Are single dose oral medications for post root treatment pain relief effective?

shutterstock_70250746-assorted pills

The pain associated with root canal treatment is a major source of fear for patients. Pre treatment, treatment, and post treatment pain is anticipated, experienced, remembered, and shared by patients. The aim of this trail was to compare the effects of single doses of three oral medications on postoperative pain following instrumentation of root canals in teeth with irreversible pulpitis.

Patients who had anterior or premolar teeth with irreversible pulpitis without any signs and symptoms of acute or chronic apical periodontitis and moderate to severe pain were randomised to one of 4 groups by balanced block random allocation into four groups of 25 each receiving a single dose of either:-

  • Placebo
  • Tramadol (100 mg)
  • Novafen (325 mg of paracetamol, 200 mg ibuprofen and 40 mg caffeine )
  • Naproxen (500 mg)

immediately after the first appointment where the pulp was removed, and the canals were fully prepared. Pain intensity was scored on a 10-point VAS before and after treatment for up to 24 h postoperatively.

They found that at the 6, 12 and 24 h postoperative intervals after drug administration, the intensity of pain was significantly lower in the experimental groups than in the placebo group (P < 0.01).

Tramadol was significantly less effective (P < 0.05) than Naproxen, and Novafen that were similar to each other (P > 0.05).

They concluded that:-

A single oral dose of Naproxen, Novafen and Tramadol taken immediately after treatment reduced postoperative pain following pulpectomy and root canal preparation of teeth with irreversible pulpitis.

Mehrvarzfar P, Abbott PV, Saghiri MA, Delvarani A, Asgar K, Lotfi M, Karamifar K, Kharazifard MJ, Khabazi H. Effects of three oral analgesics on postoperative pain following root canal preparation: a controlled clinical trial. Int Endod J. 2011 Sep 8. doi: 10.1111/j.1365-2591.2011.01950.x. [Epub ahead of print] PubMed PMID: 21902704.

Other Relevant reviews

Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod. 2011 Apr;37(4):429-38. Review.PubMed PMID: 21419285

See also in Dental Elf 

5 to 7% of patients have persistent pain after root canal treatment


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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