Abstract

  Endodontic therapy can land up in failures leading to intra-operative and post-operative pain due to multiple factors. Managing such pain becomes a crucial factor for success of endodontic treatment and patient satisfaction in dental practice. Various treatment modalities are utilized to manage such conditions such as de-occluding from antagonist, re-instrumentation, cortical trephination, incision followed by drainage, administrating systemic antibiotics and analgesics. Transformations in the regimen of therapy to has evolved from radical to conservative mode which nowadays utilize prolonged contact of the analgesic, antibiotic or anesthetic agents to alleviate intra and/or post-operative endodontic pain through controlled drug release system minimizing the risk of systemic as well as local tissue toxicity, and at the same time providing maximum benefits to the patients. Thus, aim of this paper is to review and highlight various controlled drug delivery techniques to manage intra and post-operative endodontic pain.

Keywords: Endodontic Therapy; Local Drug Delivery; Pain Management

References

1. Genco RJ., et al. “Review of dental research in microbiology with emphasis on periodontal research”. Journal of the American Dental Association 78 (1969): 1016-1023. 
2. Pinheiro ET., et al. “Evaluation of root canal microorganisms isolated from teeth with endodontic failure and their antimicrobial susceptibility”. Oral Microbiology and Immunology 18.2 (2003):100-103. 
3. Ledezma-Rasillo G., et al. “Identification of cultivable microorganisms from primary teeth with necrotic pulps”. Journal of Clinical Pediatric Dentistry 34.4 (2010): 329-333. 
4. Fabris AS., et al. “Bacteriological analysis of necrotic pulp and fistulae in primary teeth”. Journal of Applied Oral Science 22.2 (2014): 118-124. 
5. Tabassum S and Khan FR. “Failure of endodontic treatment: The usual suspects”. European Journal of Dentistry 10 (2016): 144-147. 
6. Song M., et al. “Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery”. Journal of Endodontics 37 (2011): 1516-1519. 
7. Jayakodi H., et al. “Clinical and pharmacological management of endodontic flare-up”. Journal of Pharmacy and Bioallied Sciences 4 (2012): 294-298. 
8. Memon NA., et al. “Assessment of the Interappointment pain by using two different intracanal medicaments”. Pakistan Oral and Dental Journal 33 (2013): 145-150.
9. Martin H and Cunningham WT. “An evaluation of postoperative pain incidence following endosonic and conventional root canal therapy”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 54 (2003): 74-76.
10. Martin FE. “Carious pulpitis: microbiological and histopathological considerations”. Australian Endodontic Journal 29.3 (2003):134-137. 
11. Van Hassel HJ. “Physiology of the human dental pulp”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 32.1 (1971): 126-134.
12. Mjor IA. “Dentin permeability: the basis for understanding pulp reactions and adhesive technology”. Brazilian Dental Journal 20.1 (2009): 3-16. 
13. Kim S. “Microcirculation of the dental pulp in health and disease”. Journal of Endodontics 11.11 (1985): 465-471. 
14. Kumar V., et al. “Inflammation and repair. Robbins Basic Pathology”. Saunders, Philadelphia, London (2012): 29-74. 
15. Ryan GB and Majno G. “Acute inflammation. A review”. The American Journal of Pathology 86 (1977): 183-276. 
16. Siqueira JF Jr. “Microbial causes of endodontic flare-ups”. International Endodontic Journal 36 (2003): 453-463. 
17. Torabinejad M., et al. “Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps”. Journal of Endodontics 14.5 (1988): 261-266. 
18. Wittgow WC Jr and Sabiston CB Jr. “Microorganisms from pulpal chambers of intact teeth with necrotic pulps”. Journal of Endodontics 1 (1975): 168-171. 
19. Trope M. “Relationship of intracanal medicaments to endodontic flare-ups”. Endodontics and Dental Traumatology 6.5 (1990): 226-229. 
