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Single dose of prednisolone
reduces pain and need for postoperative analgesics, therefore it's use should
be considered for one visit root canal treatment.
Oral Prednisolone 40mg was beneficial for management of postoperative pain for 24hrs after single visit root canal treatment in symptomatic irreversible pulpitis patients, as evident from the findings of a study published in the 'Evidence-Based Dentistry'.
Endodontic treatment has been
associated with postoperative pain. After the endodontic treatment, pain can
occur within a few hours or a few days. Oral analgesics such as nonsteroidal
analgesics and acetaminophen or in combination with narcotics/opioids are the
most recommended treatment for Postoperative endodontic pain.
In the present trial, Analia
Veitz-Keenan et al. evaluated the role of oral prednisolone in the management
of postoperative endodontic pain. The authors included the patients between the
ages of 18 and 35 years having mandibular molars with symptomatic irreversible
pulpitis. Two tablets of each medicine were placed in sequentially numbered,
opaque, sealed packages for allocation concealment. Participants and operators
were blind about the assigned group. Post-graduate students were calibrated to
act as operators, and supervisors to evaluate their clinical execution. The
participants received 40 mg of prednisolone or placebo tablets 30 minutes
before a single visit root canal treatment. Patients recorded the pain level 6,
12 and 24 hours after treatment on a 100mm visual analogue scale. All patients
received a sham capsule to take if needed as postoperative analgesia. If pain
persisted, an analgesic was prescribed.
The incidence of postoperative
pain at three points; 6, 12 and 24 hrs was evaluated as the primary endpoint.
Pain intensity and the prevalence of analgesic consumption was also measured as
secondary outcomes. The relative risk reduction (RRR) and the
number-needed-to-treat (NNT) and their 95% confidence intervals (CI) were used
to represent the risk of pain incidence.
Of the 670 patients, 398 patients
with a mean age of 28.97 were included in the analysis (prednisolone group =
198; control group = 200); 259 were women and 141 men. The relative risk
reduction in pain incidence at 6, 12 and 24 hours was 20.31%, 23.39%, and
28.85% respectively. Prednisolone had significantly less post-obturation pain
intensity compared to placebo at 6, 12 and 24 hours. The RRR in sham-capsule intake
was 54% and in analgesic, intake was 55%. No adverse effects were recorded. The
NNT at 6, 12 and 24 hours was 5, 5 and 4 respectively.
The study findings suggest that
prednisolone provides effective pain relief in endodontic patients. Minimal adverse effects and
non-invasive route results in a favourable risk benefit-balance.
Evidence-Based Dentistr
Single dose oral prednisolone and post-operative endodontic pain
Analia Veitz-Keenan et al.
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