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Analgesics, Anaesthetics, Anxiolytics and Glucocorticosteroids Used in Endodontics

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Endodontic Diagnosis, Pathology, and Treatment Planning

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Summary

Patients are often apprehensive when undergoing root canal treatment and pain is often taken as synonymous with these procedures. Pain management involves correct diagnosis, appropriate dental treatment and adjunctive drug therapy where indicated. Endodontic pain will be of inflammatory origin and nonsteroidal anti-inflammatory drugs are the preferred choice for relief. Paracetamol provides effective analgesia with limited anti-inflammatory action. Effective pain management strategies are discussed for pre-, peri- and post-operative endodontic procedures.

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References

  1. Watkins CA, Lohan HL, Kirchner HL. Anticipated and experienced pain associated with endodontic therapy. J Am Dent Assoc. 2002;133(1):45–54.

    Article  PubMed  Google Scholar 

  2. Keiser K, Hargreaves KM. Building effective strategies for the management of endodontic pain. Endod Top. 2002;3:93–105.

    Article  Google Scholar 

  3. Hargreaves KM, Abbott PV. Drugs for pain management in dentistry. Aust Dent J Medications Supplement. 2005;50:S14–22.

    Article  Google Scholar 

  4. Mohammadi Z, Farhad A, Khalesi M. Pharmacological strategies to control post-operative endodontic pain. Dent Res J. 2007;4(2):61–8.

    Google Scholar 

  5. Parirokh M, Abbot PV. Various strategies for pain free root canal treatment. Iran Endod J. 2014;9(1):1–14.

    PubMed Central  PubMed  Google Scholar 

  6. Dionne R. Pre-emptive vs preventive analgesia: which approach improves clinical outcomes? Compend Contin Educ Dent. 2000;21(1):48, 51–4, 56.

    PubMed  Google Scholar 

  7. Dionne R. To tame the pain? Compend Contin Educ Dent. 1998;19(4):421–6.

    Google Scholar 

  8. Khan AA, Dionne RA. COX-2 inhibitors for endodontic pain. Endod Top. 2002;3(1):31–40.

    Article  Google Scholar 

  9. Jackson DL, Moore PA, Hargreaves KM. Preoperative non-steroidal anti-inflammatory medication for the prevention of postoperative pain. J Am Dent Assoc. 1989;119:641–6.

    Article  PubMed  Google Scholar 

  10. Doroschak AM, Bowles WR, Hargreaves KM. Evaluation of the combination of flurbiprofen and tramadol for management of endodontic pain. J Endod. 1999;25:660–3.

    Article  PubMed  Google Scholar 

  11. Moore PA, Werther JR, Seldin EB, Stevens CM. Analgesic regimens for third molar surgery, pharmacological and behavioural considerations. J Am Dent Assoc. 1986;113:739–43.

    Article  PubMed  Google Scholar 

  12. Hargreaves KM, Seltzer S. Pharmacological control of dental pain. In: Hargreaves KM, Goodis HE, editors. Seltzer and Bender’s dental pulp. Chicago: Quintessence; 2002. p. 205–26.

    Google Scholar 

  13. Cooper S. The relative efficacy of ibuprofen in dental pain. Compend Contin Educ Dent. 1986;7:578–88.

    PubMed  Google Scholar 

  14. Wright C, Antal E, Gillespie W, Albert KS. Ibuprofen and acetaminophen kinetics when taken concurrently. Clin Pharmacol Ther. 1983;34:707–10.

    Article  PubMed  Google Scholar 

  15. Marshall JG. Consideration of steroids for endodontic pain. Endod Top. 2002;3:41–51.

    Article  Google Scholar 

  16. Marshall JG, Walton RE. The effect of intra-muscular injection of steroid on post treatment pain. J Endod. 1984;10:584–8.

    Article  PubMed  Google Scholar 

  17. Krasner P, Jackson E. Management of post-treatment endodontic pain with oral dexamethasone: a double blind study. Oral Surg Oral Med Oral Pathol. 1986;62:187–90.

    Article  PubMed  Google Scholar 

  18. Glassman G, Krasner P, Morse DR, Rankow H, Lang J, Furst ML. A prospective double blind trial on the efficacy of dexamethasone for endodontic interappointment pain in teeth with asymptomatic inflamed pulps. Oral Surg Oral Med Oral Pathol. 1989;67:96–100.

