In individuals having symptomatic apical periodontitis and irreversible pulpitis, the preoperative orally administered single dose of dexamethasone, piroxicam, or prednisolone lowers the incidence and severity of postoperative pain after single-visit root canal treatment in comparison with placebo up to 24 hours.

A randomized, double-blinded, clinical trial was carried to determine the effect of oral premedication of dexamethasone, piroxicam, prednisolone, or placebo on postoperative pain after single-visit root canal therapy in teeth with symptomatic irreversible pulpitis and symptomatic apical periodontitis.

The study cohort included 160 patients. Participants were randomized to receive oral administration of either 20 mg piroxicam, 20 mg prednisolone, 4 mg dexamethasone, or a placebo 60 minutes prior to root canal treatment.

Utilizing a 10-cm visual analogue scale, the participants recorded their postoperative pain intensity at 6, 12, 24, 48, and 72 h. The intergroup comparison was carried out utilizing Kruskal-Wallis tests with post hoc assessment utilizing Dunn's test. Utilizing the chi-square tests, the pain incidence was analyzed. To assess the odds of postoperative pain, the binary logistic regression was utilized, with pain incidence as the dependent variable and type of tooth, intervention groups, gender, and age as independent variables.

Overall, 156 participants were analyzed in the trial, since four subjects dropped out during the follow-up. As found, all drugs were linked with a considerably lower occurrence of postoperative pain compared to the placebo at 6 h, 12 h, and 24 h.

Compared to the other three intervention groups, the average intensity of pain was considerably more intense at six, 12, and 24 h with placebo usage. The pain intensity was not considerably different between the premedications utilized. Gastritis was reported by one piroxicam-treated subject whereas no side effects were reported in other arms.

The odds of postoperative pain at 24 hours for individuals premedicated with dexamethasone or piroxicam or prednisolone were 5.3 times, 3.4 times, and 2.5 times less compared to the placebo, respectively. Thus, administration of dexamethasone, piroxicam, or prednisolone improved the postoperative comfort for individuals undergoing single visit root canal treatment and thus can improve their oral health linked quality of life.