Effectiveness of Pretreatment Submucosal Injections of Dexamethasone and Tramadol in Managing Endodontic Pain in Mandibular Molars
- Dr Iqra hanif, PMC Rawalakot
- Dr Muhammad Ibrahim Kousar, Azad Jammu and Kashmir medical college muzaffarbad
- Dr anas sharif, Ajk mc Muzaffarbad
- Dr Hina Munawar, Ajk medical college Muzaffarabad
- Dr Asifa Ismail, Azad Jammu and Kashmir medical college muzaffarbad
- Dr Zoha Tasawar, Saidu Medical College
ABSTRACT:
Background: An immediate after effect of root canal therapy is post- endodontic pain, a situation that is mostly experienced in teeth with symptomatic irreversible pulpitis. Pain management is crucial in enhancing the comfort and outcome of treatment in the patient. Different pharmacological drugs have been explored to minimize postoperative pain among them corticosteroids and opioid analgesics. Dexamethasone is an effective anti-inflammatory corticosteroid which suppresses inflammatory mediators, tramadol is a centrally-acting anti-pain transmitter. There has been a proposal to administer such agents sub-mucosally before initiating endodontic treatment as the possible line of action in reducing postoperative pain. Night however, there is observable little evidence in comparison of analgesic effect of dexamethasone and tramadol in administration via sub-mucosal injection prior to endodontics.
Aim: The objective of the study was to observe the similarity in the pain reduction effect that was brought about by pretreatment sub-mucosal injection dexamethasone and tramadol on mandibular molar tooth with symptomatic irreversible pulpitis.
Methods: This randomized controlled trial was done in the Department of operative dentistry, Lahore medical and dental college, during a span of six months after permission of the study synopsis. The study involved the finding of 42 patients diagnosed with symptomatic irreversible pulpitis in a tooth of the mandible in the molar. The sampling among patients was done through non-probability purposive sampling and the sample population was randomly chosen into two groups (21 patients each group). Group A was pretreated with dexamethasone sub- mucosally and Group B was pretreated with tramadol sub- mucosally before undergoing the endodontic procedure. The pain was evaluated with the help of the Visual Analogue Scale (VAS) at various postoperative periods of 6, 12, and 24 hours after treatment. The minimum sample size was estimated at 95 percent confidence level and the power of the study at 90 percent. The analytical stage used proper statistical tests to determine the difference in the mean pain scores in the two groups.
Results: The findings revealed that dexamethasone and tramadol were significantly effective in the management of endodontic pain of the post-operative period. Nevertheless, the tramadol group also had lower means of pain than the dexamethasone group at the 12-hour scale (2037.5 vs 3825). The tramadol group also exhibited rather reduced pain scores at 6 and 24 hours though the difference was not as significant. In general, the proportion of patients who felt their pain had been alleviated was higher in patients taking the tramadol as opposed to patients taking the dexamethasone, which reported fewer cases of moderate and serious pain.
Conclusion: It became possible to conclude that pretreatment sub- mucokal injection of tramadol was strongly more efficient in alleviating postoperative endodontic pain than dexamethasone in mandibular molar in teeth with symptomatic irreversible pulpitis. Tramadol use can be used as a more effective treatment of postoperative pain and effective pain management among patients that undergo a root canal procedure.
Keywords: Endodontic pains, Dexamethasone, Tramadol, Irreversible pulpitis, Root canal therapy, Sub-mucosal injection, Pain management.