    Article  PubMed  Google Scholar 

  19. Liesinger A, Marshal FJ, Marshall JG. Effect of variable doses of dexamethasone on post-treatment endodontic pain. J Endod. 1993;19:35–9.

    Article  PubMed  Google Scholar 

  20. Kaufman E, Helling I, Rotstein I, Friedman S, Sion A, Moz C, Stabholtz A. Intra-ligamentary injection of slow release methylprednisolone for the prevention of pain after endodontic treatment. Oral Surg Oral Med Oral Pathol. 1994;77:651–4.

    Article  PubMed  Google Scholar 

  21. Erhmann EH, Messer HH, Adams GG. The relationship of intracanal medicaments to postoperative pain in endodontics. Int Endod J. 2003;36:868–75.

    Article  Google Scholar 

  22. Patten JR, Patten J, Hutchins MO. Adjunct use of dexamethasone in postoperative dental pain control. Compend Contin Educ Dent. 1992;13:580–90.

    Google Scholar 

  23. Malamed SF. Local anaesthetics: dentistry’s most important drugs, clinical update 2006. CDA J. 2006;34(12):971–6.

    Google Scholar 

  24. Meechan JG. Local anaesthesia. Oral Surg. 2008;1:3–10.

    Article  Google Scholar 

  25. Jastak JT, Yagiela JA. Vasoconstrictors and local anaesthesia: a review and rationale for use. J Am Dent Assoc. 1983;107:623–30.

    Article  PubMed  Google Scholar 

  26. Milam SB, Giovanniti Jr JA. Local anaesthetics in dental practice. Dent Clin North Am. 1984;28:493–508.

    PubMed  Google Scholar 

  27. Hersh EV, Condouris GA. Local anaesthetics: a review of their pharmacology and clinical use. Compendium. 1987;8:374–81.

    PubMed  Google Scholar 

  28. Roda RS, Blanton PL. The anatomy of local anaesthesia. Quintessence Int. 1994;25:27–38.

    PubMed  Google Scholar 

  29. Saxen MA, Newton CW. Anaesthesia for endodontic practice. Dent Clin North Am. 1999;43:247–61.

    PubMed  Google Scholar 

  30. Reader A, Nusstein J. Local anaesthesia for endodontic pain. Endod Top. 2002;3:14–30.

    Article  Google Scholar 

  31. Malamed SF, Gagnon S, Leblanc D. Efficacy of articaine: a new amide local anesthetic. J Am Dent Assoc. 2000;131:635–42.

    Article  PubMed  Google Scholar 

  32. Malamed SF, Gagnon S, Leblanc D. Articaine hydrochloride: a study of the safety of a new amide local anaesthetic. J Am Dent Assoc. 2001;132:177–85.

    Article  PubMed  Google Scholar 

  33. Corbett IP, Kanaa MD, Whitworth JM, Meechan JG. Articaine infiltration for anaesthesia of mandibular first molars. J Endod. 2008;34(5):514–8.

    Article  PubMed  Google Scholar 

  34. Kanaa MD, Whitworth JM, Meechan JG. Comparison of the efficacy of 4 % articaine with 1:100,000 epinephrine and 2 % lidocaine with 1:80,000 epinephrine in achieving pulpal anaesthesia in maxillary teeth with irreversible pulpitis. J Endod. 2012;38(3):279–82.

    Article  PubMed  Google Scholar 

  35. Van Eden SP, Patel MF. Prolonged paraesthesia following inferior alveolar nerve block using articaine. Br J Oral Maxillofac Surg. 2002;40:519–20.

    Article  Google Scholar 

  36. Moore PA, Dunsky JL. Bupivacaine anaesthesia – a clinical trial for endodontic therapy. Oral Surg Oral Med Oral Pathol. 1983;55:176–9.

    Article  PubMed  Google Scholar 

  37. Dunsky JL, Moore PA. Long acting local anaesthetics: a comparison of bupivacaine and etidocaine in endodontics. J Endod. 1984;10:457060.

    Article  Google Scholar 

  38. Pogrel MA, Smith R, Ahani R. Innervation of the mandibular incisors by the mental nerve. J Oral Maxillofac Surg. 1997;55:961–3.

