July 27, 2018
Dexamethasone and symptomatic irreversible pulpitis
Brazilian researchers determined through a systematic literature review that dexamethasone might alleviate pain associated with symptomatic irreversible pulpitis. They published the results of their study in the May issue of Journal of Endodontics.
The researchers noted that no protocol existed for controlling pain associated with symptomatic irreversible pulpitis. “The pain associated with symptomatic irreversible pulpitis is usually severe and difficult to control, even with pain medications,” they wrote. “The pressure accumulated in the pulp cavity during pulp inflammation affects the nerve fiber, causing mild to extreme pain depending on inflammation severity and body response. Pulpal pain is persistent and often results from the release of inflammatory mediators, such as prostaglandins, leukotrienes, serotonin, and bradykinin.”
The intent of the study was to determine the effectiveness of dexamethasone in treating such pain. To do so, researchers used a controlled vocabulary and free key word search strategy based on the following PICOS questions: P [population], patients with a diagnosis of irreversible pulpitis needing endodontic treatment; I [intervention], on whom dexamethasone was used before, during, or after the procedure; C [comparison], compared with patients who did not use any type of medication for pain relief or other type of medication; O [outcome], and reported a higher aliquot; S [study design], in randomized human clinical trials.
They registered their study in the International Prospective Register of Systematic Reviews database and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Databases consulted included MEDLINE, Scopus, ScienceDirect, Web of Science, Latin American Caribbean Health Sciences Literature, Cochrane Library, and Google Scholar. They used the Cochrane Collaboration tool and analyzed dichotomous data (with and without pain) from eligible studies with RevMan 5 software.
Researchers did not restrict publication date or languages.
“Corticoids, such as dexamethasone, exhibit excellent anti-inflammatory efficacy, acting to interrupt the synthesis and/or release of mediators (like prostaglandins, leukotrienes, bradykinin, platelet-activating factor, and substance P) connected to the signals and symptoms of inflammation including heat, redness, edema, pain, and loss of function,” the researchers wrote.
They noted that dexamethasone might be administered by mouth or via an intraligamentary, periapical, intracanal, or intramuscular injection before, during, and after a procedure.
After screening 4,825 studies, researchers selected 523. After careful evaluation, only 5 articles remained that met the inclusion criteria. They were randomized clinical trials that analyzed pain reported by irreversible pulpitis patients within 48 hours of the procedure and whether the patients had used dexamethasone during endodontic treatment.
Researchers ultimately determined from the included studies that 4 milligrams of dexamethasone administered by mouth, through intraligamentary and mainly supraperiosteal injections into the root canal, relieved pain associated with symptomatic irreversible pulpitis for up to 24 hours. There were no reports of significant pain from patients in this systematic review after this time elapsed.
Read the original article here.
Consulting Editor: Dr. Susan Wood
Diplomate, American Board of Endodontics
Corticosteroids and endodontic pain
In an Iranian systematic review and meta-analysis, corticosteroids—especially prednisolone—appear to reduce postoperative pain in patients up to 24 hours after undergoing endodontic treatment. The researchers published their results in the July issue of Journal of Endodontics.
Researchers noted that management of postoperative pain is of significant consideration in endodontics. “Postoperative pain is a common complication of endodontic procedures, with a reported incidence of 3%-58% after root canal treatments. Such pain can lead to dissatisfaction of both patients and dental clinicians,” they wrote.
The aim of their study was to assess the efficacy of corticosteroids on postoperative endodontic pain. They performed a meta-analysis and worked in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the recommendation of the Cochrane Collaboration. They included studies that were randomized controlled trials (RCTs) comparing the efficacy of corticosteroids with that of a placebo in reducing postoperative endodontic pain.
Databases consulted included PubMed, the Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Google Scholar. There were no language restrictions, and searches were conducted up through October 2017 using the key words (root canal therapy or endodontic) and (postoperative pain) and (corticosteroids).
The researchers declared that their study is the first time a meta-analysis has evaluated the efficacy of corticosteroids on postoperative endodontic pain. A co-objective of the study was to determine/adjust between trial heterogeneity using meta-regression analysis to examine the associations between effect sizes and study level covariates.
“Systematic reviews with a meta-analysis often reveal high heterogeneity of results, which leads to a model that is not reliable in explaining the outcomes and the role of the involved variables,” researchers noted.
They used meta-regression analysis to isolate the role of each variable and adjust it to others and to avoid a stratified meta-analysis of each variable.
