Comparison Of Ibuprofen And Celecoxib For Controlling Post Endodontic Pain

Abubakar Sheikh1                                                            BDS, FCPS

Muhammad Atif Saleem Agwan2                               BDS, FCPS

Muhammad Amin3                                                         BDS, FCPS

Muhammad Athar Khan4                                            BDS, FCPS 

Ismail Sheikh5                                                                 BDS, FDS RCPS

Syed Imran Shah6                                                          BDS, FCPS 

OBJECTIVE: The objective of this study was to compare the efficacy of ibuprofen and celecoxib in controlling post endodontic pain.

METHODOLOGY: A Quasi Experimental study was conducted in the Operative Dentistry Department of Altamash Institute of Dental Medicine during fourteen months study period. One hundred patients who required  root canal treatment and fulfilled the criteria of the study were equally divided into two groups, A and B. Patients in group A were given Ibuprofen and those in group B were administered Celecoxib for 2 days following treatment. Patients rated their pain on a visual analog scale at initial and then 4, 8, 12, 24 and 48 hours after first visit of endodontic therapy. Data analysis was performed through SPSS version-13.0. Independent samples t-test was used with p-value <0.05 considered as significant.

RESULTS: There was no statistically significant difference in post endodontic pain between the groups of patients taking Ibuprofen and Celecoxib. (p value: Pre-op 0.54, 4 hrs 0.62, 8 hrs 0.86, 12 hrs 0.57, 24 hrs 0.61, 48 hrs 0.09)

CONCLUSIONS: Ibuprofen and Celecoxib have similar efficacy in controlling post endodontic pain.

KEY WORDS: Ibuprofen, Celecoxib, Postoperative pain, Visual Analogue Scale.

HOW TO CITE: Sheikh A, Agwan MAS, Amin M, Khan MA, Sheikh I, Shah SI. Comparison of Ibuprofen And

Celecoxib For Controlling Post Endodontic Pain. J Pak Dent Assoc 2014; 23(3):106-111

INTRODUCTION

Root Canal Treatment is generally considered to be a painful process1, but with proper techniques and strategies pain can be managed effectively. Optimal pain management includes both pharmacological and non-pharmacological treatment strategies2. Pain management strategies start from preoperative pain control which includes accurate diagnosis and anxiety reduction followed by intra-operative pain control which can be covered by effective local anesthetic and operative techniques. Finally postoperatively pain can be managed by different pharmacologic agents2.

Both pulpotomy and pulpectomy can relieve or reduce patient’s pain regardless of whether any medication is prescribed. They reduce tissue levels of inflammatory mediators and the elevated interstitial tissue pressure that stimulate peripheral terminals of nociceptors3. Clinical trials often demonstrate a significant and substantial

reduction in pain by 24 hours to 36 hours after pulpectomy4. Postoperative pain following root canal treatment can occur in the range of 16 to 48.5 per cent of cases, and these symptoms can last for several hours and even up to several days (23)5. Earlier studies conducted on postoperative endodontic pain have also shown that there can be moderate to severe pain varying from 15% to 25% (24, 25)6,7.

Ibuprofen and other nonselective NSAIDs inhibit both cytoprotective COX-1 enzymes and inflammatory COX2 enzymes. Consequently, the use of these agents is associated with possible damage of the gastrointestinal tract causing gastric erosions, ulcers and bleeding. Studies exhibit that COX-2-selective inhibitors are almost equally effective in controlling pain compared to NSAIDs with the additional benefit of having decreased side effects such as GI ulceration, inhibition of platelet aggregation, or increased bleeding time. Therefore, COX-2-selective inhibitors can be recommended for controlling post endodontic pain8.

Selective COX-2 inhibitors have been tested in some studies previously. In one study Celecoxib was found to have a slower onset of action when compared to ibuprofen7. Barden et al. found that a single dose of oral celecoxib, 200 mg, is quite effective for controlling postoperative pain and its efficacy is equivalent to aspirin 600-650 mg and paracetamol 1000mg9. In a study by Malmstrom et al., rofecoxib and celecoxib were compared to ibuprofen in patients who had undergone  third molar extraction. They concluded that pain control of rofecoxib was equivalent to ibuprofen, but celecoxib showed decreased analgesic efficacy compared to both the drugs10.

