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Sekhar RM, Nirmala S, Chukka RR, G SG, Kumar K N, Patil D. Comparing the Effects of Intramuscular Injections of Dexamethasone and Ketorolac Tromethamine on Post-treatment Endodontic Pain: An In Vivo Study. Cureus 2024; 16:e57086. [PMID: 38681426 PMCID: PMC11052928 DOI: 10.7759/cureus.57086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Pain is the primary reason dental patients seek endodontic therapy. Post-treatment endodontic discomfort is a sequelae of periapical inflammation and anti-inflammatory drugs such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) would be reasonable therapy options. The purpose of this study was to compare and assess the efficacy of intramuscular injections of dexamethasone and ketorolac tromethamine versus placebo in reducing post-treatment endodontic pain in individuals undergoing root canal treatment. METHODOLOGY Patients diagnosed with symptomatic irreversible pulpitis were selected. Nonsurgical endodontic therapy was carried out in a single visit. After completion of the root canal therapy, the patients were randomly assigned to one of the three groups for intramuscular drug administration. In group 1, 2 ml of sterile saline was administered, in group 2, 1 ml of 4 mg dexamethasone was administered; and in group 3, 1 ml of 30 mg ketorolac tromethamine was administered. Preoperative and postoperative pain intensity was measured by a verbal rating scale. Postoperatively, the incidence and severity of pain were recorded after four, 24, and 48 hours. RESULTS All three groups showed a highly statistically significant reduction in pain scores when compared to preoperative levels. At the end of four hours, dexamethasone and ketorolac tromethamine showed highly significant results. Dexamethasone significantly reduced pain after 24 hours when compared to ketorolac and placebo groups. At the conclusion of 48 hours, all three groups experienced a gradual decrease in pain levels. CONCLUSION Effective and complete debridement of infected root canal system provides predictable gradual reduction of post-endodontic pain.
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Affiliation(s)
- Reshma M Sekhar
- Conservative Dentistry and Endodontics, Dr. Syamala Reddy Dental College Hospital and Research Centre, Bengaluru, IND
| | - Sravani Nirmala
- Conservative Dentistry and Endodontics, SVS (Sri Venkata Sai) Institute of Dental Sciences, Mahbubnagar, IND
| | - Rakesh Reddy Chukka
- Conservative Dentistry and Endodontics, SVS (Sri Venkata Sai) Institute of Dental Sciences, Mahbubnagar, IND
| | - Srikanth Goud G
- Oral Medicine and Radiology, SVS (Sri Venkata Sai) Institute of Dental Sciences, Mahbubnagar, IND
| | - Naresh Kumar K
- Conservative Dentistry and Endodontics, SVS (Sri Venkata Sai) Institute of Dental Sciences, Mahbubnagar, IND
| | - Deepu Patil
- Conservative Dentistry and Endodontics, AME's (Academy of Medical Education's) Dental College and Hospital, Raichur, IND
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Abraham D, Singh A, Goyal A. Symptomatic Irreversible Pulpitis Induces Increased Levels of Human NLRP3 in Gingival Crevicular Fluid Compared to Saliva: A Case Control Observational Study. J Endod 2023:S0099-2399(23)00507-1. [PMID: 37634578 DOI: 10.1016/j.joen.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION The goal of this case-control observational study was to compare the levels of the human nucleotide-binding domain, leucine-rich repeat, and pyrin domain-containing-3 (NLRP3) protein in the saliva and gingival crevicular fluid (GCF) of patients with symptomatic irreversible pulpitis (SIP) and healthy controls. METHODS The 16 patients in the control group were matched with the 16 patients in the SIP group to create a total of 32 patients. In addition to saliva, GCF (n = 48) samples were collected from the involved tooth (n = 16), contralateral tooth (n = 16), and adjacent tooth (n = 16) in the SIP group. Saliva and GCF were taken from the healthy group as a baseline. An independent t-test was used for statistical analysis. The random-intercept model was used to compare the average NLRP3 levels in the SIP tooth, adjacent tooth, and contralateral tooth taking age as a covariate, and the P value was adjusted using Bonferroni correction. RESULTS There were significantly higher levels of NLRP3 in the saliva of SIP patients (1.78 ± 1.14 ng/ml) compared to the healthy control (0.70 ± 0.70 ng/ml) and in the GCF of the involved tooth (5.72 ± 0.63 ng/ml) compared to healthy people (1.60 ± 0.42 ng/ml) (P < .001). In SIP patients the mean difference of NLRP3 levels between SIP and contralateral teeth was significant at 4.13 ng/ml (95% confidence interval, 3.52-4.70 P < .001) and a mean difference between adjacent teeth and contralateral teeth was significant at 3.53 ng/ml [95% confidence interval, 2.94-4.12 P < .001]. The NLRP3 in GCF and saliva had a negative association in the affected tooth but a negligible correlation in healthy controls. CONCLUSION The NLRP3 inflammasome has the potential to be employed as a molecular diagnostic biomarker for pulpal disorders.
