Pain after root canal treatment with various apical finishing sizes

A recent study revealed that the size of apical preparation had a significant impact on postoperative pain levels. The results of this study were published in the journal BMC Oral Health. 
In this study, fifty teeth belonging to twenty-five individuals were separated into two equal groups, with twenty-five teeth in each group using E3 Azure rotary files. Group A was expanded by two sizes in relation to the Initial Binding File (IBF), extending to 40#/0.04 for the distal canals and 35#/0.04 for the mesial canals. Group B, on the other hand, was expanded by three sizes larger than the IBF: 45#/0.04 for the distal canals and 40#/0.04 for mesial canals. Patients were asked to rate their pain levels on a modified VAS form and describe their pain intensity at twelve, twenty-four, and seventy-two hours, as well as after a week. VAS data were analyzed using Freidman's test, Nemenyi post hoc test for intragroup comparisons and signed-rank test for intergroup comparisons.
The outcomes revealed that irrespective of the timing of the measurement, an enlargement of the apical preparation was significantly linked to increased pain scores (p value < 0.001). In both groups, there was a significant decline in reported pain scores over time, with scores at twelve-and twenty-four hours post-treatment significantly higher than those at other intervals (p value < 0.001). Additionally, pain scores at three days post-treatment were significantly higher than those at one week (p value < 0.001).
Thus, it can be concluded that apical preparation size significantly influenced postoperative pain levels.
 

Assessment of postoperative pain following the use of dexamethasone intracanal rinse for irreversible pulpitis

A recent study has shown that dexamethasone is superior to saline in relieving postoperative pain when utilized as the final intracanal rinse after root canal instrumentation. This study's findings were published in the Journal of the College of Physicians and Surgeons Pakistan.
Sixty patients aged 18 to 50 years, who had been diagnosed with symptomatic irreversible pulpitis were specifically chosen based on set criteria. Root canal therapy (RCT) was initiated under rubber dam after obtaining informed consent. The treatment included a pulpectomy followed by canal preparation. Patients were divided into two groups: Group A (the experimental group) received dexamethasone (4 mg/mL in a 5-mL syringe) as a final rinse, and Group B (the control group) received saline as the final rinse. They were followed up after 1 week to determine the improvement of their pain. Following data collection, teeth were filled, and permanent restoration was placed. The Chi-square test was utilized for the analysis of the data.
Dexamethasone showed a significantly higher efficacy compared to saline as a final intracanal rinse, 86.67% and 20.0%, respectively (p value < 0.05), in alleviating postoperative pain in teeth diagnosed with symptomatic irreversible pulpitis.
The above study demonstrated that dexamethasone has greater efficacy compared to saline in alleviating postoperative pain when utilized as the final intracanal rinse following root canal instrumentation. 
 

Cannabidiol Found Effective as an Analgesic for Acute Dental Pain

This study evaluated the efficacy and safety of cannabidiol (CBD) as an analgesic for acute dental pain, a condition for which nonopioid treatments are limited. In a randomized, placebo-controlled clinical trial, 61 patients with moderate to severe toothache were assigned to one of three groups: CBD10 (10 mg/kg), CBD20 (20 mg/kg), or placebo. Participants received a single oral dose, and pain was assessed over 3 hours. 
The primary outcome was pain reduction using a visual analog scale (VAS), while secondary outcomes included pain intensity, time to significant relief, maximum pain relief, bite force changes, psychoactive effects, mood alterations, and other adverse events.

Both CBD groups showed significant reductions in VAS pain scores compared to baseline and placebo, with a maximum median reduction of 73% at 180 minutes (P < 0.05). CBD20 demonstrated a faster onset of pain relief than CBD10 (15 vs. 30 minutes), with both groups achieving maximum relief at 180 minutes. The number needed to treat was 3.1 for CBD10 and 2.4 for CBD20. Bite force significantly increased in both CBD groups (P < 0.05) but not in the placebo group, with CBD20 showing significant changes compared to placebo at 90 and 180 minutes. 
Adverse effects, including sedation, diarrhea, and abdominal pain, were more common in CBD groups (P < 0.05). This trial provides initial evidence that oral CBD is an effective and safe alternative analgesic for acute dental pain.
 