Few clinical trials have been carried in dentistry to compare nonselective NSAIDs with COX-2 inhibitors. At the national level, there is hardly any such clinical trial especially in dentistry. This study was conducted with the purpose of providing dental practitioners with an option of prescribing a drug with reduced adverse effects for the management of post endodontic pain. The objective of this study was to compare the efficacy of ibuprofen and celecoxib in controlling post endodontic pain using VAS (Visual Analogue Scale).

METHODOLOGY

A quasi experimental study was conducted in the operative dentistry department, Altamash Institute of Dental Medicine, Karachi. One hundred patients requiring endodontic treatment and meeting inclusion and exclusion criteria were included in the study.

The inclusion and exclusion criteria were following:

INCLUSION CRITERIA

  1. Patients requiring root canal treatment for pain of endodontic origin.
  2. Patient reports spontaneous pain of at least 3 (0-10) in the visual analogue scale.
  3. Patient reads and understands questionnaires.
  4. Patient provides informed consent.

EXCLUSION CRITERIA

  1. Younger than 15 years or older than 65 years.
  2. Analgesic intake within last 12 h.
  3. History of allergy to NSAIDs or local anesthetics. 4. History of gastrointestinal disorders, active asthma, decreased renal function, decreased hepatic function, hemorrhagic disorders, or poorly controlled diabetes mellitus.
  4. Current use of drugs contraindicated with NSAIDs.
  5. Pregnant or nursing.

Informed consent was taken from the included patients. Purpose and procedure, risks and benefits were explained to the patient. The clinical examination included a percussion test, a cold test, periodontal probing, mobility assessment and palpation. Provisional pulpal and periradicular diagnosis were determined after clinical and radiographic examination. Pulpal diagnosis was either Irreversible pulpitis or Necrosis. Periradicular diagnosis was made as Normal, Acute periradicular periodontitis, Chronic periradicular periodontitis and Acute alveolar abscess.

The included patients were allocated into two groups by using convenience sampling. Patients in Group A(N=50) were administered ibuprofen (Brufen 400mg t.d.s) and those in Group B(N=50)  were administered celecoxib (Celbex 200mg b.i.d) for two days. Pain intensity was measured using a visual analogue scale before treatment and at 4, 8, 12, 24 and 48 hours after only the canal preparation visit on a proforma. First dose of the drug was administered before root canal preparation visit; remaining medication and pain proforma were explained to the patient and given along. They were asked to record their pre and post treatment pain on the proforma. The proforma containing VAS scores was collected from patients at the second visit when the canals were obturated.

Root canal treatment was performed in two visits. During first visit, local anaesthetic was administered; tooth was isolated under rubber dam and access obtained. Cleaning and shaping was done in the following manner: The canals were negotiated with k files #10, #15, #20 and till file #25 reaching 0.5-1.0 mm of estimated working length, which was determined radiographically. Gates Glidden burs #2-4 were used for coronal flaring. Sodium


  1. Assistant Professor Operative Dentistry Fatima Jinnah Dental College.
  2. Assistant Professor Operative Dentistry Karachi Medical and Dental College & Abbassi Shaheed Hospital.      < dratifagwan@yahoo.com >
  3. Assistant Professor & Consultant, Department of Operative Dentistry, Dental section, Dow International Medical College; DUHS, Karachi.
  4. Research Unit, Department of Medical Education King Saud bin Abdulaziz University Riyadh, Kingdom of Saudi Arabia.< matharm@yahoo.com >
  5. Professor, Department of Operative Dentistry, Altamash Institute of Dental Medicine, Karachi.
  6. Assistant Professor, Department of Operative Dentistry Women Medical College, Abbotabad.< Imranshah_78@hotmail.com >

Corresponding author: “Dr Abubakar Sheikh ” < dr_abubakar@hotmail.com >