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Affiliation(s)
- Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, School of Dental Sciences, MRIIRS, Faridabad, Haryana, India.
| | - Arundeep Singh
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, School of Dental Sciences, MRIIRS, Faridabad, Haryana, India
| | - Anjana Goyal
- Department of Biochemistry, Manav Rachna Dental College, School of Dental Sciences, MRIIRS, Faridabad, Haryana, India
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Riaz M, Zafar F, Khalid Z, Sultan T, Wali A, Siddiqui TM. Comparison of Preoperative Analgesics on the Efficacy of Inferior Alveolar Nerve Block with Patients Having Symptomatic Irreversible Pulpitis: A Double-Blinded, Randomized Controlled Trial. Eur Endod J 2023; 8:246-252. [PMID: 38219036 PMCID: PMC10500210 DOI: 10.14744/eej.2023.42650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/08/2023] [Accepted: 05/22/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of preoperative analgesics on inferior alveolar nerve blocks (IANB) during root canal treatment in patients with symptomatic irreversible pulpitis of the mandibular molars. METHODS This study was a randomized, double-blinded, superiority trial with a parallel study design. A total of 120 subjects with symptomatic irreversible pulpitis were randomly assigned to one of four groups: group A (con- trol, Vitamin E, Evion 400 mg), group B (Diclofenac sodium, Voltral SR100 100 mg), group C (Piroxicam, Feldene 20 mg), and group D (Tramadol, Tramal 50 mg). The patients recorded preoperative pain levels, and after admin- istration of local anaesthesia intraoperative pain levels using the Heft-Parker visual analogue scale before and after the oral administration of the analgesics. Statistical analysis was performed using the Kruskal-Wallis test. RESULTS All the analgesic groups showed a significant effect on the efficacy of the inferior alveolar nerve block in contrast to the control group (p<0.05). However, no significant difference was found between the drug groups on the effectiveness of the inferior alveolar nerve block (p>0.05). No side effects were reported in the present study. CONCLUSION Preoperative analgesics significantly increase the effectiveness of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. Therefore, preoperative analgesics should be considered to increase the effectiveness of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis on the mandibular molars. (EEJ-2023-02-033).
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Affiliation(s)
- Maryam Riaz
- Department of Oral Biology, Baqai Medical University Dental College, Karachi, Pakistan
| | - Farjad Zafar
- Department of Dental Implantology, Baqai Medical University Dental College, Karachi, Pakistan
| | - Zara Khalid
- Department of Operative Dentistry and Endodontics, Baqai Medical University Dental College, Karachi, Pakistan
| | - Tipu Sultan
- Department of Periodontology, Baqai Medical University Dental College, Karachi, Pakistan
| | - Aisha Wali
- Department of Research and Development, Baqai Medical University Dental College, Karachi, Pakistan
| | - Talha Mufeed Siddiqui
- Department of Operative Dentistry and Endodontics, Baqai Medical University Dental College, Karachi, Pakistan
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Urkande NK, Mankar N, Nikhade PP, Chandak M. Beyond Tradition: Non-surgical Endodontics and Vital Pulp Therapy as a Dynamic Combination. Cureus 2023; 15:e44134. [PMID: 37753005 PMCID: PMC10518373 DOI: 10.7759/cureus.44134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Symptomatic irreversible pulpitis and apical periodontitis in mature permanent teeth present challenges in their management. Traditional treatment approaches, such as root canal therapy or tooth extraction, may compromise tooth structure and oral function. This review article explores the combination of non-surgical endodontic treatment and vital pulp therapy as an alternative approach for these conditions. The purpose is to examine this combined approach's effectiveness, benefits, challenges, and limitations. The objectives include reviewing the literature, evaluating clinical outcomes, discussing potential benefits, and providing recommendations for clinical practice. The combination approach aims to preserve tooth structure, promote healing, and reduce postoperative complications. The article discusses the rationale for combining the two techniques, presents evidence supporting their efficacy, and outlines the techniques and protocols involved. Clinical outcomes, case studies, potential challenges, and comparative analysis with traditional approaches are also explored. Future directions and research recommendations highlight areas for further investigation, innovations, and the development of clinical guidelines. In conclusion, the combination of non-surgical endodontic treatment and vital pulp therapy offers a valuable strategy for managing mature permanent mandibular molars with symptomatic irreversible pulpitis and apical periodontitis. Further research and advancements are needed to refine the treatment protocol and expand the evidence base, and clinicians should stay updated to provide optimal care and improve patient outcomes.
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Affiliation(s)
- Neha K Urkande
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College And Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikhil Mankar
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College And Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pradnya P Nikhade
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College And Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Manoj Chandak
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College And Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Singla R, Laller V, Gill GS, Jain N, Kumar T, Dhillon JS. Comparative assessment of the outcome of complete pulpotomy using mineral trioxide aggregate and Biodentine in mature permanent mandibular molars with symptomatic irreversible pulpitis: A randomized clinical trial with 18 months of follow-up. J Conserv Dent Endod 2023; 26:402-408. [PMID: 37705539 PMCID: PMC10497083 DOI: 10.4103/jcd.jcd_170_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 09/15/2023]
Abstract
Background Mature permanent teeth with irreversible pulpitis have traditionally been managed with pulpectomy. With advancements in pulp biology and dental materials, many clinicians are using vital pulp therapies like pulpotomy to manage such teeth. The current study was conducted to help clinicians in making decisions about case selection and choice of material for such cases. Aim This randomized clinical trial evaluated the outcome of complete pulpotomy, using mineral trioxide aggregate (MTA) and Biodentine, in permanent mandibular molars with symptomatic irreversible pulpitis (SIP). Materials and Methods Fifty patients with moderate-to-severe pain in mandibular molars with SIP were included in this prospective, parallel, single-blind clinical trial. Coronal pulp was completely removed and hemostasis was achieved with a cotton pellet moistened with 2.5% sodium hypochlorite. Subsequently, the radicular orifices were randomly covered with MTA or Biodentine. All teeth were permanently restored with composite restoration at the same appointment. Clinical evaluation was performed at 1 week, 3 months, 6 months, 12 months, and 18 months and radiographic evaluation was done after 6 months, 12 months, and 18 months. Mann-Whitney U and Chi-square tests were utilized for statistical analysis. Results Success rates of MTA and Biodentine pulpotomy were 63.6% and 69.6%, respectively, with no significant difference between the two groups at any follow-up period (P > 0.05). Conclusion There were no significant differences in complete pulpotomy success rates between MTA and Biodentine over 18 months in mandibular molars with SIP.