    Article  PubMed  Google Scholar 

  39. Meechan JG. Why does local anaesthesia not work every time? Dent Update. 2005;32:66–8.

    PubMed  Google Scholar 

  40. Yonchak T, Reader A, beck M, Meyers WJ. Anaesthetic efficacy of unilateral and bilateral inferior alveolar nerve blocks to determine cross innervation in anterior teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:132–5.

    Article  PubMed  Google Scholar 

  41. Frommer J, Mele FA, Monroe CW. The possible role of the mylohyoid nerve in mandibular posterior tooth sensation. J Am Dent Assoc. 1972;85:113–7.

    Article  PubMed  Google Scholar 

  42. Jablonski NG, Cheng CM, Cheng LC, Cheung HM. Unusual origins of the buccal and mylohyoid nerves. Oral Surg Oral Med Oral Pathol. 1985;60:487–8.

    Article  PubMed  Google Scholar 

  43. Malamed S. Handbook of local anaesthesia. 3rd ed. St Louis: Mosby; 1990. p. 1–332.

    Google Scholar 

  44. Hargreaves KM. Pain mechanisms of the pulpodentine complex. In: Hargreaves KM, Goodish HE, editors. Seltzer and Bender’s dental pulp. Chicago: Quintessence Publications; 2002.

    Google Scholar 

  45. Dworkin S. Anxiety and performance in the dental environment: an experimental investigation. J Am Soc Psychosom Dent Med. 1967;14:88–103.

    PubMed  Google Scholar 

  46. Wong M, Jacobsen P. Reasons for local anaesthesia failures. J Am Dent Assoc. 1992;12:69–73.

    Article  Google Scholar 

  47. Wong M, Lytle WR. A comparison of anxiety levels associated with root canal therapy and oral surgery treatment. J Endod. 1991;17:461–5.

    Article  PubMed  Google Scholar 

  48. Meechan JG. Intraoral topical anaesthesia. Periodontol 2000. 2008;46:56–79.

    Article  PubMed  Google Scholar 

  49. Hutchins Jr HS, Young FA, Lackland DT, Fishburne CP. The effectiveness of topical anaesthesia and vibration in alleviating the pain of oral injections. Anesth Prog. 1997;44(3):87–9.

    PubMed Central  PubMed  Google Scholar 

  50. Coleman RD, Smith RA. The anatomy of mandibular anaesthesia: review and analysis. Oral Surg Oral Med Oral Pathol. 1982;54:148–53.

    Article  PubMed  Google Scholar 

  51. Cohen HP, Cha BY, Spandberg LS. Endodontic anaesthesia in mandibular molars: a clinical study. J Endod. 1993;19:370–3.

    Article  PubMed  Google Scholar 

  52. Kennedy S, Reader A, Nusstein J, Beck M, Meyers WJ. The significance of needle deflection in success of the inferior alveolar nerve block in patients with irreversible pulpitis. J Endod. 2003;29:630–3.

    Article  PubMed  Google Scholar 

  53. Friedman MJ, Hochman MN. The AMSA injection: a new concept for local anesthesia of maxillary teeth using a computer-controlled injection system. Quintessence Int. 1998;29(5):297–303.

    PubMed  Google Scholar 

  54. Friedman MJ, Hochman MN. P-ASA block injection: a new palatal technique to anesthetize maxillary anterior teeth. J Esthet Dent. 1999;11(2):63–71.

    Article  PubMed  Google Scholar 

  55. Gow-Gates GA. Mandibular conduction anaesthesia: a new technique using extra-oral landmarks. Oral Surg Oral Med Oral Pathol. 1973;36:321–8.

    Article  PubMed  Google Scholar 

  56. Malamed SF. The Gow-Gates mandibular block. Evaluation after 4,275 cases. Oral Surg Oral Med Oral Pathol. 1981;51:463–7.

    Article  PubMed  Google Scholar 

  57. Montagnese TA, Reader A, Melfi R. A comparative study of the Gow Gates technique and a standard technique for mandibular anaesthesia. J Endod. 1984;10:158–63.

    Article  PubMed  Google Scholar 

  58. Akinosi JO. A new approach to the mandibular nerve block. Br J Oral Surg. 1977;15:83–7.

    Article  PubMed  Google Scholar 

  59. Todorovic L, Stajcic Z, Petrovic V. Mandibular verses inferior alveolar dental anesthesia: clinical assessment of three different techniques. Int J Oral Maxillofac Surg. 1986;15:733–8.

