ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Relative Effectiveness of Naproxen vs. Ibuprofen for Postoperative Pain Following Non-surgical Root Canal Therapy Is Unknown
Clinical Question In patients diagnosed with irreversible pulpitis, is naproxen more effective at reducing post-operative pain levels following non-surgical root canal therapy compared to ibuprofen?
Clinical Bottom Line There are no studies that directly compare naproxen and ibuprofen analgesic efficacy following non-surgical root canal therapy, i.e., their relative effectiveness. However, the effectiveness of NSAIDs is well-documented in several endodontic studies using ibuprofen as the prototypical drug. Given the similar mechanisms of action, these two drugs are expected to be similarly effective. Nonetheless, high quality randomized clinical trials are warranted to directly test the analgesic efficacy of naproxen and ibuprofen post endodontic treatment.
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) 32668310Zanjir/202011 studies on patients with various pulpal and periapical diagnosesSystematic Review and Network Meta-Analysis
Key resultsThe combination of NSAIDs and acetaminophen were significantly effective in reducing immediate pain after NSRCT. However, NSAIDs alone were more effective after 1 or 2 days.
#2) 15230906Menhinik/2004Patients with symptomatic irreversible pulpitis diagnosisRandomized Controlled Trial
Key resultsMenhinick et al. reported that the combination of ibuprofen 600 mg and acetaminophen 1000 mg was significantly more effective than ibuprofen alone and placebo in reducing the postoperative pain after NSRCT.
Evidence Search Evidence Search “(((nonsurgical endodontic)) AND (control)) AND (postoperative pain) “ “(((nsaids) AND (postoperative)) AND (nonsurgical root canal)) AND (pain)”
Comments on
The Evidence
Validity: In Zanjir/2020 the research question was precisely mentioned in the introduction of this paper. MEDLINE, Embase, Cochrane CENTRAL, CINAHL, and Scopus were among the databases searched. They also used various sources such as textbooks, expert opinions, etc.; therefore, there is only a slight chance of missing critical studies. Two independent authors applied appropriate inclusion criteria to select studies for the systematic review, and the risk of bias was measured by two independent individuals. There were different data regarding the doses and timelines of medication, but the authors used set scales to calibrate all the studies. Menhinick/2004 reported baseline similarities between two groups of patients in different aspects (baseline pain, pulpal and periradicular diagnoses and type of teeth treated). Patients were randomized by Microsoft Excel 2000 randomizing software. All the treatment protocols were similar between two groups, other than the medication they received. Out of 93 subjects, only 57 returned their “pain recording diaries” (61.2% recall rate). Data analysis was performed on the subjects that returned the diaries. For blindness, a certified pharmacist had all the medication in same colored gelatinous capsules and the empty space was filled with lactose powder. The evaluators of the diaries were blinded to the medication assigned to the groups. Perspective: According to study by Menhinick et al., ibuprofen alone and also in combination with acetaminophen has good analgesic effects for post NSRCT pain. Zanjir et al. also report on effectiveness of ibuprofen for pain reduction after endo treatment. However, there is no consistency with the dosage and time intervals of medication. Thus, there seems a gap in knowledge regarding the lowest effective dose.
Applicability NSAIDs are the go-to medication for reducing postoperative pain after non-surgical root canal therapy (NSRCT). However, recent studies in the medical field have reported cardiac side effects related to prolonged NSAID use. Side effects such as MI and strokes have been reported with ibuprofen use over 7 days (Bali, et al.). According to recent studies there is a need to evaluate the effectiveness of new analgesics for postoperative pain or shorter duration of NSAID use. Naproxen is an effective NSAID with longer duration of action and lower effective dose. There have been no studies regarding postoperative endodontic pain and naproxen as the medicament.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Postoperative pain, irreversible pulpitis, iborpofen, naproxen
ID# 3455
Date of submission: 11/30/2020spacer
E-mail pardis.azar@outlook.com
Author Pardis Soleimanzadeh Azar
Co-author(s) Dr. Andrew Grove
Co-author(s) e-mail Grovea@livemail.uthscsa.edu
Faculty mentor/Co-author Dr. Anibal Diogenes
Faculty mentor/Co-author e-mail Diogenes@uthscsa.edu
Basic Science Rationale
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