Alleviation of acute dental pain from localised apical periodontitis: A prospective randomised study comparing two emergency treatment procedures

Objective To compare the outcomes of two emergency treatment procedures to alleviate pain from localised symptomatic apical periodontitis: complete chemo-mechanical disinfection (CMD) of the root canal system, or removal of necrotic tissue from the pulp chamber (RNT), that is without instrumentation of the root canals. Methods Fifty-seven consecutive patients from the emergency clinic at Malmo University met the inclusion criteria: spontaneous pain and/or pain on percussion and palpation, non-bleeding pulp in the canal orifice, pain >= 4 on a Numeric Rating Scale and >= 18 years of age. The diagnosis was symptomatic apical periodontitis, in the absence of swelling and/or fever. Pre-operative pain levels and intake of analgesics were registered. The patients were randomised to one of the two treatment groups. Three to five days post-operatively, the patients were contacted by telephone and asked to grade their current pain level and report any post-operative intake of analgesics and antibiotics. Results Of the patients treated with CMD of the root canal system, 26/30 (87%) reported satisfactory pain relief, compared with 22/27 (81%) of those treated by RNT. There was no mean difference in pain relief between the two groups (P = 0.879). Post-operatively, 37% in each group reported using analgesics and one in each group reported using antibiotics. Conclusion Three to five days after treatment, a majority (>80%) in both groups reported adequate pain relief, in some cases in combination with analgesics. Removal of necrotic and infected tissue from the pulp chamber might therefore be a cost-effective emergency treatment alternative to complete chemo-mechanical disinfection.