NSAIDs and acetaminophen have the greatest effect – ZWP online – the news portal for the dental industry

Endo: NSAIDs and paracetamol have the greatest effect

Photo: lizaelesina – stock.adobe.com

What is the best postoperative medication for pain relief after non-surgical root canal treatment? A new study addresses this question.

The study from Iran is based on the evaluation of various data sources, including the Medline, Embase, CENTRAL, Cumulative Index to Nursing, Allied Health Literature and Scopus databases, as well as the WHO International Clinical Trials Registry. Data was collected through July 31, 2019. All randomized clinical trials (RCTs) of non-surgical endodontic therapy with pharmaceutical treatments performed after surgery to relieve pain in adult patients were eligible.

Oral medications were divided into placebo, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, acetaminophen, NSAIDs + acetaminophen, corticosteroids, NSAIDs + benzodiazepines, and NSAIDs + opioids.

Low efficacy of painkillers compared to placebo

With moderate safety, NSAIDs + acetaminophen were more effective than placebo 6-8 hours after nonsurgical root canal treatment (MD = 22; 95% CrI = [-38, -7,2]). With very little difference, NSAIDs had a greater effect than placebo at 12 and 24 hours (MD = 28; 95% CrI = [49, 7] or MD = 15; 95% CRI = [27, 2,3]). At 6, 12, and 24 hours, the other drugs were no more effective than placebo in reducing pain. After 48 hours, no treatment was more effective than placebo. A subgroup analysis found that other drugs, such as corticosteroids and acetaminophen, were no more effective than placebo for patients unable to take NSAIDs. Six studies provided safety data and concluded that the therapies are safe and pose no significant risk.


The very low to moderate quality of evidence suggests that postoperative administration of NSAIDs and acetaminophen or NSAID alone reduces discomfort after nonsurgical root canal therapy in patients with irreversible pulpitis or pulpal necrosis.

Study information: https://doi.org/10.1038/s41432-022-0265-8

Those: nature.com

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