Title Preoperative Administration of a Single dose of Corticosteroids Provides Better Postoperative Analgesia as Compared to Placebo in Endodontic Patients
Clinical Question For patients with symptomatic pulpitis, does preoperative medication of corticosteroids reduce postoperative pain compared to a placebo after single-visit root canal therapy?
Clinical Bottom Line Preoperative administration of a single dose of corticosteroids provides better postoperative analgesia as compared to placebo in endodontic patients. This is supported by a meta-analysis of three randomized control trials in which treatment with a single dose of corticosteroid outperformed treatment with a placebo.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
30054100Suneelkumar/20183 randomized control trials/561 patientsMeta-Analysis
Key resultsPremedication with a single dose of oral prednisolone (30-40 mg) reduced the incidence of postoperative pain at 6 hours (mean difference = -21.93; 95% confidence interval [CI]: -35.72 to -8.13; substantial heterogeneity with I2 = 80%), 12 hours (mean difference = -22.21; 95% CI: -28.69 to -15.72; moderate heterogeneity with I2 = 31%), and at 24 hours (mean difference = -22.57; 95% CI: -37.14 to -8.00; substantial heterogeneity with I2 = 87%. The GRADE PRO tool revealed the certainty of evidence to be very low for 6 & 24 hours and moderate for 12 hours.
Evidence Search ((Patients) OR (humans[MeSH Terms])) AND (Corticosteroids)) OR (adrenal cortex hormones[MeSH Terms])) AND (preoperative)) AND (root canal therapy)) AND (postoperative pain)) OR (pain relief[MeSH Terms])
Comments on
The Evidence
Validity: Two review authors independently assessed papers reporting on randomized control trials that included adults with a diagnosis of symptomatic irreversible pulpitis, with or without apical periodontitis, who were undergoing single-visit root canal therapy. Any discrepancy in evaluation between reviewers was resolved with the help of a third reviewer. The authors searched the PubMed/MEDLINE, SCOPUS, and Cochrane databases and clinicaltrails.gov site to identify articles published up to February 2018. An initial 518 citations were identified. After eliminating 37 duplicates and 476 studies that didn’t fulfill the particular criteria, 5 studies remained. All 5 studies were included in the qualitative analysis while 3 of those studies were used for quantitative analysis. The strict inclusion standards of randomized control studies demonstrates high validity of the analyses preformed. Perspective: Preventing the development of and achieving relief from postendodontic pain remains a challenge in dentistry. NSAIDS, opioids, and combinations of other drugs have been used to manage postoperative pain from endodontic treatment. The knowledge of other alternatives should be known as it may aid in their treatment approach for managing postendodontic pain.
Applicability Nonsurgical root canal treatment is aimed at eliminating pain of endodontic origin. However, posttreatment pain after endodontic treatment has been reported in 25%-40% of all endodontic patients (Nixdorf, 2010). The use of a single dose of corticosteroids can help reduce postendodontic pain and also help minimize the repeated intake of analgesics.
Specialty (Endodontics) (General Dentistry)
Keywords Corticosteroids, root canal treatment, endodontic treatment, postoperative pain, pain relief
ID# 3449
Date of submission 11/25/2020
E-mail grovea1@livemail.uthscsa.edu
Author Andrew Grove, DMD
Co-author(s) Pardis Soleimanzadeh Azar, DDS
Co-author(s) e-mail azarp@livemail.uthscsa.edu
Faculty mentor Asma Khan, BDS, PhD
Faculty mentor e-mail khana2@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