Authors: Marshall JG.
Title: Consideration of steroid for endodontic pain.
Journal: Endodontic Topics
Date: Jan 2002
Citation: 3:41-51, 2002
Category: Endodontic Pharmacology
Evidence-based Ranking: 5
Purpose/Objective: To consider the use of steroids specifically glucocorticoids in the management of endodontic pain.

Discussion: Endodontic pain is often associated with chronic inflammation, the presence of bacterial by-products, influx of immune cells and activation of the cytokine network and other inflammatory mediators. The chronicity of pulpal and periapical inflammation permits sprouting of nociceptor terminals and thus change the peripheral anatomy of the pain system. In humans, cortisol is the primary glucocorticoid that is continuously synthesized and secreted from the adrenal cortex. Glucocorticoids inhibit the inflammatory response by its effect on gene transcription that produces a decrease in the release of vasoactive and chemoattractive factors like bradykinin and certain cytokines that occur during periapical inflammation. Glucocorticoids when given over a short course is unlikely to be harmful although it is contraindicated with patients that have systemic fungal infection, patients that have hypersensitivity to the drug, patients with ulcerative colitis, pyogenic infection, diverticulitis, peptic ulcer, renal insufficiency, hypertension, osteoporosis, pregnancy, diabetes mellitus, ocular herpes, acute psychosis and history of TB. Steroids have been used as intracanal medicaments, by Wolfsohn (1957) and EhrmanÂ’s Ledermix (1965), to control pain. Several studies also reported the use of steroids by systemic administration. Oral dexamethasone, intraligamentary, intrasseous and intramuscular administration of steroids have shown decrease in endodontic post treatment pain. The studies show that they have the best efficacy and most appropriately used for those patients who present with moderate to severe pain and teeth with pulpal necrosis and associated radiolucencies (chronic inflammatory processes) than pain associated with irreversible pulpitis. Intraoral injection of 6-8mg of dexamethasone or 40mg of methylprednisolone OR oral dose of 48mg methlprednisolone/day for 3 days and 10-12mg dexamethasone/day for 3 days is suggested by the literature reviewed. Antibiotics are not routinely recommended in conjuction with corticosteroids in the management of the otherwise healthy patient.

Conclusions: Steroids is efficacious as an adjunct to but not a replacement for appropriate endodontic treatment in the lessening of endodontic post treatment pain.

ReviewerÂ’s comments: An excellent comprehensive review of the literature about steroids in endodontics.