The effect of Ibuprofen premedication on postoperative pain following primary teeth pulpotomy : a randomized clinical trial

Introduction

pain 37% to 95% tooth extraction,pulpotomy and SSC Facial expression

Wong- Baker faces

Pulpotomy The most common treatment of primary teeth. Shafie:65/6% of patients reported pain after pulpotomy

premedication Several studies pre-treatment with analgesic medications reduces post-operative pain after RCT following tooth extraction in children Ibuprofen, paracetamol, diclofenac, tramadol paracetamol and ibuprofen for post-operative pain in children and OTC ibuprofen (4-10 mg/kg) = paracetamol (7-15 mg/kg) for moderate to severe pain

Method & Material Randomized clinical trial –split mouth IRCT2016102930553N1 The mean pain score during the first 24 h following treatment was considered the primary outcome Sample size : 49 45 (6-10 years) informed consent

The inclusion criteria were: patients aged 6-10 years old bilateral primary molar teeth with carious lesions the teeth were restorable, no tenderness to percussion and no pain except after eating no clinical and/or radiographic signs of pulp degeneration no sinus tract, no or minimal physiological resorption

Exclusion criteria were: Usage of analgesic in last 24 hours any systemic diseases that contra-indicated conservative pulp therapy (such as leukemia and some types of malignancies) radiographic findings internal resorption & widening of PDL furcation or periapical radiolucency root canal calcifications

Results

Results 49 children 45 children 17 girls and 28 boys Mean of age 6.8 year All of the patients reported post-operative pain in both groups

روز اول روز دوم روز سوم Mean of pain(placebo/ibuprofen) P value   Mean of pain(placebo/ibuprofen) P value روز اول ( 2.09±0.79/ 1.76±0.91) 0.032 روز دوم (1/24±0/061 1/07±0/72) 0.154 روز سوم (0.69±0.56 0.58±0/62) 0.197

The number of patient who had pain at different days after pulpotomy

Incidence of use of analgesia among 2 groups

Discussion

Discussion pre-treatment with ibuprofen significantly decreased post-operative pain MTA & CEM : pulp capping, perforation repair, apical plug and root- end filling & as pulpotomy agents in primary molar teeth In the present study, CEM cement was used as the pulpotomy agent

mean pain score(day 1) Placebo 2/09± 0/79 Ibuprofen 1/76±0/91

Discussion the mean pain score(day 2 and 3) in the placebo group was  higher than ibuprofen(not significant) Baygin(2011) ibuprofen-paracetamol Gazal(2007) (ibuprofen+paracetamol)-ibuprofen Primosch(1995) acetaminophen-ibuprofen- placebo

Discussion following dental extractions or GA administration of paracetamol, ibuprofen and diclofenac

Discussion ibuprofen and paracetamol had the same analgesic and antipyretic effect higher pain relief with ibuprofen when compared to paracetamol(meta-analysis) 400 mg ibuprofen provided superior analgesia over 1,000 mg paracetamol both medications have similar safety spectra

Conclusion

The amount of post-operative pain was significantly lower in patients who received ibuprofen before treatment in comparison with placebo group

If it is not contraindicated, using ibuprofen as a premedication can be useful.it can be administrated 45 min before procedure to decrease postoperative pain