INFLUENCE OF IRRIGATION SOLUTIONS ON POSTOPERATIVE PAIN IN ENDODONTIC
Keywords:
endodontic irrigation, endodontic therapy, irreversible pulpitis, irrigation solutions, post-endodontic painAbstract
The aim of this study was to evaluate the impact of different irrigation solutions on the level of post-operative pain in patients with irreversible pulpitis undergoing single-visit endodontic therapy.
A total of 80 patients with symptomatic irreversible pulpitis were included in this prospective randomized follow-up clinical study. To avoid and minimize interpersonal variability in treatment, all endodontic therapy procedures were the same for all patients, and the therapy was performed by one therapist. The patients were randomly divided into four groups according to the type of irrigant solution used during the root canal instrumentation phase: in the first group, the root canals were irrigated with 5.25% sodium hypochlorite (Chloraxid 5.25% Cerkamed medical company Poland), in the second group group 2% sodium hypochlorite were used (Chloraxid 2% Cerkamed medical company Poland), in the third group irrigation was done with 3% hydrogen peroxide, while in the fourth group 2% chlorhexidine gluconate (Gluco-Chex 2% Cerkamed medical company Poland) was used. The visual analogue scale (VAS) was used to determine the intensity of pain after intervention. The patients recorded the data in the survey questionnaire in the periods of 6 hours, 12, 24 and 48 hours, as well as 7 days after the intervention. It was indicated that the patients determine and record the spontaneous pain and the pain during percussion. Each patient was scheduled seven days after the intervention, when they returned the completed questionnaire. Preoperative and postoperative pain intensity in the indicated periods were evaluated using the Kruskal–Wallis test. A two-sided analysis with a significance level of p<0.05 was used to determine statistical significance.
Pain after endodontic therapy is quite common, but most often due to the intensity does not require reinvention and does not disturb the patient's daily life. The pain reaches its peak 6-12 hours after the intervention and is most intense, after which it significantly decreases. On the seventh day most patients no longer feel any pain or it manifests as slight discomfort. The appearance and intensity of the pain is influenced by the used irrigation. Hypochlorite at a concentration of 5.25% gives significantly higher pain than other examined irrigans in the first 6, 12, and 24 hours, not only in duration but also in intensity of that pain. After 48 hours the difference between the groups for percutaneous pain was insignificant, while for spontaneous pain there was significance between the hypochlorite groups and chlorhexidine. After 7 days there is no difference in the degree of pain no matter what the irrigation was used. All irrigants have their advantages and disadvantages. Which irrigant is most suitable to use during processing depends on the diagnosis. The use of 5.25% hypochlorite is not recommended for teeth with vital pulp as an irrigant, which significantly increases the pain after the endodontic therapy.
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