The management of pre- and post-operative pain is a key component of endodontic treatment with studies reporting that the incidence of post operative pain (flare-up) ranges from  3-58%.   Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common medication used for managing pain after root canal treatment (RoCT). The aim of this study was to compare the effect of on-demand and a regular prescription of ibuprofen on pain levels after single-visit root canal treatment of mandibular and maxillary molar teeth with irreversible pulpitis.

Adult patients with a first or second mandibular or a maxillary molar tooth with acute irreversible pulpitis and normal periapical radiographic appearance without sensitivity to percussion willing to undergo endodontic treatment were randomised.  RoCT was performed to a standard protocol. All patients were advised to use one 400mg ibuprofen table at the end of the treatment. Those randomised to group one were advised to use their medication if they felt pain; those in group two were instructed to use the analgesic every 6 hours for at least 24 hours. Patients were instructed to complete a visual analog scale (VAS) form to rate their pain at 24 and 48 hours after the root canal treatment and to record their analgesic use on the same form.

• 60 patients were randomised (2 were excluded as their forms were not returned).
• There was no significant difference in patients’ pain levels at 24 and 48 hours after root canal treatment.
• 4 patients  (2 from each group) had pain that was not relieved by the analgesics.
• Patients in group 1 used significantly fewer tablets ( 2.67 ± 0.46) than those in group 1, (4.67 ± 0.58)
• No significant side effects were reported

The authors concluded:-

In patients who had irreversible pulpitis with no moderate to severe spontaneous pain, prescribing ibuprofen on a regular basis after RoCT had no significant effect on pain relief compared with an on-demand regimen up to 48 hours after treatment.

Links

Parirokh M, Sadr S, Nakhaee N, Abbott PV, Manochehrifar H. Comparison between  Prescription of Regular or On-demand Ibuprofen on Postoperative Pain after Single-visit Root Canal Treatment of Teeth with Irreversible Pulpitis. J Endod. 2014 Feb;40(2):151-4. doi: 10.1016/j.joen.2013.09.024. Epub 2013 Oct 27. PubMed PMID: 24461395.

Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. Int Endod J. 2008 Feb;41(2):91-9. Epub 2007 Oct 23. Review. PubMed PMID: 17956561.