Post-operative pain and discomfort in not uncommon after root canal treatment with incidence of between 3-58% being reported. While non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce post-endodontic pain and number of studies have also demonstrated benefits with corticosteroids.
The aim of this review was to assess the effectiveness of dexamethasone in controlling pain associated with symptomatic irreversible pulpitis
Methods
Searches Were conducted in the Medline, Scopus, ScienceDirect, Web of Science, Latin American Caribbean Health Sciences Literature, The Cochrane Library, and Google Scholar databases with no restrictions on date or language stop. Randomised controlled trials (RCTs) in patients with irreversible pulpitis undergoing endodontic treatments where dexamethasone was used to alleviate pain were considered. Two reviewers independently selected studies abstract data and assessed risk of bias using the Cochrane tool. The main outcome was pain with results being dichotomised as pain /no pain and with data being meta-analysed using a fixed effects model.
Results
- 5 RCTs involving a total of 292 patients were included.
- Dosages and administration varied across all 5 studies.
- All 5 studies were considered to be at unclear risk of bias.
- Meta-analysis showed statistically significant reduction of pain in patients receiving dexamethasone at 8,12, and 24 hours.
| Pain at | Relative Risk (95% CI) |
| 8 hrs | 1.97 (1.48–2.62) |
| 12hrs | 1.54 (1.62–3.98) |
| 24hrs | 2.58 (1.29–5.15) |
Conclusions
The authors concluded: –
the pain felt by patients diagnosed with symptomatic irreversible pulpitis can be alleviated with dexamethasone administered by mouth and/or via intracanal, intraligamentary, and mainly supraperiosteal injections for up to 24 hours. After this time elapsed, no significant pain was reported by the patients included in this systematic review. Therefore, the action of dexamethasone for endodontic pain relief is effective during the first 24 hours, which is the period during which most patients report feeling pain.
Comments
Recently (Dental Elf – 18th Jun 2018) we looked a broader review of the use of steroids to reduce post endodontic pain. That review included 7 dexamethasone studies compared to the 5 included in this review with only 3 studies being common to both reviews. Both reviews suggest a benefit in terms of pain reduction form the use of steroids. However, the studies include a wide range of administration routes and dosage and are relatively small so additional well conducted studies to examine these elements would be helpful to further inform clinical practice.
Links
Primary Paper
Nogueira BML, Silva LG, Mesquita CRM, Menezes SAF, Menezes TOA, Faria AGM,Porpino MTM. Is the Use of Dexamethasone Effective in Controlling Pain Associated with Symptomatic Irreversible Pulpitis? A Systematic Review. J Endod. 2018 May;44(5):703-710. doi: 10.1016/j.joen.2018.02.006. Epub 2018 Mar 20. Review.PubMed PMID: 29571913.
Original review protocol on PROSPERO
Other references
Dental Elf – 18th Jun 2018
Thank so much for this amazing post
So can I use dexamethasone as irrigant after shaping and cleaning to avoid flare up ?
As we note in the comments while the findings suggest a benefit the included studies are small and include a wide range of administration routes and dosages so further high-quality reseach is needed to improve the available evidence