Strategies for managing pain during endodontic treatment

Abstract

Many patients associate root canal treatment with pain. Unfortunately, local anaesthetic techniques such as infiltrations and inferior alveolar nerve blocks are not very effective as single injections for acute irreversible pulpitis. This review discusses strategies for more effective pain management for such situations. Pain control before, during and after treatment is essential for effective patient management. Adequate pain control during treatment also reduces post-operative pain. Effective pain management begins with a thorough understanding of the conditions being treated and an accurate diagnosis. In some cases, premedication with non-steroidal anti-inflammatory drugs can help reduce intra-operative pain. Pain management during treatment involves standard local anaesthetic solutions and injection techniques plus increased volumes and supplementary injections. Once anaesthesia is achieved, treatment can be commenced and the root canal system can be medicated to relieve pain. These should be followed by flexible post-operative pain management strategies for the individual patient and specific condition.

Pre‐operative ketorolac efficacy with different anesthetics, irrigants during single visit root canal treatment of mandibular molars with acute irreversible pulpitis

“…Aggarwal et al (9) also had the same observation of pre‐operative administration of ketorolac tromethamine having no significant effect on the success of IANB. The current observation of no significant difference between lignocaine and articaine for intra‐operative pain is in accordance with a review article (2). Males had significantly higher intra‐operative pain intensity in this study but no clear explanation could be deduced for this occurrence.…”

“…Pulp testing the teeth prior to access preparation for sufficient anaesthesia is an important procedure (2), and the recommended method is the application of cold stimuli (2). However, in the present study it was seen that there was a significant association between pain on percussion after local anaesthetic administration and intra‐operative pain intensity in both anaesthetic groups compared with the cold test response.…”

“…Difficulties associated with clinical treatment of these teeth include attaining satisfactory anaesthesia to perform root canal treatment and the control of post‐treatment pain (1). Several strategies have been employed for achieving profound anaesthesia in these situations and for controlling the post‐operative discomfort (2). Among the most investigated strategies is the use of pre‐operative analgesics (2,3).…”

“…Several strategies have been employed for achieving profound anaesthesia in these situations and for controlling the post‐operative discomfort (2). Among the most investigated strategies is the use of pre‐operative analgesics (2,3). However, there is a lack of scientific evidence regarding the efficacy of oral pre‐operative analgesicsin controlling both the intra‐operative and post‐operative pain following single visit root canal treatment for mandibular teeth with acute irreversible pulpitis.…”

Effect of laser assisted local anesthesia in single-visit root canal treatment for mandibular molar teeth with acute irreversible pulpitis

“…Achieving satisfactory anesthesia and reducing the incidence of post-treatment discomfort are the particular difficulties encountered in the endodontic treatment of these teeth (1). Multiple strategies have been exploredto attain profound anesthesia and to control post-operative pain in these situations (2). An earlier report from the authors’ department concluded that pre-operative ketorolac tromethamine was not effective in reducing the intra-operative pain for mandibular molar teeth with acute irreversible pulpitis and apical periodontitis when using inferior alveolar nerve blocks (IANB) with both lignocaine and articaine anesthetic agents.…”