The effect of calcium hydroxide on post-treatment pain

Abstract

The purpose of this clinical study is to assess whether calcium hydroxide as an intracanal medication affects post-treatment pain in teeth especially odontogenic pain which comes from inflammation of the pulp and periradicular tissues when compared with no intracanal medication.From 213 patients who has been treated 237 root canals due to significant pain (moderate-tosevere), we recorded their age, sex, treated tooth, degree of pain, pre-operative states of the tooth. We classified patients into 2 test group; Group 1 (not gain intracanal Ca(OH)2), Group 2 (gain intracanal Ca(OH)2). Through the survey from the patients, we let them write down the occurrence and degree of post-treatment pain in 4hours, 2days, 7days after treatment as none, mild, moderate or severe. The followings were evaluated; the overall incidence of flare-ups, the overall incidence of post-treatment pain in each group at each time period, the incidence of post-treatment pain in each group at each time period as related to pre-operative states of the teeth. These were compared statistically with Chi-square analysis (p < 0.05).Under the condition of this investigation, no difference was observed in the incidence of post-treatment pain between the two groups. Therefore, Ca(OH)2 as intracanal medication had no effect on preventing or decreasing the post-treatment pain. [J Kor Acad Cons Dent 31(2):86-95, 2006]

Calcium hydroxide intracanal medication effects on pain and flare-up: a systematic review and meta-analysis

“…On comparing CH with no ICM, CH does not seem to affect postoperative pain prevention within the first 24 hours [10], yet it could be of benefit afterward in reducing pain risk by about 12% within the following 2 days and 87% afterward (Figure 2A and 2B) [4,10,21]. Results, however, should be interpreted with caution due to the overall low-to-moderate quality evidence (Supplementary Table 5).…”

“…The characteristics of the included studies are summarized in Tables 1 and 2. All the included studies were RCTs with parallel-arm or multi-arm design and published in English language except for one study in Korean [10]. A total of 1,643 participants with 1,699 teeth were Flare-up VRS 1d, 2d, 3d, 7d Incidence † CH = 4/10, CHX = 0/10, TAP = 0/10 Uyan et al [25] 2018 Zero events CH, calcium hydroxide; CHX, chlorhexidine; CS/AB, corticosteroid and antibiotic combination; d, day; DAP, double antibiotic paste; h, hour; HP-VAS, Heft-Parker visual analogue scale; ICM, intracanal medication; m, month; NRS, numerical rating scale; TAP, triple antibiotic paste; UPAT, Universal pain assessment tool; VAS, visual analogue scale, VRS, verbal rating scale; w, week.…”

“…On comparing CH with no ICM, 3 studies assessed pain incidence [4,10,21]. At the ≤ 1-day interval, there was no difference in pain risk (RR, 1.93; 95% CI, 0.80 to 4.66; 1 study, 127 teeth, High RoB) [10]; the certainty of evidence (CoE) is very low (Supplementary Table 5).…”

“…On comparing CH with no ICM, 3 studies assessed pain incidence [4,10,21]. At the ≤ 1-day interval, there was no difference in pain risk (RR, 1.93; 95% CI, 0.80 to 4.66; 1 study, 127 teeth, High RoB) [10]; the certainty of evidence (CoE) is very low (Supplementary Table 5). At the > 1-day-till-3-days interval, CH decreased the risk of pain (RR pooled , 0.88; 95% CI, 0.82 to 0.95; I 2 = 47%; 477 teeth, 3 studies, 1 'Some Concerns' & 2 High RoB, Figure 2A) [4,10,21]; the CoE is moderate (Supplementary Table 5).…”

“…Calcium hydroxide and post-endodontic pain (RR pooled , 0.13; 95% CI, 0.03 to 0.65; I 2 = 0%; 167 teeth, 2 studies, 2 High RoB, Figure 2B) [4,10]; the CoE is low (Supplementary Table 5). 2 studies [11,27] reported data for pain intensity.…”