Efficacy of Different Drugs to Control Post Root Canal Treatment Pain
Condition: Pain; Postoperative Pain; Irreversible Pulpitis
MeSH terms: Pulpitis
Study type: Interventional
Phase: Phase 2

Summary: 
      Root canal therapy will ideally eliminate post-endodontic pain but occasionally analgesics
      are needed to diminish the pain [1]. Development of pain after completion of root canal
      treatment may undermine patients' confidence in the procedure and the clinician [2].
      Non-steroidal anti-inflammatory drugs are one of the most frequently taken analgesic
      medications for dental pain. Their popularity attributed to their efficacy in relieving pain
      and fever and low side effect profile at therapeutic doses [3]. Mono-therapy analgesic has a
      low effect on dental pain. Improvement was performance by combining analgesics with different
      mechanisms of action without raising any adverse effects [4], was effective in controlling
      moderate to severe pain. The combination of a non-steroidal anti-inflammatory drug (NSAID)
      and paracetamol has shown additive analgesia for treating dental pain in several studies
      [5,6]. Endodontic treatment with a lower prevalence of postoperative pain is usually the
      treatment of choice. There have been no controlled dental studies evaluating the additive
      effects of combining a non-steroidal anti-inflammatory drug with paracetamol. Breivik et al
      [6] & Menhinick et al [7] found that a combination of acetaminophen and ibuprofen was more
      effective than ibuprofen alone in managing postoperative pain. Aim of the present study, to
      evaluate the efficacy of the paracetamol when used alone and in combinations with three
      groups of drugs to control postoperative endodontic pain.
    

Detailed description: 
      Background: Management of pain is challenging part of dental treatment, sometimes pain is a
      major postoperative symptom after many dental procedures especially for endodontics. The aim
      of the present randomized clinical trial was to investigate the efficacy of using paracetamol
      alone and three combinations of non-steroidal anti-inflammatory drugs with paracetamol, to
      control postoperative endodontics pain.

      Methodology: 185 patients who had anterior or premolar teeth with irreversible pulpitis
      without any signs and symptoms of apical periodontitis and with moderate to severe pain.
      Patients were divided by allocation randomization into five groups. Four experimental groups
      receiving different medication; group I (single dose of paracetamol); group II (ibuprofen /
      paracetamol); group III (diclofenac k / paracetamol), group IV (mefenamic acid /paracetamol)
      and group V (no medication group). The groups received the medication after the first
      appointment where the pulp removed, and canals fully prepared. Pain intensity was scored
      based on 10-point VAS before and after treatment for up to 8 hours postoperatively. Sign test
      used for comparing pain score before and after treatment. This randomized control clinical
      trial was conducted on patients who were considered potential candidates if they had moderate
      to severe spontaneous pain of odontogenic origin (40-100 mm on a visual analogue scale, VAS).
      Patients were selected from those attending the Conservative dentistry clinics in both the
      University and the Teaching Hospital Emergency Clinic.

      The medications were prepared in the laboratories of faculty of Pharmacy. Four groups of
      medications were prepared as follows; Group I: paracetamol 1000mg Group II: ibuprofen 600mg +
      paracetamol 1000mg, Group III: Mefenamic acid 500mg + Paracetamol 1000mg Group IV: Diclofenac
      K 50mg + paracetamol 1000 mg
    

Intervention name(s): Root Canal Treatment; Paracetamol; Ibuprofen; Mefenamic acid; Diclofenac
Intervention type(s): Procedure; Drug; Drug; Drug; Drug
Intervention description(s): A standardized endodontic procedures performed.
Other intervention name(s): Endodontic treatment
Intervention MeSH terms: Acetaminophen; Ibuprofen; Diclofenac; Mefenamic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment