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12A.A. Yuldasheva
MODERN ADVANCES IN THE PREVENTION AND TREATMENT OF POSTOPERATIVE PAIN
Postoperative pain after non-surgical root canal treatment is a multifactorial phenomenon and is associated with the presence of periapicalpathol-ogy, missed canals, inadequate cleaning and shaping, apical debris extrusion, apical patency during instrumentation, extrusion of irrigation and intracanal preparations and bite restoration, as well as tooth type and gender. There is a close relationship between preoperative and postoperative pain. Patients with severe preoperative pain are likely to experience greater postoperative pain, and there is conflicting data on the relationship between pulp condition and postoperative pain.
Key words: Postoperative pain, dentistry, prevention.
Introduction: Pain after non-surgical root canal treatment has been proven to occur in 3 -69.3% of patients. Microorganisms are, a major factor in postoperative pain, and there is no significant difference in postoperative pain between single and multiple treatments. In particular, mechanical factors such as overuse of instruments or extrusion of root canal obturation materials are associated with pain after endodontic treatment, and sodium hypo-chlorite (NaOCl) extrusion causes severe pain, swelling and tissue damage when used as periapical tissue irrigant.
Several studies have reported that pulp condition contributes to postoperative pain. Most studies have shown that patient age was not associated with pain after non-surgical root canal treatment. Thus, decreased pain sensitivity with age is not associated with changes in physiological pain systems. However, pulp chamber recession complicates root canal treatment in older patients and leads to more severe postoperative pain.
The aim of the study: To improve the effectiveness of prediction, prevention and treatment of pain arising after endodontic treatment of teeth.
Material and methods of research: This study was conducted in the dental clinic "Denta Medik" in Samarkand. All patients were treated in the period from January 2015 to December 2021. We studied 50 patients, older than 20 years, who had pulpitis after endodontic treatment, the complaints were about pain after root canals filling.
Results: The incidence of postoperative pain during the first 24 to 48 hours was found to range from 3 to 69.3%. In other studies, moderate to severe pain was observed. There is a close relationship between preoperative and postoperative pain. Patients with severe preoperative pain are likely to experience more severe postoperative pain. Most studies have shown that patient age is not related to pain after nonsurgical root canal treatment. Women experience more pain after this treatment than men. The frequency of pain after nonsurgical root canal treatment is also higher in the mandibular arch and molars. Intracanal administration of medications is also associated with pain after root canal treatment. There is no clear evidence that there are significant differences in postoperative pain between single and multiple root canal treatments. Pre-treatment analgesia applied 30 minutes before root canal treatment reduces postoperative pain and may be helpful, especially in patients with a low pain threshold.
Postoperative pain after root canal treatment in these patients ranged from mild to moderate and occurred even after optimally performed procedures. We have developed endodontic techniques and devices to reduce postoperative pain. A flexible, severity-based medication plan was used to control and treat pain after root canal treatment. The application of current research reduced pain after root canal treatment and improved patient outcomes. Women experienced more pain after non-surgical root canal treatment than men. Underlying the gender differences may be biological differences between men and women resulting from changes in serotonin and non-adrenaline hormones. Similarly, cortisol modulates pain sensation and is secreted in higher amounts in men than in women.
Pain relief is often more important to patients than successful root canal treatment. Prevention and management of postoperative pain after non-surgical root canal treatment is an integral part of successful outcomes. Providing patients with information about expected postoperative pain and managing pain by prescribing medication increased patient confidence, their pain threshold and improved patients' views of future dental treatment. Pre-treatment analgesia administered 30 minutes before root canal treatment decreased postoperative pain and therefore according to our results is useful, especially in patients with a low pain threshold.
© A.A. Yuldasheva, 2022.
Premedication with nonsteroidal anti-inflammatory drugs (NSAIDs) prior to endodontic treatment blocked the cyclooxygenase (COX) pathway and therefore blocked pain signals prior to sensation. One study showed that premedication with a single dose of ibuprofen did not reduce postoperative pain after root canal treatment. However, the study sample was small (29 patients), and no information was provided as to whether the pulp was vital or necrotic. In addition, a preoperative single oral dose of prednisolone (30 mg) or dexamethasone (4 mg) significantly reduced postoperative pain. The use of a prolonged local anesthetic during treatment can also significantly reduce postoperative pain after non-surgical root canal treatment and it is suggested that this effect occurs by blocking nociceptive impulses for a long enough period of time to prevent central hyperalgesia in the early stages of inflammation after root canal treatment. Intracanal cryotherapy with 2-4°C saline solution flushing for 5 minutes as the final flushing fluid can significantly reduce postoperative pain. Cryotherapy restricts tissue metabolism and blood flow to the tissues, thereby inducing vasoconstriction.
