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.