    Article  PubMed  Google Scholar 

  60. Yucel E, Hutchinson I. A comparative evaluation of the conventional and closed mouth technique for inferior alveolar nerve block. Aust Dent J. 1995;40:15–6.

    Article  PubMed  Google Scholar 

  61. Mercuri LG. Intraoral second division nerve block. Oral Surg Oral Med Oral Pathol. 1979;47:109–13.

    Article  PubMed  Google Scholar 

  62. Cohn SA. The advantages of the greater palatine foramen block technique. J Endod. 1986;12:268–9.

    Article  PubMed  Google Scholar 

  63. Lilienthal B. A clinical appraisal of intra-osseous dental anaesthesia. Oral Surg Oral Med Oral Pathol. 1975;39:692–7.

    Article  PubMed  Google Scholar 

  64. Leonard MS. The efficacy of intra-osseous injection. J Am Dent Assoc. 1995;126:81–6.

    Article  PubMed  Google Scholar 

  65. Coggins R, Reader A, Nist R, Beck M, Meyers WJ. Anaesthetic efficacy of the intraosseous injection in mandibular and maxillary teeth. Oral Surg Oral Med Oral Pathol Radiol Endod. 1996;81:634–41.

    Article  Google Scholar 

  66. Parente SA, Anderson RW, Herman WW, Kimbrough WF, Weller RN. Anaesthetic efficacy of the supplemental intraosseous injection for teeth with irreversible pulpitis. J Endod. 1998;24:826–8.

    Article  PubMed  Google Scholar 

  67. Replogle K, Reader A, Nist R, Beck M, Weaver J, Meyer J. Cardiovascular effects of intraosseous injections. J Am Dent Assoc. 1999;130:649–57.

    Article  PubMed  Google Scholar 

  68. Walton RE, Abbott BJ. Periodontal ligament injection: a clinical evaluation. J Am Dent Assoc. 1981;103:571–5.

    Article  PubMed  Google Scholar 

  69. Malamed SF. The periodontal ligament (PDL) injection: an alternative to inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol. 1982;53:117–21.

    Article  PubMed  Google Scholar 

  70. D’Souza JE, Walton RE, Peterson LC. Periodontal ligament injection: an evaluation of the extent of anaesthesia and post injection discomfort. J Am Dent Assoc. 1987;114:341–4.

    Article  PubMed  Google Scholar 

  71. Ah Pin PJ. The use of intraligamentary injections in haemophiliacs. Br Dent J. 1987;162:151–2.

    Article  PubMed  Google Scholar 

  72. Roahen JO, Marshall FJ. The effects of periodontal ligament injection on pulp and periodontal tissues. J Endod. 1990;16:28–33.

    Article  PubMed  Google Scholar 

  73. Birchfield J, Rosenberg PA. Role of the anaesthetic solution in intrapulpal anaesthesia. J Endod. 1975;1:26–7.

    Article  PubMed  Google Scholar 

  74. Smith GN, Smith SA. Intrapulpal injection: distribution of an injected solution. J Endod. 1983;9:167–70.

    Article  PubMed  Google Scholar 

  75. VanGheluwe J, Walton R. Intrapulpal injection. Factors related to effectiveness. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83:38–40.

    Article  PubMed  Google Scholar 

  76. Clark TM, Yagiela JA. Advanced techniques and armamentarium for dental local anaesthesia. Dent Clin North Arm. 2010;54:757–68.

    Article  Google Scholar 

  77. Dabarakis NN, Alexander V, Tsirlis AT, Parissis NA, Nikolaos M. Needle-less local anaesthesia: clinical evaluation of the effectiveness of the jet anaesthesia injex in local infiltration anaesthesia in dentistry. Quintessence Int. 2007;38:E572–6.

    PubMed  Google Scholar 

  78. Arapostathis KN. Comparison of acceptance, preference and efficiency between Jet injection INJEX and local infiltration anaesthesia in 6–11 year old dental patients. Anesth Prog. 2010;57:3–12.

    Article  PubMed Central  PubMed  Google Scholar 

  79. Nanitsos E, Vartuli R, Forte E, Dennison PJ, Peck CC. The effect of vibration on pain during local anaesthesia injections. Aust Dent J. 2009;54:94–100.

