Authors: Seltzer S, Naidorf IJ.
Title: Flare-ups in endodontics: II. Therapeutic measures.
Journal: J Endod
Date: Dec 1985
Citation: 11(12):559-67
Category: Endodontic Emergencies
Evidence-based Ranking: 5
Purpose/Objectives: To present treatment regimens for the relief of pain during endodontic therapy.

Treatment: Relief of Occlusion – disagreement persists whether or not occlusal relief aids in pain reduction; literature supports both arguments. Premedication of the Pulp Chamber or Root Canal at the First Appointment – no evidence exists indicating premedication of the canal system prior to instrumentation helps relieve symptoms of flare-ups. Establishment of Drainage – In the presence of suppuration, drainage is the most effective method to reduce pain and swelling (through the tooth or soft tissue). Intracanal Medicaments – medicaments claming to afford relief from, or to prevent pain during root canal therapy include antimicrobials, irrigation solutions, sulfa compounds, and corticosteroids – none of which cause significant reduction of pain. Systemic Drugs – Antibiotics – locally and systemically provide some relief, though controversial as to if it is imagined or real relief. Rational to use should depend on culturing and sensitivity testing. Corticosteroids – successfully used to reduce pain and swelling. Tryptophan – an essential amino acid helps reduce pain. Analgesics – Nonnarcotic – relieve pain without altering consciousness. Eg – Aspirin and acetominophen. NSAID – analgesic activity primarily based on inactivation protaglandin production by inhibition of the cyclooxygenase enzyme. Eg – Ibuprofen, naproxen. Narcotic – most commonly prescribed for severe pain controlling reactions to pain. They react with opioid receptors on a neuronal level. Eg – morphine, codeine, meperidine, and percodan. Placebos - pain maybe relieved by placebos. The effects are based on the patient’s comprehension of, and emotional response to drug administration.

Treatment of Pain After Completion of Endodontic Therapy: Post operative pain more frequently noticed in patients who present with pre-operative pain. Overextension of instruments, debris, and filling material can cause periapical inflammation. In rare cases paresthesia and pain of the lower jaw have occurred. They usually resolve within 1 year post-op. Acupuncture – not enough analgesia to perform endodontics. No efficacy in treating flare-ups. Explanations and Instructions – detailed explanations of the procedures, expected benefits, and possible pain response help minimize patients’ anxiety and post-operative discomfort.

Author’s Conclusion: Many factors are responsible for post operative pain and swelling

Reviewer’s Comments: The article provides an excellent and comprehensive overview.