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Affiliation(s)
- Rakesh Singla
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India
| | - Vipula Laller
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India
| | - Gurdeep Singh Gill
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India
| | - Namita Jain
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India
| | - Tarun Kumar
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India
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Sahai A, Gupta A, Abraham D, Aggarwal V, Singh A, Sharma G, Gurawa A. Evaluation of postoperative pain using warm versus room temperature sodium hypochlorite as an irrigant in mandibular molars with irreversible pulpitis: A randomized controlled trial. J Conserv Dent Endod 2023; 26:458-465. [PMID: 37705557 PMCID: PMC10497089 DOI: 10.4103/jcd.jcd_276_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 09/15/2023]
Abstract
Introduction The study evaluates and compare the effect of 3% warm NaOCl with NaOCl at room temperature in root canal irrigation on postoperative pain. Materials and Methods In this randomized controlled trial, mandibular molars with symptomatic irreversible pulpitis in healthy 18-year-old patients and above were included. The sample consisted of 56 patients evaluating the postoperative pain, allocated randomly into 2 groups of 3% NaOCl at two different temperatures, i.e. at room temperature and at 60°C. Endodontic treatment was initiated for each group and instrumentation was done using MTwo rotary files. The final irrigation was performed according to the groups assigned. For each included tooth, preoperative and postoperative pain scores at 6, 12, 24, 48, and 72 h were collected through the Heft Parker Visual Analog Scale. Statistical analysis was performed using independent t-test, Chi-square test, Mann-Whitney U-test, and Friedman test followed by Wilcoxon test. Results The mean percentage reduction in pain scores was significantly higher among the warm NaOCl group as compared to the control group at different time intervals (P < 0.001). The mean number of analgesics taken was significantly lower among the warm NaOCl group as compared to the control group (P < 0.001). Conclusion The warm NaOCl group recorded less postoperative pain than the control group during the first 72 h following single-visit endodontic therapy.
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Affiliation(s)
- Aarushi Sahai
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Arundeep Singh
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Garima Sharma
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Alka Gurawa
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
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Gaudin A, Clouet R, Boeffard C, Laham A, Martin H, Del Valle GA, Enkel B, Prud'homme T. Comparing intraosseous computerized anaesthesia with inferior alveolar nerve block in the treatment of symptomatic irreversible pulpitis: A randomized controlled trial. Int Endod J 2023. [PMID: 37209243 DOI: 10.1111/iej.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/22/2023]
Abstract
AIM The aim of this study was to compare the cardiovascular effects (heart rate, oxygen saturation (SpO2 ), systolic and diastolic blood pressure) and the anaesthetic efficacy of intraosseous computerized anaesthesia (ICA) versus inferior alveolar nerve block (IANB) in Symptomatic irreversible pulpitis (SIP). METHODOLOGY The study protocol was registered with ClinicalTrials.gov (NCT03802305). In a randomized, prospective clinical trial, 72 mandibular molar teeth with SIP were randomly allocated to conventional IANB injection (n = 36) or ICA injection (n = 36), both with 1.8 mL of 4% articaine with 1:100,000 epinephrine. The primary objective was to assess the cardiovascular parameters (heart rate, oxygen saturation, blood pressure) before, during, and after the anaesthesia. The secondary objectives were to compare ICA with IANB for success and postoperative outcomes for up to 3 days. RESULTS The maximum increase in heart rate in the ICA group was greater than in the IANB. Other cardiovascular parameters did not show differences throughout the clinical procedure. There were no statistically significant differences (P > .05) between groups for sex, age, or anxiety. The total success rate of ICA (91.43%) was significantly higher (P = 0.0034) than that of IANB (69.44%). CONCLUSIONS This study establishes that ICA is safe and efficient in the first intention for the treatment of SIP of the mandibular molar.
