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Title Corticosteroids Provide Better Postoperative Endodontic Pain Relief Compared to Placebo
Clinical Question In patients receiving non-surgical endodontic therapy, do corticosteroids provide better postoperative endodontic pain relief compared to placebo?
Clinical Bottom Line Corticosteroids provide better postoperative endodontic pain relief compared to placebo. Different types and dosages of corticosteroids have different levels of analgesic efficacy.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 29709296Shamszadeh/20181088 patients in 18 Randomized clinical trialsSystematic Review and Meta-Analysis
Key resultsPatients who received corticosteroids had greater postoperative pain relief after endodontic treatment at 6 hours (SMD = -1.03; 95% CI, -1.55 to -0.51; P=.000), 12 hours (SMD = -1.089; 95% CI, -1.71 to -.46; P = .001) and 24 hours (SMD = -0.957; 95% CI, -1.34 to -0.56; P=.000).
Evidence Search (endodontic OR root canal) AND (corticosteroids OR corticosteroid) AND (pain relief OR postoperative pain)
Comments on
The Evidence
Validity: This article is the highest level of evidence as a systematic review and meta-analysis including 18 randomized controlled trials. Two independent reviewers screened articles, collected data, and evaluated the quality of study reporting. None of the studies reported incomplete outcome data. The high number of randomized controlled trials and large number of patients included in the study demonstrates high validity of the analyses performed, and increases confidence in the conclusions. Perspective: Corticosteroids had a postoperative pain-reducing effect in endodontic patients for a period up to 24 hours. Different types and dosages of corticosteroids produced different levels of analgesic efficacy. The three main types of corticosteroids studied in this article were prednisolone, dexamethasone, and betamethasone. At 6 hours, prednisolone had a more significant effect on pain relief than the other two drugs due to faster onset. It is speculated that this was because prednisolone has a shorter half-life and diffuses across the cell membrane at a faster rate to affect gene transcription.
Applicability This topic is applicable to dentists performing endodontic treatment on vital and nonvital teeth in adult patients over 15 years old. In the presence of no contraindications (for example, systemic fungal infection), it has been shown that a single dose of corticosteroids has no harmful effects such as insomnia and psychosis (Shimmer, Parker, 1996). Therefore, corticosteroids appear to be another tool besides ibuprofen and acetaminophen (Menhinick, 2004) in the pharmacological management of postoperative endodontic pain.
Specialty/Discipline (Public Health) (Endodontics) (General Dentistry)
Keywords Corticosteroids, endodontic treatment, root canal treatment, pain relief, postoperative pain
ID# 3350
Date of submission: 11/14/2018spacer
E-mail osada@livemail.uthscsa.edu
Author Akihiko Osada
Co-author(s) e-mail
Faculty mentor/Co-author Nikita Ruparel
Faculty mentor/Co-author e-mail Ruparel@uthscsa.edu
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