The effect of pretreatment submucosal injections of tramadol and dexamethasone on post‐endodontic pain in mandibular molar teeth with symptomatic irreversible pulpitis: a randomized controlled clinical trial

Abstract

AimTo establish the effects of submucosal single doses of two medicines on postoperative pain after root canal treatment in mandibular molar teeth with symptomatic irreversible pulpitis.MethodologyIn this randomized controlled, double‐blind clinical trial, 90 patients with the diagnosis of symptomatic irreversible pulpitis in their mandibular first or second molars were included and randomly divided into three groups (n = 30): a control group that received normal saline and two experimental groups that received a single dose of either tramadol (100 mg 2 mL−1) or dexamethasone (8 mg 2 mL−1). After local anaesthesia and before treatment, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars, and a routine single‐visit root canal treatment procedure was performed in all groups. After the root canal treatments, the patients were asked to score their pain level using the Heft–Parker visual analogue scale (0–170 mm) at 6, 12, 24, 48 and 72 h. The experimental groups were compared using one‐way anova or Kruskal–Wallis H‐test. The groups that were significantly different were compared pairwise using Student's t‐test or the Mann–Whitney U‐test. The findings were expressed as the mean ± standard deviation or median (min‐max). The categorical variables were tested using the chi‐square test or Fisher's exact chi‐square test, and the results were expressed as counts and percentages.ResultsAt the 6‐h and 48‐h time intervals, the intensity of pain was significantly less in both the dexamethasone and tramadol groups than in the control group (P < 0.0167). At the end of 12 h, the pain level in the dexamethasone group was significantly less compared to the other groups (P < 0.0167).ConclusionsPretreatment submucosal dexamethasone and tramadol injections significantly diminished post‐treatment endodontic pain of patients with symptomatic irreversible pulpitis following single‐visit root canal treatment. However, dexamethasone was more effective than tramadol in pain reduction in the first 12 h.

The Comparison of Short-Term Postoperative Pain in Single- versus Multiple-Visit Root Canal Treatment: A Systematic Review and Meta-Analysis Study

“…erefore, the clinician could optimize the treatment procedures in different stages to control postendodontic pain [4,10]. e effect of visit number on postendodontic pain is one of the intratreatment factors, which has been studied in different studies.…”

Effect of premedication on postoperative pain after root canal therapy in patients with irreversible pulpitis: a systematic review and meta-analysis

“…The characteristics of the included studies are summarized in Table 2 . Of the 10 studies that were included in this review, six were from Iran [ 12 13 15 20 22 29 ], two were from Egypt [ 30 31 ], and there was one each from India [ 16 ] and Turkey [ 32 ]. All studies were conducted between 2010–2020.…”

“…Corticosteroids and NSAIDs were used in four[ 20 22 33 34 ] and five studies [ 12 13 15 29 32 ], respectively. In one study, both were used as premedications[ 16 ].…”

“…In one study, both were used as premedications[ 16 ]. Among corticosteroids, dexamethasone was administered through submucosal [ 32 ] and intraligamentary [ 20 ] routes, while prednisolone was administered orally[ 16 22 31 ]. In NSAIDs, piroxicam was administered via the intraligamentary route [ 29 ], and diclofenac potassium[ 30 ], ibuprofen [ 12 13 ], and indomethacin [ 13 ] were administered orally.…”

“…Additional analgesic intake: Ibuprofen in four [ 15 16 22 32 ], acetaminophen in three [ 12 15 22 ], diclofenac potassium in two [ 30 31 ], and no specific drug was prescribed as rescue medication in three studies[ 13 20 29 ]. Additional analgesic intake was significantly higher in the control group than in the premedication group in three studies [ 15 31 32 ], while no significant difference was observed in three studies [ 12 20 29 ]. Two studies failed to mention the analysis of rescue medication intake, while two studies excluded patients who used rescue medication.…”