The role of prophylactic ibuprofen and N-acetylcysteine on the level of cytokines in periapical exudates and the post-treatment pain

Aim The primary aim was to identify techniques used to sample and analyse periradicular tissue fluid (PTF) in permanent teeth diagnosed with apical disease during root canal treatment. Secondly, to identify the types of inflammatory mediators studied using this approach. Methodology Data Sources: PubMed, EMBASE, Cochrane Library, Science Direct, Web of Science and OpenGrey. Eligibility Criteria: Clinical studies published until 1 June 2018 which utilized orthograde techniques to sample and analyse PTF were included. Cell culture, laboratory or animal studies and those concerned with investigating inflammatory mediator activity from within healthy or diseased pulp tissue, and not periradicular tissues, were excluded. Study appraisal and methods: In accordance with PRISMA guidelines, data were extracted on study characteristics, target mediators, sampling and assay techniques and the parameters associated with the PTF sampling and eluting protocol. A qualitative synthesis was conducted, and studies were critically appraised using a modified version of the Cochrane risk of bias tool. Results Study Characteristics: From 251 studies, 33 were eligible for inclusion. Sampling techniques included the use of paper points (n = 27), fine needle aspiration (n = 4) and filter strips (n = 2). Assay techniques included enzyme‐linked immunosorbent assay (n = 18), quantitative polymerase chain reaction (n = 9), radioimmunoassay (n = 4), colorimetric assay (n = 2), immunofluorometric assay (n = 1) and cytometric bead array (n = 1). Forty‐five different inflammatory mediators were targeted at the proteomic/metabolomic (n = 25) or transcriptomic level (n = 9). Limitations: Significant heterogeneity exists within the methodology, and only 5 studies disclosed unambiguous information about their PTF sampling and eluting protocols. Conclusions Paper points and proteomic/metabolomic analysis are currently the preferred methods for studying and analysing PTF during root canal treatment. The most studied analytes were IL‐1β and TNF‐α. Implications: Further research is required to develop an optimized PTF sampling and eluting protocol to overcome methodological heterogeneity, and future studies are advised to follow a standardized approach to reporting their methodology.

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“…,b, Ehsani et al . ). Seven studies excluded samples when ‘more than a small amount of blood’ was retrieved (Kuo et al .…”

Section: Resultsmentioning

confidence: 97%

“…()––2 mm past WL602After Instrumenting7 daysqPCRTRIzol (−µl)–––Ehsani et al . ()Kerr 40WL301After Instrumenting–ELISAPBS (300 µL)–60–Tavares et al . ()––2 mm past WL602After Instrumenting15 daysqPCRTRIzol (−µL)10–25 at 12 000 g Grga et al .…”

Section: Resultsmentioning

confidence: 99%

A systematic review of methods used to sample and analyse periradicular tissue fluid during root canal treatment

et al. 2019

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“…In the periodontal field, the benefit of NAC was also demonstrated by several studies in which it prevented the expression of LPS-induced inflammatory mediators during the inflammatory process (Hsu and Wen, 2002;Kim et al, 2007) and bone resorption (Lee et al, 2005). In addition, it has been proposed that NAC can be a substitute for ibuprofen for post-endodontic pain (Ehsani et al, 2012) and an alternative controlling agent against Enterococcus faecalis biofilm (Quah et al, 2012). Although the combined use of NAC with antibiotics will require careful studies, but its clinical usefulness as a controlling agent for oral infectious diseases would not be limited.…”

Section: Discussionmentioning

confidence: 96%

“…Recently, it was shown that NAC inhibits the growth of Enterococcus faecalis, which is often associated with endodontic treatment failures (Rôças et al, 2004), and eradicates its biofilm (Quah et al, 2012). Moreover, it has been proposed that NAC can be a substitute for ibuprofen for post-endodontic pain (Ehsani et al, 2012). However, the effect of NAC on other oral pathognes has not been studied.…”

Section: Introductionmentioning

confidence: 98%

In vitro effects of N-acetyl cysteine alone and in combination with antibiotics on Prevotella intermedia

et al. 2015

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N-acetyl cysteine (NAC) is an antioxidant that possesses anti-inflammatory activities in tissues. In the field of dentistry, NAC was demonstrated to prevent the expression of LPS-induced inflammatory mediators in phagocytic cells and gingival fibroblasts during the inflammatory process, but the effect of NAC on oral pathogens has been rarely studied. Here, we examined the effect of NAC against planktonic and biofilm cells of Prevotella intermedia, a major oral pathogen. NAC showed antibacterial activity against the planktonic P. intermedia with MIC value of 3 mg/ml and significantly decreased biofilm formation by the bacterium even at sub MIC. NAC did not affect the antibiotic susceptibility of planktonic P. intermedia, showing indifference (fractional inhibitory concentration index of 0.5-4) results against the bacterium in combination with ampicillin, ciprofloxacin, tetracycline or metronidazole. On the other hand, viability of the pre-established bacterial biofilm exposed to the antibiotics except metronidazole was increased in the presence of NAC. Collectively, NAC may be used for prevention of the biofilm formation by P. intermedia rather than eradication of the pre-established bacterial biofilm. Further studies are required to explore antibacterial and anti-biofilm activity of NAC against mixed population of oral bacteria and its modulatory effect on antibiotics used for oral infectious diseases.

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“…The remaining 26 articles were included for assessment of full texts, and one article was excluded because the subjects were treated with drugs during the intervention (Ehsani et al . ) (Fig. ).…”

Section: Literature Searchmentioning

confidence: 93%

The Presence and involvement of interleukin‐17 in apical periodontitis

2019

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Apical periodontitis (AP) is a chronic inflammatory disease characterized by periapical tissue inflammation and destruction of the associated alveolar bone. It is caused by microbial infections within the root canal and the resultant host immune responses in the periapical tissues. The proinflammatory cytokine interleukin (IL)‐17 has been shown to play an important role in many inflammatory diseases. There is increasing evidence of the presence of IL‐17 in AP, which might be associated with disease pathogenesis. Moreover, several animal studies indicate the potential role of IL‐17 in periapical inflammation and the resultant bone resorption in AP. This article reviews recent studies regarding the collective in vitro, in vivo and clinical evidence of the presence and involvement of IL‐17 in AP. A search related to IL‐17 in apical periodontitis was conducted on PubMed, EMBASE and Web of Science databases using keywords and controlled vocabulary. Two independent reviewers first screened titles and abstracts and then the full texts that were included. A total of 25 papers were identified, of the 25 included articles, 7 involved laboratory studies on cell cultures, 11 involved animal experimentations, and 7 were observational studies using human clinical samples. In conclusion, evidence for the presence of IL‐17 in AP from human and animal models is clear. However, there is relatively little information currently available that would highlight the specific role of IL‐17 in AP.

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The role of prophylactic ibuprofen and N-acetylcysteine on the level of cytokines in periapical exudates and the post-treatment pain

Cited by 17 publications

References 32 publications

A systematic review of methods used to sample and analyse periradicular tissue fluid during root canal treatment

A systematic review of methods used to sample and analyse periradicular tissue fluid during root canal treatment

In vitro effects of N-acetyl cysteine alone and in combination with antibiotics on Prevotella intermedia

The Presence and involvement of interleukin‐17 in apical periodontitis

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