ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title A Prophylactic Dose Of A Cox-2 Inhibitor is Better Than Ibuprofen In Preventing Post-Endodontic Pain 12-24 hours Post Pulpectomy
Clinical Question Does a prophylactic dose of a Cox-2 inhibitor reduce pain more than ibuprofen for post-endodontic pain?
Clinical Bottom Line At short duration (4 to 8 hrs after pulpectomy) rofecoxib did not provide significantly better pain relief than ibuprofen, but at longer duration (12 to 24 hrs), rofecoxib demonstrated significantly better pain relief than both ibuprofen and placebo. (See Comments on the CAT below)
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) 12540224Gopikrishna/200345 patientsDouble blind with randomization
Key resultsA double-blind study of 45 patients with single-dose oral administration of 50 mg of rofecoxib, 600 mg of ibuprofen, or a placebo started before the regular root canal therapy that was conducted in two visits. Visual analog scale ratings of pain intensity were collected upon patient reports at 0, 4, 8, 12, 24, 48, and 72 h after completion of pulpectomy. Analysis data indicates that at the 4- and 8-hrs periods, rofecoxib did not provide significantly better pain relief than ibuprofen. However, at the 12- and 24-hrs periods, rofecoxib provided significantly better pain relief than ibuprofen.
Evidence Search ("cyclooxygenase 2 inhibitors"[MeSH Terms] OR "cyclooxygenase 2 inhibitors"[All Fields] OR "cox 2 inhibitor"[All Fields] OR "cyclooxygenase 2 inhibitors"[Pharmacological Action]) AND postendodontic[All Fields] AND ("pain"[MeSH Terms] OR "pain"[All Fields]) AND ("ibuprofen"[MeSH Terms] OR "ibuprofen"[All Fields]) AND postendodontic[All Fields] AND ("pain"[MeSH Terms] OR "pain"[All Fields]) ...view in PubMed
Comments on
The Evidence
The study was a single dose, double-blind RTC. with three randomized, parallel treatment groups. Appropriate follow-up-periods were employed. Inclusion and exclusion criteria were applied to subject selection.
Applicability Prophylactic administration of rofecoxib can reduce post-endodontic pain in the 12-24 hours period better than ibuprofen. It should be noted that rofecoxib (Vioxx) was voluntarily withdrawn from the market in 2004 by Merck because of adverse cardiac events associated with chronic use. However, the Food and Drug Administration allowed it back into the market in 2005 with a black box warning that the drug increased the risk of heart attacks and strokes.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords cyclooxygenase 2 inhibitors, ibuprofen, post-endodontic pain, rofecoxib
ID# 814
Date of submission: 04/14/2011spacer Revised: 03/22/2012
E-mail doank@livemail.uthscsa.edu
Author Khiem Doan
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Charles Hermesch, DMD
Faculty mentor/Co-author e-mail HERMESCH@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Scott Makins, Lilley Gharavi and Richard Carnahan, Jr. (San Antonio, TX) on 10/14/2014
A PubMed search conducted in October 2014 found a more recent publication: Madani 2013, PMID 24352312. This randomized, double-blinded study involved sixty patients with symptomatic, mandibular molars. Each patient received either 60 mg, 90 mg, 120 mg of the selective COX-2 inhibitor Etoricoxib or 400 mg ibuprofen after the initial session of endodontic therapy. Pain levels were assessed via the Visual Analog Scale (VAS) at 2, 4, 6, 12, 24, 48 and 72 hours post treatment with no significant difference between the performances of the two drugs detected.
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