Effect of supraperiosteal injection of dexamethasone on postoperative pain

Abstract

Many patients suffer from mild, moderate or severe pain during or after root canal therapy. The purpose of this study was to evaluate the efficacy of supraperiosteal injection of dexamethasone into the periapical tissues to prevent postoperative pain associated with inflammation. In a double-blind, placebo-controlled clinical trial, 100 patients with moderate or severe pain who were referred to dental school of Tehran Islamic Azad University participated in this study. All patients had a tooth with clinical diagnosis of irreversible pulpitis. After administration of local anaesthesia, access cavity was prepared. Then, the root canals were instrumented to a minimum of a No. 25 K-file. One millilitre dexamethasone (8 mg 2 mL(-1)) or placebo was injected around the tooth. The severity of pain was assessed with regard to a modified visual analogue scale after 6, 12, 24 and 48 h. The data was analysed statistically with chi-square test. Dexamethasone was considerably effective on controlling the severity of pain during the first 24 h; in contrast, there was no difference between dexamethasone and placebo groups 48 h after the first appointment. A single dose of dexamethasone infiltrated around the apex of a tooth with irreversible pulpitis could be effective in reduction or prevention of postoperative endodontic pain during the first 24 h.

Single-Dose of Submucosal Injection of Dexamethasone Affects the Post Operative Quality of Life After Third Molar Surgery

“…Findings of this study is quite similar to the previous studies using submucosal route. VAS Score and total number of analgesics used was not statistically different between the groups [12][13][14][15]. However, Majid [16] found that the significant analgesic effect could be a different mechanism which was not clearly explained.…”

“…Many reports support the use of local application of dexamethasone in the setting of TMS [11][12][13][14][15][16]. But those studies demonstrated conflicting results because of the limited number of subjects, different route and dose of corticosteroid administered, use of different surgical techniques and lack of standardized anaesthetic technique (Local or General).…”

“…Therefore, this study intended to produce rapid action before the inflammatory mediator release. But reviewing various previous studies, the reason of rapid action that occurs in a few minutes as in this study could be due to nongenomic path of action by administering submucosal (tropical) injection of dexamethasone [10][11][12][13][14][15][16]. This pathway does not require de novo protein synthesis and acts by modulating the level of activation and responsiveness of target cells, such as monocytes, T cells, and platelets and also leads to peripheral vasoconstriction which further increases local drug concentrations [27].…”

“…However, method of usage of corticosteroid in literature has varied; most effective agents, site, dose and route have yet to be defined with respect to TMS [9]. Despite the frequent clinical use of dexamethasone, there are a few reports of corticosteroid administered in proximity to surgical site which have shown positive response after TMS [10][11][12][13][14][15][16]. Even though, QOL measures after administration of preoperative single dose submucosal dexamethasone remains poorly investigated.…”

The Effect of Preoperative Administration of Antihistamine, Analgesic and Placebo on Postoperative Pain in Teeth with Symptomatic Apical Periodontitis: A Randomized Controlled Trial

“…A recent systematic review showed that between 3% and 58% of patients were reported to have experienced endodontic postoperative pain (5). The management of postoperative pain has been the subject of many research studies, including preoperative explanations and instructions (6), long-acting anesthesia (7), the glide path (8), occlusal reduction (9, 10), medication using salicylic acid (11), non-steroid anti-inflammatory drugs (NSAIDs) (12), combination of ibuprofen and acetaminophen (13), narcotic analgesics (14), a combination of narcotic analgesics with aspirin (15) or acetaminophen (16), and steroidal anti-inflammatory drugs (17,18).…”