World Journal of Dentistry

Register      Login

VOLUME 10 , ISSUE 5 ( September-October, 2019 ) > List of Articles

ORIGINAL RESEARCH

Evaluation of NSAIDs in Acute Odontogenic Pain: A Quadriblind Study

Karthik R Mohan, Mohan Narayanan, Pethagounder Thangavel Ravikumar, Saramma M Fenn, Sabitha Gokulraj, Amirthaleka

Keywords : Analgesics, Irreversible pulpitis, Odontogenic pain

Citation Information : Mohan KR, Narayanan M, Ravikumar PT, Fenn SM, Gokulraj S, A. Evaluation of NSAIDs in Acute Odontogenic Pain: A Quadriblind Study. World J Dent 2019; 10 (5):384-389.

DOI: 10.5005/jp-journals-10015-1649

License: CC BY-NC 4.0

Published Online: 01-10-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Odontogenic pain refers to pain arising from the teeth or their supporting structures, the oral mucous membrane, the maxilla or mandible, or periodontal ligament membrane. Management of odontogenic pain becomes challenging in the modern era to the clinician due to its diversified etiologies. Aim: The primary aim is to evaluate the efficacy of NSAIDs in treating acute odontogenic pain due to acute pulpitis, acute periapical abscess, and acute pain after root canal therapy. Materials and methods: Patients visiting the outpatient department, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation, with odontogenic pain due to acute pulpitis and acute periapical abscess were randomly selected. A total of 80 patients were considered and divided into 4 groups (n = 20 were prescribed paracetamol, n = 20 were prescribed ibuprofen, n = 20 were prescribed aceclofenac, n = 20 were prescribed ketorolac). The patients in each group were not aware of the analgesic drug prescribed. (quadriblind drug trial). Pain was analyzed by the visual analog score (VAS) graded from 0 to 10, and the VAS scores were recorded at initial, 30-minutes, 1-hour, and 2-hours intervals. Result: Ketorolac is better in relieving the odontogenic pain when compared to paracetamol, ibuprofen, and aceclofenac. Conclusion: Ketorolac is an effective NSAID in relieving the odontogenic pain. Clinical significance: This study helps to evaluate the effectiveness of nonsteroidal anti-inflammatory drugs for odontogenic pain and helps in identifying the more potent NSAID for odontogenic pain without the use of inferior alveolar nerve block.