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Affiliation(s)
- Alexis Gaudin
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, Nantes, France
| | - Roselyne Clouet
- Nantes Université, CHU Nantes, Unité d'Investigation Clinique en Odontologie, UIC 11, Nantes, France
| | - Camille Boeffard
- Nantes Université, CHU Nantes, Unité d'Investigation Clinique en Odontologie, UIC 11, Nantes, France
| | - Amany Laham
- Nantes Université, CHU Nantes, Unité d'Investigation Clinique en Odontologie, UIC 11, Nantes, France
| | - Hamida Martin
- Nantes Université, CHU Nantes, Unité d'Investigation Clinique en Odontologie, UIC 11, Nantes, France
| | - Gilles Amador Del Valle
- Nantes Université, CHU Nantes, Unité d'Investigation Clinique en Odontologie, UIC 11, Nantes, France
| | - Bénédicte Enkel
- Nantes Université, CHU Nantes, Unité d'Investigation Clinique en Odontologie, UIC 11, Nantes, France
| | - Tony Prud'homme
- Nantes Université, CHU Nantes, Unité d'Investigation Clinique en Odontologie, UIC 11, Nantes, France
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Elnaghy AM, Elshazli AH, Elsaka SE. Effectiveness of oral premedication of meloxicam, ketorolac, dexamethasone, and ibuprofen on the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, double-blind, randomized controlled trial. Quintessence Int 2023; 54:92-99. [PMID: 36421046 DOI: 10.3290/j.qi.b3605097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The aim of this prospective, double-blind, randomized controlled trial was to compare the effect of oral premedication of meloxicam, ketorolac, dexamethasone, ibuprofen, or placebo on the success of inferior alveolar nerve blocks (IANB) of mandibular posterior teeth in patients experiencing symptomatic irreversible pulpitis. METHOD AND MATERIALS Two hundred and fifty emergency patients in moderate to severe pain diagnosed with symptomatic irreversible pulpitis of a mandibular first or second molar randomly received, in a double-blind manner, identical capsules containing either meloxicam 7.5 mg, ketorolac 10 mg, dexamethasone 0.5 mg, ibuprofen 600 mg, or placebo 60 minutes before the administration of an IANB. Profound lip numbness was assessed after 15 minutes. Access cavities were then prepared and success of IANB was defined as no or mild pain (Heft-Parker visual analog scale recordings) during access preparation and root canal instrumentation. The data were analyzed using chi-square and Kruskal-Wallis tests. RESULTS The overall success rates for the meloxicam 7.5 mg, ketorolac 10 mg, dexamethasone 0.5 mg, and ibuprofen 600 mg groups were 52%, 64%, 54%, and 58%, respectively, with no significant differences in success rates among the premedications groups (P > .05). However, the tested premedications revealed significant differences compared with the placebo group (32% success rate) (P < .05). CONCLUSION Premedication with meloxicam, ketorolac, dexamethasone, and ibuprofen increased the efficacy of IANB in mandibular molars with symptomatic irreversible pulpitis. (Quintessence Int 2023;54:92-99; doi: 10.3290/j.qi.b3605097).
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Miroshnychenko A, Ibrahim S, Azab M, Roldan Y, Diaz Martinez JP, Tamilselvan D, He L, Urquhart O, Tampi M, Polk DE, Moore PA, Hersh EV, Carrasco-Labra A, Brignardello-Petersen R. Injectable and topical local anesthetics for acute dental pain: 2 systematic reviews. J Am Dent Assoc 2023; 154:53-64.e14. [PMID: 36608963 PMCID: PMC10871026 DOI: 10.1016/j.adaj.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Local anesthesia is essential for pain control in dentistry. The authors assessed the comparative effect of local anesthetics on acute dental pain after tooth extraction and in patients with symptomatic irreversible pulpitis. TYPES OF STUDIES REVIEWED The authors searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the US Clinical Trials registry through November 21, 2020. The authors included randomized controlled trials (RCTs) comparing long- vs short-acting injectable anesthetics to reduce pain after tooth extraction (systematic review 1) and evaluated the effect of topical anesthetics in patients with symptomatic pulpitis (systematic review 2). Pairs of reviewers screened articles, abstracted data, and assessed risk of bias using a modified version of the Cochrane risk of bias 2.0 tool. The authors assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Fourteen RCTs comparing long- vs short-acting local anesthetics suggest that bupivacaine may decrease the use of rescue analgesia and may not result in additional adverse effects (low certainty evidence). Bupivacaine probably reduces the amount of analgesic consumption compared with lidocaine with epinephrine (mean difference, -1.91 doses; 95% CI, -3.35 to -0.46; moderate certainty) and mepivacaine (mean difference, -1.58 doses; 95% CI, -2.21 to -0.95; moderate certainty). Five RCTs suggest that both benzocaine 10% and 20% may increase the number of people experiencing pain reduction compared with placebo when managing acute irreversible pulpitis (low certainty). PRACTICAL IMPLICATIONS Bupivacaine may be superior to lidocaine with epinephrine and mepivacaine with regard to time to and amount of analgesic consumption. Benzocaine may be superior to placebo in reducing pain for 20 through 30 minutes after application.
