Page 16 - GP Spring 2020

A Comparative Study of Pain Reduction in Untreated and

Treated Acute Irreversible Pulpitis: A Clinical Trial

By Indu Cherangapadath Radhakrishnan, C.S. Karumaran, and Anil Kumar

Introduction chemical mediators that results in reducing • 0 - indicates no pain.
Irreversible pulpitis is an inflammatory pain.
condition of the pulp and is characterized • 1 - indicates mild pain which was
by acute or chronic pain, which represents The aim of this study was to evaluate the ef- recognizable but not discomforting.
more than 45% of dental emergencies. ficiency of intraosseous injection of methyl
Acute/symptomatic irreversible pulpitis is prednisolone acetate in achieving adequate • 2 - indicates moderate pain which was
associated with intermittent or spontaneous anesthesia, pain reduction, and the ability discomforting but bearable.
severe pain that remains even after the re- to perform pulpectomy with comfort in
moval of the stimulus. The etiology may be patients with acute irreversible pulpitis in • 3 - indicates severe pain which caused
due to dental caries, loss of marginal seal permanent teeth. considerable discomfort and was diffi-
under a restoration, dental trauma leading cult to bear.
to pulpal exposure, or associated with den- Methodology
tinal cracks. 1 Eighty patients between the ages of 18 to The study was conducted on 80 patients di-
35 with acute irreversible pulpitis pain and vided into 4 groups of 20 each.
Recommended emergency treatment for requiring emergency treatment participat-
pain associated with symptomatic irrevers- ed in the study. All patients were in good Group I: 20 patients were administered
ible pulpitis is partial endodontic treatment health as determined by written health his- intraosseous methyl prednisolone acetate
(pulpotomy) or pulpectomy under local tory and oral questioning. Patients present- (Depo-Medrol) injection and recalled for
th
anesthesia. The purpose of this procedure ing with any contraindications to cortico- root canal treatment on the 7 day.
2
is to partially or completely remove the steroids (systemic fungal infections, ocular
pulp in order to alleviate the pain associ- herpes simplex, primary glaucoma, ulcer- Group II: 20 patients were administered
ated with the condition. This is possible ative colitis, severe osteoporosis, poorly intraosseous saline injection and recalled
3
th
only if local anesthesia works effectively. controlled insulin-dependent diabetes mel- on the 7 day for root canal treatment (con-
Achieving adequate anesthesia in such a litus, compromised immune status psycho- trol group).
clinical situation is a major challenge to the sis) and contraindications to the injection Group III: 20 patients were prescribed
clinician where there is a high probability techniques or solutions were excluded antibiotics (amoxicillin 500mg thrice daily
of local anesthetic failure and a need for from this study. for 3 days) and were recalled on the 7 day
th
additional anesthesia. 4,5,6 The teeth that are for evaluation and root canal treatment.
most difficult to anesthetize with acute irre- The primary investigator selected the pa-
versible pulpitis are the mandibular molars tients who satisfied the inclusion criteria Group IV: 20 patients received an in-
followed by mandibular premolars, maxil- and the clinical protocols. All patients who traosseous injection using 2% lidocaine
lary molars and premolars, and mandibular consented to participate were evaluated in with 1:100,000 epinephrine and emergency
anterior teeth. the General Hospital attached to the Ragas pulpectomy was performed. The patients
Dental College, India by a physician. Pa- th
Intraosseous technique is a supplemental tients underwent routine blood tests, blood were recalled on the 7 day to continue root
canal treatment.
anesthetic delivery system which allows pressure evaluation, blood sugar testing,
for the delivery of local anesthetic solution and ECG. When all the health parameters All patients from each group were given 20
directly into the bone distal to the tooth to were satisfactory and within normal range, analgesics (Tylenol) tablets and asked to
be anesthetized, except in maxillary and those patients were included in the study. take them whenever they experienced se-
mandibular second molars where the an- Informed written consent was obtained vere pain and to document it.
esthetic solution is deposited mesial to the from each subject in the presence of a com-
tooth to be anesthetized. Though the rate mon witness. Groups 1 and 2 (40 patients) were given an
6
of the onset of anesthesia is rapid with this intraosseous injection of either 1ml (40mg/
technique, it may not alleviate the pain The patients included in this study had a ml) of methylprednisolone acetate (De-
completely in some patients with acute tooth with clinical diagnosis of acute ir- po-Medrol) or 1ml of 0.9% preservative
irreversible pulpitis. Gallatin et al. did a reversible pulpitis and had moderate to free sterile saline (sodium chloride). The
study on untreated irreversible pulpitis severe spontaneous pain associated with a Depo-Medrol solution contained 40 mg/ml
using an intraosseous injection of methyl maxillary or mandibular premolar or molar. of Depo-Medrol, 2.9% polyethylene glycol
prednisolone, a glucocorticoid, which was They exhibited a positive response to elec- vehicle, 0.0195% myristyl-γ-picolinium
continued by Brami et al. and Claffey et tric pulp testing and prolonged response chloride preservative, and 0.9% sodium
7
al. They concluded that intraosseous in- to cold pulp testing with Endo-Frost. The chloride solution, according to the manu-
8
jection of methyl prednisolone was effec- tooth had history of spontaneous pain, per- facturer. Depo-Medrol formulation con-
tive in reducing pain associated with acute cussion sensitivity, and radiographically taining benzyl alcohol was not used due to
irreversible pulpitis. widened periodontal ligament space. allergy concerns.
Corticosteriods (Glucocorticoids), such as Pain evaluation and percussion pain evalu- The dental cartridges were prepared by re-
Depo-Medrol, are a class of drugs that act ation were done using a pain scale of 0 to moving the rubber plunger from the stan-
by interrupting the synthesis and release of 3 (Gallatin et al.) 2

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