The effect of various desensitizers on pulpal blood flow after full crown preparation using laser Doppler flowmetry

In a recent study, similar levels of effectiveness were observed in treating dentine hypersensitivity and pulpal blood flow with Bifluoride 12, Teethmate, and Copal Varnish. This study’s findings were published in the journal Odontology.
18 patients with a total of 42 teeth suffering from dentine hypersensitivity after full crown preparations were randomly divided to receive treatment with Bifluoride 12, Teethmate, or Copal Varnish. The severity of dentine hypersensitivity was assessed using a Schiff air index (SAI) and visual analog scale (VAS). The assessment of pulpal blood flow involved the use of laser Doppler flowmetry (LDF), with the findings recorded in perfusion units (PU). Evaluations were conducted at the initial stage, after five minutes, after seven days, and after one month subsequent to the administration of desensitizing agents. Statistical analysis was carried out using Wilcoxon and two-way ANOVA tests (p value < 0.05).

The tested desensitizers did not show any significant difference in terms of VAS and PU values. VAS values significantly decreased at seven days and one month after the desensitizers were applied, compared to the baseline in all groups. Only the Copal Varnish group exhibited a notable difference in PU values at the five-minute and seven-day intervals post-desensitizer application (p value < 0.05). A statistically significant difference was found between different time points in relation to SAI scores in all groups (p value < 0.05).

Thus, it can be concluded that Bifluoride 12, Teethmate, and Copal Varnish demonstrated similar effectiveness in managing dentine hypersensitivity and pulpal blood flow. To fully evaluate their impact on pulpal status, it is important to conduct long-term clinical trials with larger sample sizes and histological studies.
 

Comparison of tramadol-celecoxib co-crystal with tramadol or placebo for managing acute moderate-to-severe pain following oral surgery

According to a recent study, the co-crystal of tramadol-celecoxib (CTC) showed superior pain relief when compared to tramadol or placebo and also displayed an improved benefit/risk profile in comparison to tramadol. The findings were published in the journal Advances in Therapy.

A total of 726 adults were randomly assigned to five groups (2:2:2:2:1). Different treatment groups were assigned varying doses of medication, such as twice daily 100mg CTC (n = 164), 150 mg CTC (n = 160), or 200 mg CTC (n = 160), four times a day 100mg tramadol (n = 159), or  four times a day placebo (n = 83). Twice daily placebo was also given to individuals in the CTC groups. Total of pain intensity differences measured from 0 to 4 hours (SPID_0–4; visual analog scale) was the primary endpoint. The key secondary endpoints of the study assessed rescue medication use and 4-hour 50% responder rates. Safety endpoints included laboratory measures, adverse events, and the Opioid-Related Symptom Distress Scale (OR-SDS) score.

All CTC doses were more effective than placebo (P value < 0.001) for primary and key secondary endpoints. Additionally, they exhibited superiority over tramadol for SPID_0-4  (Analysis of covariance least squares mean differences [95% CI]: - 37.1 [- 56.5, - 17.6], - 40.2 [- 59.7, - 20.6], and - 41.7 [- 61.2, - 22.2] for 100 mg , 150 mg , and 200 mg CTC, respectively; P value < 0.001) and 4-hour 50% responder rate. The 4-hour 50% responder rates were 32.9% for CTC 100 mg, 33.8%  for CTC 150 mg, 40.6% for CTC 200 mg, 20.1% for tramadol, and 7.2% for placebo groups, respectively. Rescue medication consumption was less in the 100-mg (P value = 0.013) and 200-mg (P value = 0.003) CTC groups in comparison to the tramadol group. Tramadol by itself exhibited the highest occurrence of adverse events and OR-SDS scores.

Thus, it can be concluded that CTC provided superior pain relief compared to tramadol or placebo and also showed an improved benefit/risk profile in comparison to tramadol.