Efficacy of Different Drugs to Control Post Root Canal Treatment Pain

Phase 2

Completed

• Conditions: Postoperative Pain; Irreversible Pulpitis; Pain
• Interventions: Procedure: Root Canal Treatment; Drug: Paracetamol; Drug: Ibuprofen; Drug: Mefenamic acid; Drug: Diclofenac

• Registration Number: NCT02417337
• Lead Sponsor: University of Khartoum

Brief Summary

Root canal therapy will ideally eliminate post-endodontic pain but occasionally analgesics are needed to diminish the pain \[1\]. Development of pain after completion of root canal treatment may undermine patients' confidence in the procedure and the clinician \[2\]. Non-steroidal anti-inflammatory drugs are one of the most frequently taken analgesic medications for dental pain. Their popularity attributed to their efficacy in relieving pain and fever and low side effect profile at therapeutic doses \[3\]. Mono-therapy analgesic has a low effect on dental pain. Improvement was performance by combining analgesics with different mechanisms of action without raising any adverse effects \[4\], was effective in controlling moderate to severe pain. The combination of a non-steroidal anti-inflammatory drug (NSAID) and paracetamol has shown additive analgesia for treating dental pain in several studies \[5,6\]. Endodontic treatment with a lower prevalence of postoperative pain is usually the treatment of choice. There have been no controlled dental studies evaluating the additive effects of combining a non-steroidal anti-inflammatory drug with paracetamol. Breivik et al \[6\] \& Menhinick et al \[7\] found that a combination of acetaminophen and ibuprofen was more effective than ibuprofen alone in managing postoperative pain. Aim of the present study, to evaluate the efficacy of the paracetamol when used alone and in combinations with three groups of drugs to control postoperative endodontic pain.

Detailed Description

Background: Management of pain is challenging part of dental treatment, sometimes pain is a major postoperative symptom after many dental procedures especially for endodontics. The aim of the present randomized clinical trial was to investigate the efficacy of using paracetamol alone and three combinations of non-steroidal anti-inflammatory drugs with paracetamol, to control postoperative endodontics pain.

Methodology: 185 patients who had anterior or premolar teeth with irreversible pulpitis without any signs and symptoms of apical periodontitis and with moderate to severe pain. Patients were divided by allocation randomization into five groups. Four experimental groups receiving different medication; group I (single dose of paracetamol); group II (ibuprofen / paracetamol); group III (diclofenac k / paracetamol), group IV (mefenamic acid /paracetamol) and group V (no medication group). The groups received the medication after the first appointment where the pulp removed, and canals fully prepared. Pain intensity was scored based on 10-point VAS before and after treatment for up to 8 hours postoperatively. Sign test used for comparing pain score before and after treatment. This randomized control clinical trial was conducted on patients who were considered potential candidates if they had moderate to severe spontaneous pain of odontogenic origin (40-100 mm on a visual analogue scale, VAS). Patients were selected from those attending the Conservative dentistry clinics in both the University and the Teaching Hospital Emergency Clinic.

The medications were prepared in the laboratories of faculty of Pharmacy. Four groups of medications were prepared as follows; Group I: paracetamol 1000mg Group II: ibuprofen 600mg + paracetamol 1000mg, Group III: Mefenamic acid 500mg + Paracetamol 1000mg Group IV: Diclofenac K 50mg + paracetamol 1000 mg

Study Timeline

• Study Start: 2012-08
• Primary Completion: 2014-08
• Study Completion: 2015-01
• Study First Submitted: 2015-03-30
• Status Verified: 2015-04
• Study First Submitted QC: 2015-04-14
• Last Update Submitted: 2015-04-14
• Study First Posted: 2015-04-15
• Last Update Posted: 2015-04-15

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 170

Inclusion Criteria

1. Patient reported spontaneous pain moderate to severe, ranging from 50 to 100 mm on a VAS (0-100 mm);
2. Adult patients presented for emergency endodontic treatment with a symptomatic maxillary or mandibular tooth (anterior and premolar) with a pulpal diagnosis of Irreversible pulpitis and normal periapex.
3. Patient choose to have root canal treatment for pain of endodontic origin.
4. The patient presented with American Society of Anesthesiologists (ASA) I or II medical history (ASA 1963).
5. The patient had read and thoroughly understood the pain score level sheet

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Exclusion Criteria

1. Patients below 18 years of age;
2. Analgesic taken within the last 4 hours;
3. History of allergy to NSAIDs, paracetamol or local anaesthetics;
4. History of uncontrolled systemic disease [gastrointestinal (GI) disorders, oesophageal reflux, active asthma, decreased hepatic function, haemorrhagic disorders, or poorly controlled diabetes mellitus].
5. Patients currently taking opioids, monoamine oxidase inhibitors, tricyclic antidepresssants, carbamazepine, diuretics, or anticoagulants;
6. There was history of opioid addiction or abuse; and
7. Pregnant or nursing female patients.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group III	Root Canal Treatment	Mefenamic acid 500mg + Paracetamol 1000mg
Group I	Paracetamol	paracetamol 1000mg
Group II	Root Canal Treatment	ibuprofen 600mg + paracetamol 1000mg,
Group IV	Paracetamol	Diclofenac K 50mg + paracetamol 1000 mg
Group I	Root Canal Treatment	paracetamol 1000mg
Group V	Root Canal Treatment	No medication
Group IV	Root Canal Treatment	Diclofenac K 50mg + paracetamol 1000 mg
Group II	Ibuprofen	ibuprofen 600mg + paracetamol 1000mg,
Group III	Paracetamol	Mefenamic acid 500mg + Paracetamol 1000mg
Group II	Paracetamol	ibuprofen 600mg + paracetamol 1000mg,
Group III	Mefenamic acid	Mefenamic acid 500mg + Paracetamol 1000mg
Group IV	Diclofenac	Diclofenac K 50mg + paracetamol 1000 mg

Primary Outcome Measures

Name	Time	Method
Efficacy of different Drugs to Control Post Root Canal Treatment Pain as measured by Visual Analogue Scale.	8 hours	The patients were asked to make entries on the VAS (numerical score) every hour for the first 4 hours after taking the medication and then every 2 hours following that; a total of six entries over 8 hours.

Trial Locations

Locations (1)

University of Khartoum, Faculty of Dentistry,; 🇸🇩 Khartoum, Sudan