The effect of pretreatment submucosal injections of tramadol and dexamethasone on post-endodontic pain in mandibular molar teeth with symptomatic irreversible pulpitis: a randomized controlled clinical trial

Aim To establish the effects of submucosal single doses of two medicines on postoperative pain after root canal treatment in mandibular molar teeth with symptomatic irreversible pulpitis. Methodology In this randomized controlled, double-blind clinical trial, 90 patients with the diagnosis of symptomatic irreversible pulpitis in their mandibular first or second molars were included and randomly divided into three groups (n = 30): a control group that received normal saline and two experimental groups that received a single dose of either tramadol (100 mg 2 mL(-1)) or dexamethasone (8 mg 2 mL(-1)). After local anaesthesia and before treatment, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars, and a routine single-visit root canal treatment procedure was performed in all groups. After the root canal treatments, the patients were asked to score their pain level using the Heft-Parker visual analogue scale (0-170 mm) at 6, 12, 24, 48 and 72 h. The experimental groups were compared using one-way anova or Kruskal-Wallis H-test. The groups that were significantly different were compared pairwise using Student's t-test or the Mann-Whitney U-test. The findings were expressed as the mean +/- standard deviation or median (min-max). The categorical variables were tested using the chi-square test or Fisher's exact chi-square test, and the results were expressed as counts and percentages. Results At the 6-h and 48-h time intervals, the intensity of pain was significantly less in both the dexamethasone and tramadol groups than in the control group (P < 0.0167). At the end of 12 h, the pain level in the dexamethasone group was significantly less compared to the other groups (P < 0.0167). Conclusions Pretreatment submucosal dexamethasone and tramadol injections significantly diminished post-treatment endodontic pain of patients with symptomatic irreversible pulpitis following single-visit root canal treatment. However, dexamethasone was more effective than tramadol in pain reduction in the first 12 h.