Background: One of the main reasons for post endodontic pain is the polymicrobial intracanal flora that may survive the initial disinfection. A single antimicrobial agent might not provide adequate disinfection, and an antimicrobial combination such as triple antibiotic paste was tested to achieve this goal. Aim: The study aimed to assess the efficacy of three intra-canal medicaments on post root canal preparation pain. Materials and Methods: Eighty patients with single-rooted necrotic teeth and symptomatic apical periodontitis were randomly assigned to four treatment groups (n = 20). Their preoperative pain was recorded on Wong-Baker’s FACES pain rating scale. After chemo-mechanical canal preparation, intracanal medications were applied to the groups (Group 1 (20% calcium hydroxide), Group 2 (2% chlorhexidine), Group 3 (tri-antibiotic paste), Group 4 (no medication (Control group)). Patients were instructed to record pain on the Wong-Baker FACES pain rating scale at 4, 48, 72 and 96 hrs, postoperatively. Pain scores were analyzed using a one-way ANOVA test and Tukey’s post hoc test and, if significant, Dunn’s test was used for pair-wise comparisons. The significance level was set at a p-value ≤ 0.05. Results: Tukey’s post hoc test revealed significantly lower pain scores in Group 3 compared with other groups at all follow up intervals. Dunnett’s test showed significantly lower pain in Group 3 compared with the Control group at 48, 72 and 96 hrs, postoperatively. Conclusions: Triple-antibiotic paste showed effective pain control as an intracanal medication on necrotic teeth with symptomatic apical periodontitis.

Introduction:  In early phase of irreversible pulpitis, there is normally no clinically significant sings of infections specially bacterial infections but still there are a lot of dental practitioners that prescribe antibiotics in case of irreversible pulpitis, though there is limited data evidence that the antibiotic penicillin cause reduction in percussion sensitivity and pain (Nagle, Reader, Beck, & Weaver, 2000).There is increasing trend by dental prescription regarding over use of antibiotics in treatment of orofacial and endodontic infections and the culture in these dental infections isolated those pathogens that are multi drug resistant towards commonly prescribed antibiotics (Rôças & Siqueira Jr, 2013). Setting: Sandeman Provincial Hospital and Bolan Medical Complex Hospital Quetta. Study Duration: Duration of this study was 6 months that is from March till August 2021. Results: Majority (n=68,55.3%) of respondents were general dental practitioners followed by operative dentistry respondents (n=21,17.1%). Majority (n=54,43.9) of prescribers were having perception that analgesic should be prescribed and perform concurrent pulpectomy while (n=25, 20.3%) of prescribers had perception that in patients with irreversible pulpitis, prescribe antibiotics, analgesics and perform concurrent pulpectomy whereas majority (n= 6) of orthodontics would Immediately prescribes analgesic and schedule for RCT later.  Prescribers having experience of 1 to 10 years would prescribe analgesic and perform concurrent pulpectomy. Conclusion This study concluded that majority of dental practitioners had perception of prescribing antibiotics in irreversible pulpitis while there were still a good number of those dental prescribers that had perception of prescribing analgesics and performing concurrent Pulpectomy.