As a result, a decrease in the external temperature of the root surface restrained inflammatory reactions, reducing the release of substances that cause pain and reducing edema in the periapical region. Localized inflammation in this case played a crucial role in the development of odontogenic pain, and pain after root canal treatment was the result of periapical tissue inflammation.
NSAIDs including ibuprofen, aspirin, flurbiprofen, ketorolac and etodolac are most commonly used to control pain after root canal treatment. Prostaglandin synthesis is prevented by NSAIDs by reducing the enzymatic activity of COX 1 and 2. In addition, for moderate to severe pain, a combination of 2 or more drugs is ideally used to reduce the dose of each drug, thereby minimizing side effects. For example, a combination of NSAIDs and acetaminophen can improve pain relief for toothache. Similarly, a combination of ibuprofen and paracetamol is effective in reducing pain after root canal treatment when taken immediately after the procedure. However, when NSAID combinations are not effective pain management strategies, narcotic analgesics should be considered. Therefore, a flexible plan of medication administration for pain control is recommended and should be determined based on the severity of the pain. In addition, medications should be administered four times a day until the pain subsides. Pre-treatment analgesia administered 30 minutes before root canal treatment reduces postoperative pain and therefore may be helpful, especially in patients with a low pain threshold. Pretreatment with nonsteroidal antiinflammatory drugs (NSAIDs) prior to endodontic treatment blocks the cyclooxygenase (COX) pathway and therefore can block pain signals prior to sensation. One study showed that premedication with a single dose of ibuprofen did not reduce postoperative pain after root canal treatment. However, the study sample was small (50 patients), and no information was provided as to whether the pulp was vital or necrotic.
In addition, a preoperative single oral dose of prednisolone (30 mg) or dexamethasone (4 mg) significantly reduced postoperative pain. The use of a prolonged local anesthetic (bupivacaine) during treatment can also significantly reduce postoperative pain after non-surgical root canal treatment and it is suggested that this effect occurs by blocking nociceptive impulses for a long enough period of time to prevent central hyperalgesia in the early stages of inflammation after root canal treatment. Intracanal cryotherapy with 2-4°C saline solution flushing for 5 minutes as the final flushing fluid can significantly reduce postoperative pain. Cryotherapy restricts tissue metabolism and blood flow to the tissues, thereby inducing vasoconstriction.
As a result, reducing the external temperature of the root surface can inhibit inflammatory reactions, reduce the release of substances that cause pain, and reduce swelling in the periapical region. Localized inflammation plays a crucial role in the development of odontogenic pain, and pain after root canal treatment is the result of periapical tissue inflammation. NSAIDs including ibuprofen, aspirin, flurbiprofen, ketorolac and etodolac are most commonly used to control pain after root canal treatment. Prostaglandin synthesis is prevented by NSAIDs by reducing the enzymatic activity of COX 1 and 2. In addition, for moderate to severe pain, a combination of 2 or more drugs is ideally used to reduce the dose of each drug, thereby minimizing side effects. For example, a combination of NSAIDs and acetaminophen can improve pain relief for toothache. Similarly, a combination of ibuprofen and paracetamol is effective in reducing pain after root canal treatment when taken immediately after the procedure. However, when NSAID combinations are not effective pain management strategies, narcotic analgesics should be considered. Therefore, a flexible plan of medication administration for pain control is recommended and should be determined based on the severity of the pain. In addition, medications should be administered four times a day until the pain subsides.
The effects of reducing occlusion to relieve postoperative pain after root canal treatment are inconclusive. In teeth with symptomatic apical periodontitis, occlusion reduction had no effect on pain after root canal treatment. However, another study showed that occlusal reduction of teeth with biting pain was effective in reducing postoperative pain.
The frequency of pain after nonsurgical root canal treatment is also higher in mandibular arch and molars. This difference may be the result of the dense trabecular pattern of the mandibular bone, which reduces blood flow and concentrates infection, thereby delaying healing. Such effects are related to the complex anatomy of the mandibular molars. Nevertheless, apical dilatation due to excessive instrumentation during root canal treatment can
ISSN 2223-4047
Вестник магистратуры. 2022. № 2-2 (125)
increase the incidence and intensity of postoperative pain. Intracanal medication administration is also associated with pain after root canal treatment. Compared to no dressing, dressing necrotized canals with chlorhexidine alone or calcium hydroxide with chlorhexidine reduces postoperative pain.
Conclusion. Thus, pain management is often more important for patients than successful root canal treatment. Prevention and management of postoperative pain after non-surgical root canal treatment is an integral part of successful outcomes. Providing patients with information about expected postoperative pain and managing pain by prescribing medication increases patient confidence, raises their pain threshold and improves patients' outlook on future dental treatment.
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YULDASHEVA AZIZA ANVAROVNA - 2nd year master's student of the department of dentistry, Samarkand State Medical Institute
