Effect of pretreatment medication on postendodontic pain: A double-blind, placebo-controlled study

BACKGROUND: Posttreatment endodontic pain has been reported in 25%–40% of all endodontic patients. Effective management of endodontic pain represents a continuing challenge. AIM: To evaluate and compare the efficacy of preoperative single dose of nonsteroidal anti-inflammatory drug, piroxicam (20 mg), with two types of corticosteroid drugs – dexamethasone (4 mg) or deflazacort (30 mg) – for the prevention and control of postendodontic pain. MATERIALS AND METHODS: A total of 132 volunteers selected for nonsurgical root canal therapy were randomly divided into the following four groups (n = 30 each) according to preoperative medication given: Group 1, piroxicam (20 mg); Group 2, dexamethasone (4 mg); Group 3, deflazacort (30 mg); and Group 4, placebo. The preoperative medications were administrated 1 h before the start of standard endodontic treatment. Patients were instructed to complete a pain diary using Visual Analog Scale preoperatively and at 6-, 12-, 24-, 48-, and 72-h intervals after root canal instrumentation. STATISTICAL ANALYSIS: The correlation between preoperative endodontic pain to postoperative pain and pair-wise comparison of four groups was evaluated by Kruskal–Wallis analysis of variance test followed by Mann–Whitney U-test. RESULTS: Compared to the placebo group, piroxicam, dexamethasone, and deflazacort resulted in a statistically significant reduction in postendodontic pain at 6, 12, and 24 h (P < 0.05). CONCLUSION: Preoperative single oral dose of piroxicam or dexamethasone or deflazacort is equally effective in controlling postendodontic pain.