Endodontic Pharmacology

 The most common problems seen in patients with endodontic

problems are pain and periapical infection

 Presence of preoperative pain or mechanical allodynia is the

most consistent factor that predicts post endodontic pain

 Sometimes, pain control becomes difficult in endodontics and

use of analgesics and antibiotics become essential to provide
pain free procedures
Pain control
 Correct diagnosis of etiological factors of pain and proper treatment of
the problem leads to lesser incidences of pain

 Drugs are to be used only as an adjunct to the dental treatment

 Pain control can be achieved through:

Local anaesthesia
Analgesics
NSAIDs
Opiods
Pain Control

Considerations for Effective Pain Control

 1. Diagnosis

 2. Definitive dental treatment

 3. Drugs
Pain Control

Pretreat with NSAIDs or acetaminophen when appropriate

Use long-acting local anaesthetics when indicated

Use a flexible prescription plan

Prescribe “by the clock” rather than as needed

Local anaesthetic agents

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Local anaesthesia

 Adequate pulpal anaesthesia is necessary for treatment of pulpally

involved tooth

 Occasionally, achieving profound pulpal anaesthesia by traditional

methods does not happen - most commonly seen in mandibular
teeth

 Intra pulpal injection helps to achieve anaesthesia in these

conditions
 Intrapulpal Injection

 Intrapulpal injection should be given only after all other supplemental

techniques have failed

 This technique achieves pain control by application of pressure and

utilizing the pharmacologic action of the local anaesthetic agent

 Indication: Tooth with lack of profound anaesthesia

 Nerves anesthetised: Terminal nerve endings at site of injection

Technique

 Inform the patient that he/she will experience a brief period of

mild to moderate pain during/after the injection

 Insert a 25/27 gauge needle firmly into the pulp chamber

 Deposit the anaesthetic agent under pressure as back pressure is

shown to be a major factor in producing anaesthesia

 Deposit 0.2-0.3ml of anaesthetic agent under pressure

 Bending of the needle also helps to deposit the local

anaesthetic agent under pressure.
Advantages
 Requires less volume (0.2-0.3ml)
 Early onset

Disadvantages
 Possible duration of pulpal anaesthesia - 15 to 20 minutes
 Only supplemental to traditional techniques
 Brief period of pain during or after insertion of solution
 Results are not predictable and it may vary
Recent advances in Local anaesthesia
 These methods of administering local anaesthesia more comfortable
and less traumatic to the patient

WAND system of local anaesthesia

Comfort control syringe

Transcutaneous Electrical Nerve Stimulation local anaesthesia

(TENS)

Electronic Dental anaesthesia (EDA)

Needleless syringes
Analgesics

 NSAIDs

 Opioid analgesics
Analgesics
Analgesics in Endodontics

}
 Acetaminophen
 Aspirin
NSAIDs
 Ibuprofen
 Ketorolac

}
 Morphine
 Codeine Opiods
 Tramadol
 Choice of NSAIDs
 Mild-to-Moderate pain with a little inflammation—Paracetamol or
low dose ibuprofen

 Patients with a history of asthma - Paracetamol

 Gastric intolerance – Paracetamol

 Pregnancy - Paracetamol

 Short lasting painful condition with minimal inflammation—

Ketorolac, Ibuprofen

 Pre-existing medical condition – Consult physician and consider

drug interactions
Principles for prescribing antibiotics

 Consider the risk/benefit equation

 Use only when indicated

 Choose the narrowest spectrum that will be effective

 Prescribe an adequate dose for the required duration

Antibiotics

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Antibiotics in Endodontics

 Penicillins

 Clindamycin

 Tetracyclines

 Macrolides

 Metronidazole
Antibiotics in Endodontics

 Conditions requiring antibiotics

 Systemic involvement with symptoms like fever, malaise and

lymphadenopathy

 Presence of persistent infections

 Indications of progressive infection like increasing swelling,

cellulitis or osteomyelitis
 Conditions not requiring antibiotics

 Localized fluctuant swelling

 Chronic apical abscess

 Teeth with sinus tract

 Teeth with necrotic pulp

 Irreversible pulpitis without signs and symptoms of infection

 Apical periodontitis without signs and symptoms of infection

AAE Recommendations – Antibiotic prophylaxis

Regimen:
Single dose
30 – 60
minutes
before
procedure

Cephalosporins are not to be prescribed to

patients with a history of allergy to penicillin
References

 Textbook of Endodontics, 3rd Ed – Nisha Garg

 Textbook of Endodontics, 4th Ed – Nisha Garg
 Essay:
 Antibiotics and analgesics in Endodontics
 Pain control in Endodontics
 Endodontic pharmacology

 Short notes:
 Anaesthetic Techniques in Endodontics – FEB 2019
 Antibiotics in Endodontics
 Analgesics in Endodontics
 Effective pain control in Endodontics
 Antibiotic prophylaxis
 Intrapulpal anaesthesia