After eliminating study articles that did not meet selection criteria, researchers included in the meta-analysis 18 RCTs (comprising 1,088 patients) examining the effect of corticosteroids and placebos on postoperative pain in adults undergoing root canal therapy. Corticosteroids administered during the first 24 hours after endodontic treatment, researchers hypothesized, led to significantly lower pain scores compared with those of placebos. They also determined that “[t]he analgesic efficacy of corticosteroids can be influenced by the type and dose of the drug.”
Read the original article here.
Leading clinician reviews Envy self-etch, self-adhesive cement
This short video provides the clinical experiences of Dr. David Burt when incorporating Envy self-etch, self-adhesive cement into his dental practice.
Dental anxiety and irreversible pulpitis
Dental anxiety associated with endodontic pain is prevalent in a high percentage of people with irreversible pulpitis, Chinese researchers concluded in a study published online June 7 in BMC Oral Health.
“Irreversible pulpitis is an infuriating medical condition that involves spontaneous and impulsive pain,” researchers wrote. “Such pain might compel the patients suffering from pulpitis to seek emergency dental care. Nonetheless, the fear of pain during and after treatment might prompt some level of dental anxiety in patients, leading to delay or avoidance of treatment.”
The purpose of the cross-sectional study was to evaluate the prevalence of dental anxiety and its relationship with pain, among other variables, in Chinese adult patients with irreversible pulpitis seeking dental care.
Participants included 130 Chinese adult patients at the Stomatological Hospital of Chongqing Medical University. To be included, patients had to be older than 18 years and younger than 70 years, have received a diagnosis of irreversible pulpitis by 3 dentists designated as qualified to participate in the study, and have pulp inflammation due to dental caries. Researchers excluded patients if they suffered from psychiatric diseases, took analgesics/antipsychotic drugs within 24 hours, or were illiterate.
Participating patients completed a 3-part questionnaire to provide their demographics (section 1), levels of dental anxiety (section 2), and pain intensity (section 3).
In section 2, researchers used the Chinese version of Modified Dental Anxiety Scale (MDAS) to assess levels of dental anxiety. They also used a clinical anxiety rating scale (CARS) during the endodontic treatment to evaluate the extent of anxiety that patients displayed, based on patients’ expressions, speech, and behaviors.
A visual analog scale (VAS) made up section 3. Researchers used it to evaluate pain intensity for the first and most recent dental experiences, to assess pain before and during the current endodontic therapy.
Researchers calculated a mean total MDAS score and CARS score for all the categorized variables. They used independent sample t test and 1-way analysis of variance to compare mean MDAS score and CARS score between categories in a same variable. They also used Tukey post hoc test to control for multiple comparisons and Spearman rank correlation to assess strength of association between MDAS and pain reported at the first or most recent dental experience or before or during the current endodontic treatment. Other data analysis methods included Pearson and Spearman rank correlation to evaluate association between CARS score and the variables.
A main result of the study was that 83.1% of participants reported moderate to high levels of dental anxiety, which is higher than the findings in previous studies, researchers wrote.
Other findings of the study include that 16.2% of the participants met the criteria for specific phobia. Based on study dentists’ judgment, 36.2% of participants displayed moderate to severe anxiety during visits for endodontic treatment in the study.
Researchers cautioned about the study’s limits, owing to its design, writing, “Further prospective controlled trials are needed to confirm the causality between dental anxiety and pain management in adult patients with irreversible pulpitis seeking dental care.”
They suggested conducting an investigation of enhanced pain management, such as general anesthesia, on extremely anxious patients to assess the effect on their dental anxiety.
Read the original article here.
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AAE adopts new guideline to encourage high-quality patient care
The AAE developed a white paper on treatment standards to describe the current standards of practice for endodontic treatment. The white paper identifies the knowledge, skills, and behaviors that define competency in endodontics for any dentist who performs nonsurgical endodontic treatment. It describes current methods of endodontic access, canal shaping, disinfection, obturation, and restoration.
The treatment standards white paper accompanies the AAE’s white paper on endodontic competency released last year, which describes the standards of diagnosis, treatment planning and prognostication for endodontic treatment.
Learn more by visiting aae.org/guidelines.
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2-Steps to simplifying endodontic instrumentation
Learn how to maintain the original canal anatomy while thoroughly cleaning the canal. These short endodontic videos will show you an easy and effective a 2-step instrumentation process. Click here to view.
JADA+ Specialty Scans and JADA+ Scans
JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic, healthy aging, and osseointegration. View past issues here.
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