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Effectiveness of various medications on postoperative pain following complete instrumentation

  • Author Footnotes
    1 Dr. Torabinejad is professor and director of the graduate program. Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA.
    Mahmoud Torabinejad
    Correspondence
    Address requests for reprints to Dr. Mahmoud Torabinejad, Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA 92350.
    Footnotes
    1 Dr. Torabinejad is professor and director of the graduate program. Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA.
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  • Author Footnotes
    2 Dr. Cymerman is in private practice, Lake Grove, NY.
    Jerome J. Cymerman
    Footnotes
    2 Dr. Cymerman is in private practice, Lake Grove, NY.
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  • Author Footnotes
    3 Dr. Frankson is a member of the Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA.
    M. Frankson
    Footnotes
    3 Dr. Frankson is a member of the Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA.
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  • Author Footnotes
    4 Dr. Lemon is chairman, Department of Endodontics, School of Dentistry, Louisiana State University, New Orleans, LA.
    Ronald R. Lemon
    Footnotes
    4 Dr. Lemon is chairman, Department of Endodontics, School of Dentistry, Louisiana State University, New Orleans, LA.
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  • Author Footnotes
    5 Dr. Maggio is in private practice, Oak Brook, IL.
    Joseph D. Maggio
    Footnotes
    5 Dr. Maggio is in private practice, Oak Brook, IL.
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  • Author Footnotes
    6 Dr Schider is professor and chairman, Department of Endodontics, Goldman School of Graduate Dentistry, Boston, MA.
    Herbert Schilder
    Footnotes
    6 Dr Schider is professor and chairman, Department of Endodontics, Goldman School of Graduate Dentistry, Boston, MA.
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  • Author Footnotes
    1 Dr. Torabinejad is professor and director of the graduate program. Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA.
    2 Dr. Cymerman is in private practice, Lake Grove, NY.
    3 Dr. Frankson is a member of the Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA.
    4 Dr. Lemon is chairman, Department of Endodontics, School of Dentistry, Louisiana State University, New Orleans, LA.
    5 Dr. Maggio is in private practice, Oak Brook, IL.
    6 Dr Schider is professor and chairman, Department of Endodontics, Goldman School of Graduate Dentistry, Boston, MA.
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      The root canals of 588 consecutive nonsurgical patients with varying levels of pain were completely instrumented in 10 endodontic practices and 4 endodontic graduate programs. The participants were sequentially assigned to one of nine medications and a placebo. The severity of pain was assessed by the visual analog scale for 72 h following instrumentation.
      Among all of the parameters studied, three factors (preoperative pain, apprehension, and types of medication) were found to be significant in determining postinstrumentation pain.
      An association was found between the intensity of pre- and postoperative pain. As the intensity of preoperative pain increased, the chances for more severe postoperative pain increased (p < 0.0001). In addition, an association between the presence of apprehension before any treatment and postoperative pain was also noted (between 0.012 < p < 0.047).
      Examination of the time-effect curves for various medications in patients with no or mild pain showed no statistical significant difference between the effectiveness of different medications and placebo. However, a multiple comparison of the effectiveness of various medications and placebo on patients in moderate and severe preoperative pain showed that ibuprofen, ketoprofen, erythromycin base, penicillin, and methylprednisolone plus penicillin were more effective than placebo within the first 48 h following complete instrumentation.
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