PDF Share
  1. Renton T. Dental (Odontogenic) Pain. Rev Pain 2011;5(1):2–7. DOI: 10.1177/204946371100500102.
  2. Curtis P, Gartman LA, Green DB. Utilization of ketorolac tromethamine for control of severe odontogenic pain. J Endod 1994;20(9):457–459. DOI: 10.1016/S0099-2399(06)80038-5.
  3. Praveen R, Thakur S, Kirthiga M. Comparative Evaluation of Premedication with Ketorolac and Prednisolone on Postendodontic Pain: A Double-blind Randomized Controlled Trial. J Endod 2017;43(5):667–673. DOI: 10.1016/j.joen.2016.12.012.
  4. Rainsford KD. Anti-inflammatory drugs in the 21st century. Subcell Biochem 2007;42:3–27.
  5. Brune K. The Pharmacological profile of non-opioid (OTC) analgesics: aspirin, paracetamol (acetaminophen), ibuprofen and phenazones. Agents Actions Suppl 1988;25:9–19.
  6. Boutaud O, Aronoff DM, Ichardson JH, et al. Determinants of the cellular specificity of acetaminophen as an inhibitor of Prostaglandin H(2) synthases. Proc Natl Acad Sci USA 2002;99:7130–7135. DOI: 10.1073/pnas.102588199.
  7. Ouellet M, Percival MD. Mechanism of acetaminophen inhibition of cyclooxygenase isoforms. Arch Biochem Biophys 2001;38:7273–7380. DOI: 10.1006/abbi.2000.2232.
  8. González-Alvaro I, Carmona L, Díaz-González F, et al. Aceclofenac, a new nonsteroidal antiinflammatory drug, decreases the expression and function of some adhesion molecules on human neutrophils. J Rheumatol 1996;23(4):723–729.
  9. Davies NM. Clinical pharmacokinetics of ibuprofen. The first 30 years. Clin Pharmacokinet 1998a;34:101–154. DOI: 10.2165/00003088-199834020-00002.
  10. Buckley MM, Brodgen RN. Ketorolac. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential. Drugs 1990;39:86–109. DOI: 10.2165/00003495-199039010-00008.
  11. Ianiro SR, Jeansonne BG, McNeal SF, et al. The effect of preoperative acetaminophen or a combination of acetaminophen and Ibuprofen on the success of inferior alveolar nerve block for teeth with irreversible pulpitis. J Endod 2007;33(1):11–14. DOI: 10.1016/j.joen.2006.09.005.
  12. Ramachandran A, Khan SIR, Mohanavelu D, et al. The efficacy of pre-operative oral medication of paracetamol, ibuprofen, and aceclofenac on the success of maxillary infiltration anesthesia in patients with irreversible pulpitis: A double-blind, randomized controlled clinical trial. J Conserv Dent 2012;15(4):310–314. DOI: 10.4103/0972-0707.101881.
  13. Moore RA, Derry S, McQuay HJ. Single dose oral aceclofenac for postoperative pain in adults. Cochrane Database Syst Rev 2009;8(3):CD007588. DOI: 10.1002/14651858.CD007588.pub2.
  14. Sadehein A. A comparison of ketorolac tromethamine and acetaminophen codeine in the management of acute apical periodontitis. Journal of Endodontics [Internet] 2019 Feb;25(4):257–259, available from: https://www.jendodon.com/article/S0099-2399(99)80154-X/fulltext.
  15. Bezrukova IV, Gerchikov LN. The analgesic action of the preparation Ketanov in the combined treatment of patients with pulpitis and periodontitis. Stomatologiia (Mosk) 2000;79(2):10–11.
  16. Aggarwal V, Singla M, Kabi D. Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. J Endod 2010;36(3):375–378. DOI: 10.1016/j.joen.2009.11.010.
  17. Jena A, Shashirekha G. Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: a placebo-controlled clinical study. J Conserv Dent 2013;16(2):171–174. DOI: 10.4103/0972-0707.108209.
  18. Yadav M, Grewal MS, Grewal S, et al. Comparison of Preoperative Oral Ketorolac on Anesthetic Efficacy of Inferior Alveolar Nerve Block and Buccal and Lingual Infiltration with Articaine and Lidocaine in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind Study. J Endod 2015;41(11):1773–1777. DOI: 10.1016/j.joen.2015.06.008.
  19. Sivaramakrishnan G, Sridharan K. Oral Ketorolac with Inferior Alveolar Nerve Block for Irreversible Pulpitis: A Systematic Review and Meta-analysis. Open Dent J 2018;12:340–346. DOI: 10.2174/1874210601812010340.
  20. Vieyra JP, Acosta FO, Enriquez FJJ, et al. The Effect of Preoperative Administration of Single-Dose Ketorolac, Non-Steroidal Anti-Inflammatory Drug and Placebo on Postoperative Pain in Teeth with Irreversible Pulpitis and Apical Periodontitis. J Dental Sci 2018;3(4):000175.
  21. Gowri S, Sridharan K. Oral Ketorolac with Inferior Alveolar Nerve Block for Irreversible Pulpitis: A Systematic Review and Meta-analysis. The Open Dentistry Journal 2018;12:340–346. DOI: 10.2174/1874210601812010340.
  22. de Geus JL, Wambier LM, Boing TF, et al. Effect of Ibuprofen on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A meta-analysis. Aust Endod J 2019;45(2):246–258. DOI: 10.1111/aej.12306.
  23. Menhinick KA, Gutmann JL, Regan JD, et al. The efficacy of pain control following nonsurgical root canal treatment using ibuprofen or a combination of ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled study. Int Endod J 2004;37(8):531–541. DOI: 10.1111/j.1365-2591.2004.00836.x.
  24. Parirokh M, Ashouri R, Rekabi AR, et al. The effect of premedication with ibuprofen and indomethacin on the success of inferior alveolar nerve block for teeth with irreversible pulpitis. J Endod 2010;36(9):1450–1454. DOI: 10.1016/j.joen.2010.05.007.
  25. Pozzi A, Gallelli L. Pain management for dentists: the role of ibuprofen. Ann Stomatol (Roma) 2012 Apr 15;2(3–4 Suppl):3–24.
  26. Shahi S, Mokhtari H, Rahimi S, et al. Effect of premedication with ibuprofen and dexamethasone on success rate of inferior alveolar nerve block for teeth with asymptomatic irreversible pulpitis: a randomized clinical trial. J Endod 2013;39(2):160–162. DOI: 10.1016/j.joen.2012.10.011.
  27. Smith EA, Marshall JG, Selph SS, et al. Nonsteroidal Anti-inflammatory Drugs for Managing Postoperative Endodontic Pain in Patients Who Present with Preoperative Pain: A Systematic Review and Meta-analysis. J Endod 2017 Jan;43(1):7–15.
  28. Pulikkotil SJ, Nagendrababu V, Veettil SK, et al. Effect of oral premedication on the anaesthetic efficacy of inferior alveolar nerve block in patients with irreversible pulpitis - A systematic review and network meta-analysis of randomized controlled trials. Int Endod J 2018;51(9):989–1004. DOI: 10.1111/iej.12912.
  29. Nagendrababu V, Pulikkotil SJ, Veettil SK, et al. Effect of Nonsteroidal Anti-inflammatory Drug as an Oral Premedication on the Anesthetic Success of Inferior Alveolar Nerve Block in Treatment of Irreversible Pulpitis: A Systematic Review with Meta-analysis and Trial Sequential Analysis. J Endod 2018;44(6):914–922. DOI: 10.1016/j.joen.2018.02.017.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.