Cold Sodium Hypochlorite Reduces Post-Op Pain in Endodontic Patients: Study Finds
India: In patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis, treatment with cold sodium hypochlorite (NaOCl) as the final irrigant led to significantly lesser post-operative pain at 6 hours than room temperature and warm NaOCl, a recent study has found. The findings were published online in Journal of Endodontics on July 08, 2024.
Symptomatic irreversible pulpitis is characterized by severe, spontaneous, and lingering tooth pain caused by inflammation and infection of the dental pulp. Effective management of this condition is crucial to alleviate pain and preserve tooth structure through root canal therapy.
Alpa Gupta, Manav Rachna International Institute of Research and Studies Faridabad, Haryana, India, and colleagues aimed to evaluate the effect of cryotreated and warm NaOCl on post-operative pain in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis.
Root canal procedures are essential for preserving natural teeth and alleviating severe dental pain associated with irreversible pulpitis. By investigating the impact of irrigation solutions on post-operative pain, this research contributes to advancing evidence-based practices in endodontics.
The study included Sixty-six individuals with initial pain scores of ≥ 54mm on the Heft Parker Visual Analogue Pain Scale (HP-VAS), diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis according to the American Association of Endodontists (AAE) guidelines. The access preparation and instrumentation of the root canals followed a standardized protocol for the procedure.
The root canals were randomly assigned to three groups based on the temperature of the final irrigant, and 3% NaOCl was irrigated: Control (at 25°C), cold NaOCl (2°C), and warm NaOCl (60°C) (n = 22/group).
Root canal treatment was performed during the same appointment. Pain levels were evaluated before and after the procedure at 6, 24, 48, and 72 hours using the HP-VAS, and the amount of pain relief medication taken was recorded. Statistical analyses appropriate for the data were employed for interpretation.
The following were the key findings of the study:
· Compared to the other two groups, the cold NaOCl group had a lower HP-VAS score at all follow-up intervals.
· Between groups, there was a statistically significant difference in post-operative pain scores at 6 and 72 hours.
· None of the subjects experienced any postoperative discomfort at 72 hours in the control and cold NaOCl group.
"In patients with irreversible pulpitis and apical periodontitis, our research demonstrated that employing cold (2°C) sodium hypochlorite during root canal treatment significantly decreased immediate postoperative pain compared to solutions at room temperature (25°C) and warmer alternatives (60°C)," the researchers wrote.
"Utilizing cold NaOCl as the final irrigant resulted in significantly reduced pain scores at 6 hours post-operation, underscoring the potential of this straightforward modification to enhance patient comfort and recovery," they concluded.
Reference:
Lalfakawmi S, Gupta A, Duraisamy AK, Abraham D, Mrinalini, Mane AP. Impact of Cryotreated and Warm Sodium Hypochlorite on Post-Operative Pain in Teeth with Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial. J Endod. 2024 Jul 8:S0099-2399(24)00397-2. doi: 10.1016/j.joen.2024.07.002. Epub ahead of print. PMID: 38987018.
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