner DL, Jeansonne BG, Lemon RR. Current trends in endodontic treatment: report of a national survey. J Am Dent Assoc. 1996;127(9):1333–41.
11. Salarpoor M, Shahraki S, Farhad-Molashahi L, Farhad-Molashah N, Dadgar F. Effectiveness of various medications on postoperative pain of vital teeth after root canal therapy. Zahedan J Res Med Sci. 2013;16(7).
12. Kumar G, Sangwan P, Tewari S. Effect of premedication on postoperative pain after root canal therapy in patients with irreversible pulpitis: a systematic review and meta-analysis. J Dent Anesth Pain Med. 2021;21(5):397–411.
13. Di Spirito F, Scelza G, Fornara R, Giordano F, Rosa D, Amato A. Post-operative endodontic pain management: An overview of systematic reviews on post-operatively administered oral medications and integrated evidence-based clinical recommendations. Healthcare (Basel). 2022;10(5):760.
14. Ehsani M, Moghadamnia AA, Zahedpasha S, Maliji G, Haghanifar S, Mir SM, et al. The role of prophylactic ibuprofen and N-acetylcysteine on the level of cytokines in periapical exudates and the post-treatment pain. Daru. 2012;20(1):30.
15. Dalewski B, Kamińska A, Szydłowski M, Kozak M, Sobolewska E. Comparison of early effectiveness of three different intervention methods in patients with chronic orofacial pain: A randomized, controlled clinical trial. Pain Res Manag. 2019;2019:7954291.
16. Al-Sabbagh M, Okeson JP, Bertoli E, Medynski DC, Khalaf MW. Persistent pain and neurosensory disturbance after dental implant surgery: Prevention and treatment. Dent Clin North Am. 2015;59(1):143–56.