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Zhang F, Cheng R, Yang X, Lian X, Wen P. Pain Relief Effects and Safety of Transitional Therapy in the Treatment of Posterior Teeth of Pregnant Women with Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis. Int J Womens Health 2022; 14:1897-1904. [PMID: 36605256 PMCID: PMC9809172 DOI: 10.2147/ijwh.s378358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose To assess the pain relief effects and safety of transitional therapy (TT) in the treatment of posterior teeth of pregnant women with symptomatic irreversible pulpitis and symptomatic apical periodontitis. Methods A prospective cohort clinical study was conducted in the Department of Stomatology at Shenzhen Maternity & Child Healthcare Hospital, China, from January 2017 to December 2019. We enrolled 62 pregnant women with acute dental pain caused by posterior teeth with symptomatic irreversible pulpitis or symptomatic apical periodontitis. Among the 62 participants, 34 received TT, and 28 chose nontreatment during pregnancy. We evaluated the pain relief with the verbal numerical rating scale (VNRS) scores of pain perception in the clinical study, as well as the anti-bacterial medicament filling conditions of canals of in vitro models. Moreover, we investigated the safety outcomes, such as gestational age, neonatal head circumstance, birth weight, and body length. Results The VNRS scores of the participants treated with TT were significantly lower than those of the nontreatment group 2 days after treatment (P<0.001). TT treated pregnant women experienced significantly more pain decreases in VNRS scores than their counterparts(P<0.05). The optimal anti-bacterial medicament filling conditions of canals of in vitro models by TT method were comparable with those of canals instrumented with traditional RCT method. Moreover, no significant differences of safety outcomes were observed between pregnant women of these two groups. Conclusion The transitional therapy is efficient in alleviating acute dental pain of posterior teeth of pregnant women with symptomatic irreversible pulpitis and symptomatic apical periodontitis, and maintaining painless chains throughout pregnancy with no adverse effects on neonatal birth outcomes.
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Affiliation(s)
- Feng Zhang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, People’s Republic of China
| | - Rongfeng Cheng
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, People’s Republic of China
| | - Xiuqiao Yang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, People’s Republic of China
| | - Xiaohui Lian
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, People’s Republic of China
| | - Ping Wen
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, People’s Republic of China,Correspondence: Ping Wen, Department of Science and Education, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, People’s Republic of China, Email
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Gómez-Sánchez E, Franco-de la Torre L, Bologna-Molina RE, Molina-Frechero N, Serafín-Higuera NA, Hernández-Gómez A, Alonso-Castro ÁJ, Sat-Muñoz D, Isiordia-Espinoza MA. Local Tramadol Improves the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10101867. [PMID: 36292314 PMCID: PMC9602303 DOI: 10.3390/healthcare10101867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
Symptomatic irreversible pulpitis is a painful clinical condition with a broad inflammatory component. Dental anesthesia in these patients is affected by the inflammatory process, reporting a high incidence of anesthesia failure. The aim of this systematic review and meta-analytical evaluation was to determine the effect of pre-treatment with tramadol in patients with symptomatic irreversible pulpitis, as well as for pain control and adverse effects. This study was registered in PROSPERO (ID: CRD42021279262). PubMed was consulted to identify clinical investigations comparing tramadol and placebo/local anesthetics in patients with symptomatic irreversible pulpitis. Data about the anesthesia, pain control, and adverse effects were extracted. Both the anesthetic success index and the adverse effects of local tramadol and placebo were compared with the Mantel−Haenszel test and odds ratio. Data analysis showed that the local administration of tramadol increased the anesthetic success rate when compared to placebo in patients with symptomatic irreversible pulpitis (n = 228; I2 = 0; OR = 2.2; 95% CIs: 1.30 to 3.79; p < 0.004). However, local administration of tramadol increased the risk of adverse effects when compared to placebo/local anesthetics (n = 288; I2 = 0; OR = 7.72; 95% CIs: 1.37 to 43.46; p < 0.02). In conclusion, this study shows that the local administration of tramadol increases the anesthetic success index when compared to placebo in patients with symptomatic irreversible pulpitis.
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Affiliation(s)
- Eduardo Gómez-Sánchez
- Departamento de Ciencias Fisiológicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad (UDG-CA-874), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Lorenzo Franco-de la Torre
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Guadalajara 47620, Jalisco, Mexico
| | | | - Nelly Molina-Frechero
- Departamento de Salud, Laboratorio de Cariología y Medicina Oral, Universidad Autónoma Metropolitana-Xochimilco, Mexico City 04960, Mexico
| | | | - Adriana Hernández-Gómez
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Guadalajara 47620, Jalisco, Mexico
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Jalisco, Mexico
| | - Ángel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato City 36050, Guanajuato, Mexico
| | - Daniel Sat-Muñoz
- Departamento de Ciencias Fisiológicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad (UDG-CA-874), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Guadalajara 47620, Jalisco, Mexico
- Correspondence: ; Tel.: +52-(378)-119-57-86
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Franco-de la Torre L, Gómez-Sánchez E, Serafín-Higuera NA, Alonso-Castro ÁJ, López-Verdín S, Molina-Frechero N, Granados-Soto V, Isiordia-Espinoza MA. Dexamethasone Increases the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis. Pharmaceuticals (Basel) 2022; 15. [PMID: 35890176 DOI: 10.3390/ph15070878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/25/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
Inferior alveolar nerve block (IANB) has a high failure rate in subjects with symptomatic irreversible pulpitis (SIP). It has been suggested that drugs with anti-inflammatory activity could improve the efficacy of the anesthetic used for IANB. The aim of this study was to assess the effect of dexamethasone on the success of dental anesthesia in patients with SIP. An information search was performed using PubMed and Google Scholar. The risk of bias of the included studies was evaluated with the Cochrane Collaboration’s risk-of-bias tool. The anesthetic success rate, pain intensity (VAS), and adverse effects were extracted. Data were analyzed using the Mantel−Haenszel test and odds ratio or the inverse variance and standardized mean difference. Dexamethasone increased the anesthetic success in comparison with placebo (n = 502; p < 0.001; OR = 2.59; 95% CIs: 1.46 to 4.59). Moreover, patients who were given dexamethasone had lower pain scores at 6 h (n = 302; p < 0.001; MD= −1.43; 95% CIs: −2.28 to −0.58), 12 h (n = 302; p < 0.0001; MD = −1.65; 95% CIs: −2.39 to −0.92), and 24 h (n = 302; p < 0.0008; MD = −1.27; 95% CIs: −2.01 to −0.53) when compared with placebo. In conclusion, the systemic administration of dexamethasone increases the anesthetic success rate and improves pain management in patients with SIP.