20. Matusow RJ. “Endodontic cellulitis ‘flare-up’. Case report”. Australian Dental Journal 40 (1995): 36-38. 
21. Harrison JW., et al. “Incidence of pain associated with clinical factors during and after root canal therapy. Part 2. Postobturation pain”. Journal of Endodontics 9.10 (1983): 434-438. 
22. Torabinejad M., et al. “Effectiveness of various medications on postoperative pain following root canal obturation”. Journal of Endodontics 20.9 (1994): 427-431. 
23. Gesi A., et al. “Incidence of periapical lesions and clinical symptoms after pulpectomy–a clinical and radiographic evaluation of 1- versus 2-session treatment”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 101.3 (2006):379-388. 
24. Rosenberg PA., et al. “The effect of occlusal reduction on pain after endodontic instrumentation”. Journal of Endodontics 24 (1998): 492-496. 
25. Nist E., et al. “Effect of apical trephination on postoperative pain and swelling in symptomatic necrotic teeth”. Journal of Endodontics 27 (2001): 415-420. 
26. Harrington GW and Natkin E. “Mid-treatment flare-ups”. Dental Clinics of North America 36 (1992): 409-423. 
27. Hutter JW. “Facial space infections of odontogenic origin”. Journal of Endodontics 17 (1991): 422. 
28. Baumgartner JC and Xia T. “Antibiotic susceptibility of bacteria associated with endodonticabscesses”. Journal of Endodontics 29.1 (2003): 44-47. 
29. Nagle D., et al. “Effect of systemic penicillin on pain in untreated irreversible pulpitis”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 90.5 (2000): 636-640. 
30. Mehlisch DR., et al. “Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain in adolescents and adults: a randomized, double-blind, placebo-controlled, parallel-group, single-dose, two-center, modified factorial study”. Clinical Therapeutics 32.5 (2010): 882-895.
31. Menhinick KA., 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”. International Endodontic Journal 37.8 (2004): 531-541. 
32. Nezvalova-Henriksen K., et al. “Effects of ibuprofen, diclofenac, naproxen, and piroxicam on the course of pregnancy and pregnancy outcome: a prospective cohort study”. BJOG: British Journal of Obstetrics and Gynaecology 120.8 (2013): 948-959. 
33. Needleman IG., et al. “Characterization of bioadhesives for periodontal and oral mucosal drug delivery”. Journal of Clinical Periodontology 25 (1998): 74-82. 
34. Breimer DD. “Future challenges for drug delivery”. Journal of Controlled Release 62 (1999): 3-6. 
35. Mustafa M., et al. “Role of calcium hydroxide in endodontics: a review”. Global Journal of Medicine and Public Health 1 (2012): 66-70. 
36. Anjaneyulu K and Nivedhitha MS. “Influence of calcium hydroxide on the post-treatment pain in endodontics: a systematic review”. Journal of Conservative Dentistry 17 (2014): 200-207. 
37. Khan AA., et al. “The effect of calcium hydroxide on pro-inflammatory cytokines and neuropeptides”. Journal of Endodontics 34 (2008): 1360-1363. 
38. Ghanbarzadegan A., et al. “The effect of different combinations of calcium hydroxide as intra-canal medicament on endodontic pain: a randomized clinical trial study”. Iranian Endodontic Journal 14.1 (2019): 1-6.
39. Russo MC and Holland R. “Microscopical findings after protection with various dressings in pulpotomized deciduous teeth of dogs”. Revista da Faculdade de Odontologia de AracË atuba 3 (1974a): 113-123.
40. Anthony DR., et al. “The effect of three vehicles on the pH of calcium hydroxide”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 54.5 (1982): 560-565.
41. AL Sisk. “Long-acting local anesthetics in dentistry”. Anesthesia Progress 39.3 (1992): 53-60. 
42. Quillin B., et al. “Antimicrobial effect of Ca (OH)2 supplemented with metronidazole and chlorhexidine as intracanal medicaments (poster clinic no. 15)”. Journal of Endodontics 18 (1992): 187.
43. Fava LRG and Saunders WP. “Calcium hydroxide pastes: Classification and clinical indications (Review)”. International Endodontic Journal 32 (1999): 257-282. 