    Article  PubMed  Google Scholar 

  80. Roeber B, Wallace DP, Rothe V, Salama F, Allen KD. Evaluation of the effects of the Vibraject attachment on pain in children receiving local anaesthesia. J Paediatr Dent. 2011;33:46–50.

    Google Scholar 

  81. Rosenberg ES. A computer controlled anaesthetic delivery system in a periodontal practice: patient satisfaction and acceptance. J Esthet Restor Dent. 2002;14:39–46.

    Article  PubMed  Google Scholar 

  82. Fukayama H, Yoshikawa F, Kohas H, Umino M, Susuki N. Efficacy of anterior and middle superior alveolar (AMSA) anaesthesia using a new injection system: the Wand. Quintessence Int. 2003;34:537–41.

    PubMed  Google Scholar 

  83. Palm AM, Kirkegaard U, Poulsen S. The Wand verses traditional injection for mandibular nerve block in children and adolescents: perceived pain and time of onset. Pediatr Dent. 2004;26:481–4.

    PubMed  Google Scholar 

  84. Kandiah P, Tahmessebi JF. Comparing the onset of maxillary infiltration local anaesthesia and pain experience using the conventional technique vs. the Wand in children. Br Dent J. 2012;213:E15.

    Article  PubMed  Google Scholar 

  85. Smith MH, Lung KE. Nerve injuries after dental injection: a review of the literature. J Can Dent Assoc. 2006;72:559–64.

    PubMed  Google Scholar 

  86. Pogrel MA, Bryan J, Regezi J. Nerve damage associated with inferior alveolar nerve blocks. J Am Dent Assoc. 1995;126:1150–5.

    Article  PubMed  Google Scholar 

  87. Meechan JG. Local anaesthesia: risks and controversies. Dent Update. 2009;36:278–83.

    PubMed  Google Scholar 

  88. Crean S-J, Powis A. Neurological complications of local anaesthetics in dentistry. Dent Update. 1999;26:344–9.

    PubMed  Google Scholar 

  89. Alves FR, Coutinho MS, Goncalves LS. Endodontic-related facial paraesthesia: systematic review. J Can Dent Assoc. 2014;80:E13.

    PubMed  Google Scholar 

  90. Kaufman E, Hargreaves KM, Dionne RA. Comparison of oral triazolam and nitrous oxide with placebo and intravenous diazepam for outpatient premedication. Oral Surg Oral Med Oral Pathol. 1993;75:156–64.

    Article  PubMed  Google Scholar 

  91. Ehrich DG, Lundgren JP, Dionne RA, Nicoll BK, Hunter JW. Comparison of triazolam, diazepam and placebo as outpatient oral premedication for endodontic patients. J Endod. 1997;23:181–4.

    Article  PubMed  Google Scholar 

  92. Berthold CW, Dionne RA, Corey SE. Comparison of sublingually and orally administered triazolam for premedication before oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84:119–24.

    Article  PubMed  Google Scholar 

  93. Dionne RA. Oral sedation. Compendium. 1998;19:868–77.

    PubMed  Google Scholar 

  94. Dionne RA, Yagiela JA, Cote CJ, Donaldson M, Edwards M, Greenblatt DJ, Hass D, Malviya S, Milgrom P, Moore PA, Shampaine G, Silverman M, Williams RL, Wilson S. Balancing efficacy and safety in the use of oral sedation in dental outpatients. J Am Dent Assoc. 2006;137:502–13.

    Article  PubMed  Google Scholar 

  95. Chong BS, Miller JE, Sidhu SK. Alternative local anaesthetic delivery systems, devices and aids designed to minimize painful injections – a review. ENDO (Lond Engl). 2014;8(1):7–22.

    Google Scholar 

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  1. Canberra, ACT, Australia

    Bobby Patel

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Patel, B. (2015). Analgesics, Anaesthetics, Anxiolytics and Glucocorticosteroids Used in Endodontics. In: Endodontic Diagnosis, Pathology, and Treatment Planning. Springer, Cham. https://doi.org/10.1007/978-3-319-15591-3_15

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  • DOI: https://doi.org/10.1007/978-3-319-15591-3_15

  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-15591-3

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