Title Chlorohexidine Is Effective at Decreasing Postoperative Pain After Root Canal Therapy in Teeth with Pulpal Necrosis
Clinical Question For a patient undergoing root canal therapy to treat a tooth with pulpal necrosis and acute apical periodontitis, does the use of chlorhexidine after chemomechanical cleaning help decrease the incidence of postoperative pain?
Clinical Bottom Line For a patient receiving non-surgical root canal therapy to treat a tooth with pulpal necrosis and acute apical periodontitis, the use of 2% chlorhexidine gel with or without calcium hydroxide provides relief of postoperative pain. This adjunctive therapy is a relatively inexpensive method of reducing the pain patients experience after root canal therapy and would be well-accepted by a wide variety of patients and practitioners.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
23657409Singh/201364 patients with mandibular molars with pulpal necrosis and acute apical periodontitisRandomized Controlled Trial
Key results2% Chlorhexidine (CHX) gel, as compared to calcium hydroxide and placebo, was found to be extremely effective at reducing the severity of postoperative pain when used after canal cleaning and shaping as a canal dressing. Of the four groups (CHX + calcium hydroxide; CHX alone; calcium hydroxide alone; no dressing), there was a statistically significant difference in pain reduction (P < 0.05), as compared to placebo, in the two groups with chlorhexidine as a component, but not in the group given calcium hydroxide alone. The most effective treatment was a combination of calcium hydroxide and chlorhexidine.
Evidence Search ("Root Canal Irrigants"[Mesh]) AND "Chlorhexidine"[Mesh]
Comments on
The Evidence
Validity: This research was a double-blind randomized control study, so the 64 subjects were randomized into the four groups and both the clinician and the subjects were blinded, which contributed to the validity of this research. The subject selection, while specific, should be representative of how an average tooth with pulpal necrosis would respond. The follow-up period probably should have been longer, as it only lasted 96 hrs after treatment. Perspective: While similar studies have been done that suggest that CHX is ineffective at reducing postoperative pain, this research used a much higher concentration of CHX than previous studies.
Applicability While most non-surgical root canal therapies are performed in a single appointment, for those cases that are divided into two appointments, adding chlorhexidine as a part of the canal dressing is a simple, cost-effective way to provide significant postoperative pain relief for patients. However, it should be noted that the subject selection for this study included only teeth with necrotic pulps, not those with symptomatic irreversible pulpitis. For those patients with symptomatic irreversible pulpitis, this treatment may not be as effective.
Specialty (Endodontics) (General Dentistry)
Keywords endodontics, intracanal medicaments, chlorhexidine, postoperative pain, calcium hydroxide, pulpal necrosis
ID# 3143
Date of submission 03/16/2017
E-mail Kauffmane@livemail.uthscsa.edu
Author Erin Kauffman
Co-author(s) e-mail
Faculty mentor Kenneth M. Hargreaves, DDS, PhD
Faculty mentor e-mail Hargreaves@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?)
None available
Comments and Evidence-Based Updates on the CAT
None available