44. Fiore-Donno G and Baume LJ. “Effects of capping compounds containing corticosteroids on the human dental pulp”. Helvetia Odontologic Acta 6 (1962): 23-32. 
45. Abbott PV., et al. “Effects of combining Ledermix® and calcium hydroxide pastes on the diffusion of corticosteroid and tetracycline through human roots In vitro”. Endodontics and Dental Traumatology 5 (1989):  188-192.
46. Laughlin RC., et al. “Altered host immune responses to membrane vesicles from Salmonella and Gram-negative pathogens”. Vaccine 33.38 (2015): 5012-5019. 
47. Estev˜ao-Silva CF., et al. “Anethole and eugenol reduce In vitro and In vivo leukocyte migration induced by fMLP, LTB4, and carrageenan”. Journal of Natural Medicines 68.3 (2014): 567-575.
48. Leem HH., et al. “Antioxidant and anti-inflammatory activities of eugenol and its derivatives from clove (Eugenia caryophyllata Thunb.)”. Korean Journal for Food Science 40 (2011): 1361-1370. 
49. Criddle DN., et al. “Endothelium-dependent and independent vasodilator effects of eugenol in the rat mesenteric vascular bed”. Journal of Pharmacy and Pharmacology 55 (2003): 359-365. 
50. Marshall JG and Walton RE. “The effect of intramuscular injection of steroid on posttreatment endodontic pain”. Journal of Endodontics 10.12 (1984): 584-588.
51. Kaufman E., et al. “Intraligamentary injection of slow-release methylprednisolone for the prevention of pain after endodontic treatment”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 77.6 (1994): 651-654. 
52. Mehrvarzfar P., et al. “Effect of supraperiosteal injection of dexamethasone on post-operative pain”. Australian Endodontic Journal 34.1 (2008): 25-29. 
53. Bane K., et al. “Randomized clinical trial of intraosseous methylprednisolone injection for acute pulpitis pain”. Journal of Endodontics 42.1 (2016): 2-7.
54. Mehrvarzfar P., et al. “Effect of dexamethasone intraligamentary injection on postendodontic pain in patients with symptomatic irreversible pulpitis: a randomized controlled clinical trial”. Iranian Endodontic Journal 11.4 (2016): 261-266. 
55. Krasner P and Jackson E. “Management of posttreatment endodontic pain with oral dexamethasone: a double-blind study”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 62.2 (1986):187-190. 
56. Chance K., et al. “Clinical trial of intracanal corticosteroid in root canal therapy”. Journal of Endodontics 13.9 (1987): 466-468. 
57. Goldberg JM., et al. “Corticosteroid as anodyne for endodontic pain. A pilot study”. Ann Dent 45.2 (1986): 3-5. 
58. Walton RE. “Inter-appointment flare-ups: incidence, related factors, prevention, and management”. Endodontic Topics 1.3 (2002): 67-76. 
59. Anjaneyulu K and Nivedhitha MS. “Influence of Calcium Hydroxide on the post-treatment pain in endodontics: A systematic review”. Journal of Conservative Dentistry 17 (2014): 200-207. 
60. Borsook D and Edwards AD. “Antineuropathic effects of the antibiotic derivative spicamycin KRN5500”. pain Medicine 5.1 (2004): 104-108. 
61. Macaluso A., et al. “Analgesic effect of a single preoperative dose of the antibiotic ceftriaxone in humans”. The Journal of Pain 14.6 (2013): 604-612. 
62. Sakoda K., et al. “Simvastatin decreases IL-6 and IL-8 production in epithelial cells”. Journal of Dental Research 85 (2006): 520-523. 
63. Negm MM. “Effect of intracanal use of nonsteroidal anti-inflammatory agents on post-treatment endodontic pain”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 77.5 (1994): 507-513. 
64. Smith EA., et al. “Nonsteroidal anti-inflammatory drugs for managing postoperative endodontic pain in patients who present with preoperative pain: A systematic review and meta-analysis”. Journal of Endodontics 43.1 (2017): 7-15.

Citation

Citation: Prasanna T Dahake and Sudhindra M Baliga. "Local Drug Delivery Systems for Pain Management During and After Endodontic Therapy”. Acta Scientific Dental Sciences 4.3 (2020): 110-116.

Copyright

Copyright: © 2020 Prasanna T Dahake and Sudhindra M Baliga. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.