Systematic review on medications used to prevent and treat postoperative endodontic pain

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Created On: 19/02/2022

A systematic review was carried out to determine safety and efficacy of medicament therapeutic protocols to prevent and manage moderate to severe endodontic pain.

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Key take away

For preventing and controlling postoperative pain, nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used, with ibuprofen being the most investigated therapeutic agent.

Background

A systematic review was carried out to determine safety and efficacy of medicament therapeutic protocols to prevent and manage moderate to severe endodontic pain.

Method

Databases such as SciELO, MEDLINE, Cochrane Library, and LILACs were searched for randomized clinical trials that evaluated the usage of medications to prevent or control pain in adults, using a visual analog scale (VAS) as a tool for pain estimation. Researchers carried out an additional search in the references of retrieved studies.

A decline in pain scores was the major endpoint while the requirement for additional analgesia and the occurrence of adverse effects were the secondary endpoints. For measuring the likelihood of bias in pain research reports, the quality assessment of the incorporated studies was carried out following the Jadad scale.

Result

A total of 10 studies were incorporated in the systematic review. In total, 5 studies administered the medicines prior to the endodontic procedures and 5 studies administered the medicines after the endodontic procedures. These studies assessed opioid analgesics (codeine, tramadol), non-opioid analgesics (acetaminophen), steroidal anti-inflammatory (prednisolone), nonsteroidal anti-inflammatories (naproxen, etodolac, ibuprofen, ketorolac tromethamine, flurbiprofen, tenoxicam), or the link of medications in prevention or management of postsurgery pain.

A clinically meaningful association between the usage of additional analgesics and periapical diagnosis was established. Noxious events were not noted when the administration occurred prior to the endodontic procedure. When it was given after the procedure, side effects were noted in two of three trials incorporated in the assessment.

Conclusion

In clinical practice, NSAIDs are the most commonly used agent to control postoperative endodontic pain. Also, there is a substantial relation between periapical diagnoses and the usage of additional analgesics.