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Sodium Hypochlorite Concentration and Postendodontic Pain - Unveiling the Optimal Balance: A Systematic Review and
Niharika Prasad1, Parul Dasson Bajaj2, Ramya Shenoy2
1Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Journal of Endodontics
|June 16, 2024
Summary
Lower concentrations of sodium hypochlorite (NaOCl) during root canal treatment (RCT) significantly reduce postendodontic pain (PEP) and the need for rescue analgesia. This finding suggests a potential improvement in patient comfort following dental procedures.
Area of Science:
- Endodontics
- Dental Pharmacology
Background:
- Postendodontic pain (PEP) and analgesic requirements are common concerns following root canal treatment (RCT).
- Sodium hypochlorite (NaOCl) is a widely used irrigant in RCT, with varying concentrations employed.
- The impact of NaOCl concentration on PEP and analgesic use warrants systematic investigation.
Purpose of the Study:
- To systematically review the literature on the effect of different sodium hypochlorite (NaOCl) concentrations during root canal treatment (RCT) on postendodontic pain (PEP).
- To evaluate the influence of NaOCl concentration on the need for rescue analgesia following RCT.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Scopus, Web of Science, Embase), with PROSPERO registration.
- Included were randomized controlled trials assessing PEP at various intervals post-RCT.
- Meta-analyses were performed to evaluate PEP and analgesic intake, with evidence certainty assessed using GRADE.
Main Results:
- Five randomized controlled trials involving 674 patients were analyzed.
- Lower NaOCl concentrations (≤3%) were associated with significantly reduced likelihood of PEP at 24 and 48 hours compared to higher concentrations (≥5%).
- Patients receiving lower NaOCl concentrations reported significantly less moderate-to-severe PEP and required less analgesia.
Conclusions:
- Low certainty evidence suggests lower NaOCl concentrations may decrease PEP during RCT.
- Moderate certainty evidence indicates reduced analgesic requirements with lower NaOCl concentrations.
- Findings suggest cautious interpretation due to the certainty of the evidence.
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