Endodontic treatment has been a source of anxiety and fear due to the association with postoperative pain. It is usually managed by using oral analgesics such as nonsteroidal analgesics and acetaminophen or in combination with narcotics/opioids. The present research demonstrates that single dose of 40 mg prednisolone was beneficial for the control of postoperative pain up to 24hrs.

A double-blind placebo-controlled, randomised, single centre clinical trial validated by the Institutional Review Board of Ethics Committee at the School of Dentistry, Cairo University to manage post-operative endodontic pain.

The analysis involved healthy participants with mandibular molars and symptomatic irreversible pulpitis, radiographically normal periapical area and no pain on biting or percussion. The sequence generation and allocation concealment were performed by the independent Centre for Evidence-Based Dentistry.  The allocation concealment conducted using two tablets of each medication in opaque, sealed, sequentially numbered containers. Operators and participants were unknowing of the assigned group at the time of the analysis. Subjects either received 40 mg Prednisolone or placebo tablets 30 minutes prior to single visit root canal operation. The 100mm visual analogue scale used to measure the pain at 6, 12 and 24 hours following the treatment. If required postoperative analgesia, patients obtained a sham capsule. If pain continued, an analgesic was given. The frequency of postoperative pain at 6, 12 and 24 hours were considered as the primary endpoint and the rate of analgesic consumption and pain intensity considered as secondary endpoints. The risk of pain incidence presented by using the number-needed-to-treat (NNT) and the relative risk reduction (RRR) and their 95% confidence intervals (CI). 

A total of 400 participants were selected for analysis. Out of 400 patients, 398 were included as the two participants were lost to follow-up. Both groups exhibited similarity in tooth type, mean age, and gender distribution. The relative risk decline in pain frequency at six, 12, and 24 hours noticed to be 20.31%, 23.39%, and 28.85%, respectively. Individuals received Prednisolone show less post-obturation pain intensity than placebo at 6, 12 and 24 hours. The relative risk decline in analgesic consumption was 55% and in sham-capsule consumption was 54%. No adverse effects were reported. The number needed to treat (NNT) noticed at six, 12 and 24 hours were five, five and four, respectively.

The preoperative 40 mg prednisolone single dose provides considerable efficacy for postoperative pain managment up to 24hrs after single visit root canal treatment.