- 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 patients 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.
Authors Conclusion: Many factors are responsible for post operative pain and swelling
Reviewers Comments: The article provides an excellent and comprehensive overview.