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Elnaghy AM, Elshazli AH, Badr AE, Elsaka SE. Effect of preoperative tramadol, ibuprofen, ibuprofen/acetaminophen on the anaesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. AUST ENDOD J 2022; 49:165-173. [PMID: 35759555 DOI: 10.1111/aej.12642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 05/09/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this double-blind clinical trial was to compare the effect of preoperative tramadol 50 mg, tramadol 100 mg, ibuprofen 600 mg, ibuprofen 600 mg/acetaminophen 1000 mg or placebo 60 min before the administration of inferior alveolar nerve blocks (IANB) of mandibular teeth in patients experiencing symptomatic irreversible pulpitis (SIP). Two hundred and fifty emergency patients diagnosed with SIP were randomly divided into five groups and received medications. Endodontic access was begun 15 min after completion of the IANB, and all patients had profound lip numbness. The Heft-Parker visual analogue scale was used to evaluate pain. Premedication with tramadol 100 mg significantly increased the success rate to 62% than the other groups (p < 0.05). The success rates of ibuprofen, ibuprofen/acetaminophen and tramadol 50 mg groups were not significantly different (p > 0.05). Premedication with tramadol 100 mg enhanced the anaesthetic success of IANB in mandibular molars with SIP.
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Affiliation(s)
- Amr M Elnaghy
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Alaa H Elshazli
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Amany E Badr
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Shaymaa E Elsaka
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.,Department of Restorative Dental Sciences, Vision Colleges, Jeddah, Saudi Arabia
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Chen LS, Nusstein J, Drum M, Fowler S, Reader A, Guo X. Effect of a Combination of Nitrous Oxide and Intraligamentary Injection on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis. J Endod 2021; 47:1890-1895. [PMID: 34492232 DOI: 10.1016/j.joen.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The purpose of this prospective study was to determine the effect of a combination of nitrous oxide/oxygen and 1 set of supplemental intraligamentary/periodontal ligament (PDL) injections followed by a second set of PDL injections on anesthetic success in patients with symptomatic irreversible pulpitis (SIP). METHODS Ninety-four patients with a mandibular posterior tooth diagnosed with SIP received nitrous oxide/oxygen and an inferior alveolar nerve block (IANB) with 2% lidocaine with 1:100,000 epinephrine. Patients rated the pain of PDL injections and endodontic access on a visual analog scale. If moderate to severe pain was felt during treatment, the operator administered 1 set of supplemental PDL injections with 4% articaine with 1:100,000 epinephrine. If moderate to severe pain was felt again during treatment, the operator administered a second set of supplemental PDL injections. Anesthetic success was defined as having no to mild pain during endodontic treatment. RESULTS The success of the IANB with nitrous oxide was 44% (95% confidence interval [CI], 34%-54%). The overall anesthetic success rate (IANB with PDL injections) was increased from 69% (95% CI, 60%-78%) with 1 set of PDL injections to 80% (95% CI, 72%-88%) with a second set of PDL injections. CONCLUSIONS Although the second set of PDL injections increased anesthetic success, it was not sufficient to ensure complete pulpal anesthesia.
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Affiliation(s)
- Lo-Shen Chen
- Practice Limited to Endodontics, Worthington, Ohio
| | - John Nusstein
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Division of Endodontics, The Ohio State University, Columbus, Ohio.
| | - Sara Fowler
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Xiaohan Guo
- Division of Biostatistics, The Ohio State University, Columbus, Ohio
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Aksoy F, Ege B, Tosun S. The effect of pre-operative submucosal administration of dexamethasone, tramadol, articaine on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: A randomized, double-blind placebo-controlled clinical trial. Int Endod J 2021; 54:1982-1992. [PMID: 34347895 DOI: 10.1111/iej.13604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
AIM To establish the effects of submucosal tramadol, dexamethasone and articaine on the success of inferior alveolar nerve blocks (IANB) during root canal treatment of mandibular molars with symptomatic irreversible pulpitis (SIP). METHODOLOGY In this randomized double-blind, controlled clinical trial, 120 patients with the diagnosis of SIP in their mandibular first or second molars were included and randomly divided into four groups (n = 30). The control group received normal saline and three experimental groups received a single dose of dexamethasone (8 mg/2 mL), or tramadol (100 mg/2 mL) or articaine (4% / 2 mL). The pre-operative pain levels of the patients were measured with the Heft-Parker visual analogue scale (HP VAS). All patients received standard IANB of 4% articaine with 1:200000 epinephrine. Following the observation of lip numbness, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars. After 15 min, standard root canal treatment was initiated, and the pain intensity levels recorded from the access cavity preparation to pulp extirpation were measured with HP VAS. The duration of the anaesthesia was also evaluated. The experimental groups were compared using one-way ANOVA or Kruskal-Wallis H-test. The groups that were significantly different were compared pairwise using the Tukey Multiple Comparison test. The Chi-square test was used to compare the categorical variables. RESULTS The submucosal administration of articaine significantly increased the success rate to 63% in comparison with the control group that received submucosal saline (p < .05). The success rate of pulpal anaesthesia was 37% in the control group, 57% in the tramadol group and 47% in the dexamethasone group, with no significant difference in the success rate among these groups. In the dexamethasone group, the duration of the anaesthetic effect of IANB was significantly longer than those in the other groups (p < .001). CONCLUSIONS In patients with SIP, pre-operative submucosal administration of articaine increased the success rate of IANB, while administration of dexamethasone increased the duration of anaesthesia. These agents can be used in cases where effective anaesthesia cannot be obtained during root canal treatments.
