The Relationship of IntraCanal Medicaments to Endodontic Post-operative Pain In Vital and Non-vital Teeth

Endodontic postoperative pain is a common unexpected complication. This problem is not well understood and its incidence is widely varied from a study to another. No specific procedure, systemic or localized medicament found to prevent its occurrence. The antibacterial effect of intracanal medicaments was the point of concentration in studying any intracanal medicament. Their effect on postoperative endodntic pain was not well studied and still a place of controversy. The objective of this prospective-controlled study was, evaluating the ability of intracanal medicaments in reducing the incidence and/or severity of postoperative pain in both vital and non-vital teeth. Endodontic treatment was performed for sixty vital and sixty necrotic teeth by one operator in department of conservation-faculty of dentistry-university of Khartoum. All included teeth were free of symptoms at the time of treatment. The canals of all teeth were prepared at the initial visit using modified double flare technique. The medicaments were placed at the end of the first visit using a small file. Visual Analogue Scale was filled by each patient to record the degree of pain at two time periods, 6h and 24h after the end of the visit. A relatively high incidence of overall post-operative pain was found (40%). The incidence of overall mild to moderate pain was 34.2% and the incidence of flare-ups was 5.8%. In the vital teeth, the incidence was 38.3% and was 41.6% for the necrotic teeth. Flare-up records were 5% in vital teeth and 6.6 % in necrotic teeth. At 6h period after the treatment, 33.3% of patients reported mild to moderate pain and 5 % reported severe pain, whereas at 24h 22.5% of patients reported mild to moderate pain and 4.2% reported severe pain and/or swelling. In relation to the medicaments, 32.5% of teeth medicated with Ca(OH)2 reported mild to moderate pain and 2.5% reported severe pain. Teeth medicated with Ledermix resulted in an incidence of 37.5% mild to moderate pain and 2.5% flare-ups. In the control group where dry cotton pellets were placed, 32.5% of the cases recorded mild to moderate pain and 12.5% recorded flare-ups. In necrotic teeth, 55% were associated with apical radiolucency and 45% were with normal periapical appearance in the radiograph. 37.8% of teeth assocaited with periapical lesion reported mild to moderate pain while 25.9% reported these intensities of pain in teeth with normal peripaical condition. The incidence of flare-ups was 5.4% in teeth with periapical lesion and 7.4% in the normal periapical appearance group. Using Chi-Square test, no significant differences in incidence of postoperative pain in relation to different age groups, gender, tooth type, arch, pulp vitality and the medicaments used. The mean pain scores were decreased in most of the treatment groups over the follow up time. It decreased from 0.5 to 0.3, from 0.55 to 0.3 and from 0.7 to 0.55 in vital teeth medicated with Ca(OH)2, Ledermix and no medication respectively. In the necrotic teeth, pain scores were 0.35 in Ca(OH)2 group at the two periods, decreased from 0.65 at 6 h to 0.4 at 24 h in Ledermix group and from 0.85 to 0.7 in no medication group. T-Test was used for comparing the mean pain scores of the different medicaments groups at the same period and for the means for the same medicament group between the two periods of pain records (pain reduction ability of the medicament). The only significant difference were in pain reduction over time in vital teeth, vital teeth medicated with Ca(OH)2 and in vital teeth medicated with Ledermix Paste. No significant difference in pain scores between the medication groups and the control groups at the two time periods. Under the conditions of this study, the use of steroids and calcium hydroxide intracanal medicaments appears to have no relation to the incidence of postoperative pain but they demonstrated a controlling effect (reduction of the pain over time) in vital teet