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Affiliation(s)
- Fatih Aksoy
- Department of Endodontics, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Bilal Ege
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Samet Tosun
- Department of Endodontics, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
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Kumar M, Singla R, Gill GS, Kalra T, Jain N. Evaluating Combined Effect of Oral Premedication with Ibuprofen and Dexamethasone on Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial. J Endod 2021; 47:705-710. [PMID: 33548329 DOI: 10.1016/j.joen.2021.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/31/2020] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The success rate of inferior alveolar nerve block decreases exorbitantly in teeth with symptomatic irreversible pulpitis. The purpose of this prospective, double-blind, randomized clinical trial was to evaluate the combined effect of oral premedication with ibuprofen and dexamethasone on the success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis. METHODS Ninety-four adult patients actively experiencing pain and diagnosed with symptomatic irreversible pulpitis willingly participated in this study. Preoperative pain was recorded on the Heft-Parker visual analog scale. Patients were randomly allocated to 4 different groups and received placebo, 0.5 mg dexamethasone, 800 mg ibuprofen, or a combination of 0.5 mg dexamethasone and 800 mg ibuprofen. One hour after oral premedication, all patients received standard inferior alveolar nerve block containing 2% lignocaine with 1:200,000 adrenaline. Access cavity preparation was initiated 15 minutes after the administration of anesthesia. Pain scores were recorded on VAS after anesthesia, at dentin penetration to pulp chamber opening, and on file placement. Success was defined as no or mild pain (0-54 mm) throughout the procedure. RESULTS The chi-square test was used for qualitative data comparison. The 1-way analysis of variance test and post hoc Bonferroni test showed a statistically significant difference between the combination of 0.5 mg dexamethasone and 800 mg ibuprofen group and the other 3 groups (P < .001). CONCLUSIONS Preoperative administration of a combination of dexamethasone and ibuprofen improved the success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis.
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Affiliation(s)
- Mohit Kumar
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India.
| | - Rakesh Singla
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India
| | - Gurdeep Singh Gill
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India
| | - Tarun Kalra
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India
| | - Namita Jain
- Department of Conservative Dentistry and Endodontics, JCD Dental College, Sirsa, Haryana, India
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MacDonald E, Drum M, Nusstein J, Fowler S, Beck M, Reader A. Anesthetic Success Using Nitrous Oxide and a Combination of Lidocaine/Clonidine for the Inferior Alveolar Nerve Block and the Effects on Blood Pressure and Pulse in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study. J Endod 2021; 47:558-65. [PMID: 33387550 DOI: 10.1016/j.joen.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The pulpal anesthetic success rates for an inferior alveolar nerve block (IANB) alone in patients presenting with symptomatic irreversible pulpitis are less than adequate. Nitrous oxide and clonidine have shown increases in IANB success when administered individually, but their success has not been evaluated when used together. The purpose of this prospective, randomized, double-blind study was to determine the effect of nitrous oxide/oxygen plus an IANB using lidocaine/clonidine on the success of the IANB in patients with symptomatic irreversible pulpitis and to evaluate the effect of clonidine on blood pressure and pulse. METHODS Sixty-two emergency patients experiencing moderate to severe pain and a diagnosis of symptomatic irreversible pulpitis were enrolled. Subjects were randomly divided into 2 groups and received nitrous oxide/oxygen and an IANB using 2% lidocaine with either 27 μg clonidine or 18 μg epinephrine as vasoconstrictors. Blood pressure and pulse were recorded before and during the emergency endodontic treatment. Anesthetic success was defined as no or mild pain upon access and instrumentation of the canals. RESULTS The pulpal anesthetic success rate in both treatments was 58%, with no significant difference between the groups. There was no statistically significant difference in pulse or systolic blood pressure with the use of clonidine compared with epinephrine. Diastolic blood pressure was significant. CONCLUSIONS The use of nitrous/oxide plus the addition of lidocaine/clonidine for the IANB in teeth with symptomatic irreversible pulpitis resulted in no statistically significant difference in anesthetic success of the IANB. There were no statistically significant differences in pulse or systolic blood pressure with the use of clonidine compared with epinephrine; diastolic blood pressure was significant.
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Koli B, Chawla A, Logani A, Kumar V, Sharma S. Combination of Nonsurgical Endodontic and Vital Pulp Therapy for Management of Mature Permanent Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis and Apical Periodontitis. J Endod 2020; 47:374-381. [PMID: 33091455 DOI: 10.1016/j.joen.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This prospective study evaluated the outcome of a combination of nonsurgical endodontic (NSET) and vital pulp therapy (VPT) for the management of mature permanent mandibular molar teeth with symptomatic irreversible pulpitis (SIP) and apical periodontitis (AP). METHODS Institutional ethical clearance was obtained. Mandibular molar teeth (N = 60) with a definitive diagnosis of SIP and AP with a radiographic periapical index score (PAI) of ≥3 in either 1 of the roots (mesial or distal) were included. Block randomization was used for allocation. In the NSET group (n = 30), single-visit NSET was performed using a standardized operating protocol. In the NSET-VPT group (n = 30), subsequent to full pulpotomy, at the root orifice where a vital pulp was observed (as determined by the arrest of pulpal bleed upon application of a 2.5% sodium hypochlorite pressure pack), a mineral trioxide aggregate radicular barrier was placed, and it was covered with light-cured resin-modified glass ionomer cement. NSET was performed in the root exhibiting a PAI score ≥3. The tooth was permanently restored. Postoperative pain was assessed at 24, 48, and 72 hours. Teeth were followed up clinically and radiographically at 12 months. The presence/absence of symptoms and the change in PAI scores were noted. The data were statistically analyzed. RESULTS The success rate was 90% in the NSET group and 93.3% in the NSET-VPT group. According to an intergroup comparison between the proportion of teeth healed and nonhealed (radiographic), there was no significant difference (P > .05). CONCLUSIONS The combination of NSET and VPT is a viable biologically based minimally invasive treatment option for multirooted mandibular teeth with SIP and AP.
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Affiliation(s)
- Bhawna Koli
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Amrita Chawla
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajay Logani
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Sudhakar K, Kumar CS, Lavanya A, Swapna S. Influence of instrument design on post-operative pain in single-visit root canal treatment with Protaper Next and V taper 2H rotary systems in symptomatic irreversible pulpitis of multirooted teeth - A randomized clinical trial. J Clin Transl Res 2020; 5:230-235. [PMID: 32875132 PMCID: PMC7453807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/14/2020] [Accepted: 03/14/2020] [Indexed: 11/10/2022] Open
Abstract
AIM The objective of this randomized clinical trial was to clinically evaluate the incidence of postoperative pain after root canal treatment in symptomatic irreversible pulpitis of multirooted teeth using two different instruments design rotary file systems, namely, Protaper Next (PTN) and V taper 2H (VT2H). MATERIALS AND METHODS In this prospective randomized clinical trial, 60 patients with symptomatic irreversible pulpitis of multirooted teeth, indicated for root canal therapy, were randomly assigned to two groups according to instrument system used, namely, PTN and VT2H. Root canal treatments were performed in single visit. After treatment, the participants were asked to rate the intensity of post-operative pain on modified verbal descriptor scale after 8 h, 24 h, 48 h, and 72 h over the telephone by a second investigator. Patients were advised to call the second investigator by telephone if they felt very uncomfortable at any point of the follow-up time. At that time, they were asked to take ibuprofen 200 mg as the rescue drug. RESULTS No statistically significant difference was found among the two groups in relation to post-operative pain and intake of analgesic medication at 4 time points assessed (P>0.05, Kruskal-Wallis test). CONCLUSION The PTN system and VT2H rotary system were found to be equal in the incidence of post-operative pain and pain intensity was found to decrease with time, postoperatively, in both the rotary systems. RELEVANCE FOR PATIENTS The instrument design has little effect on post-operative pain in symptomatic irreversible pulpitis patients after single-visit root canal therapy.
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Affiliation(s)
- Koppala Sudhakar
- Department of Conservative Dentistry and Endodontics, Narayana Dental College and Hospital, Chintareddypalem, Nellore, Andhra Pradesh, India
| | - Chinni Suneel Kumar
- Department of Conservative Dentistry and Endodontics, Narayana Dental College and Hospital, Chintareddypalem, Nellore, Andhra Pradesh, India,
Corresponding author Chinni Suneel Kumar Department of Conservative Dentistry and Endodontics, Narayana Dental College and Hospital, Chintareddypalem, Nellore, Andhra Pradesh, India.
| | - Anumula Lavanya
- Department of Conservative Dentistry and Endodontics, Narayana Dental College and Hospital, Chintareddypalem, Nellore, Andhra Pradesh, India
| | - Sannapureddy Swapna
- Department of Conservative Dentistry and Endodontics, Narayana Dental College and Hospital, Chintareddypalem, Nellore, Andhra Pradesh, India
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Lockhart PB, Tampi MP, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Kennedy E, Lang MS, Patton LL, Paumier T, Suda KJ, Pilcher L, Urquhart O, O'Brien KK, Carrasco-Labra A. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. J Am Dent Assoc 2019; 150:906-921.e12. [PMID: 31668170 PMCID: PMC8270006 DOI: 10.1016/j.adaj.2019.08.020] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults. TYPES OF STUDIES REVIEWED The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework. RESULTS The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high. CONCLUSION AND PRACTICAL IMPLICATIONS Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.
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