The effect of calcium hydroxide on post-treatment pain

Wook Nam; Sang-Hyuk Park; Gi-Woon Choi

doi:10.5395/JKACD.2006.31.2.086

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Original Article The effect of calcium hydroxide on post-treatment pain: Wook Nam, Sang-Hyuk Park, Gi-Woon Choi; 2006;31(2):-95.
DOI: https://doi.org/10.5395/JKACD.2006.31.2.086
Published online: March 31, 2006

Department of Conservative Dentistry, Division of Dentistry, Graduate School, Kyunghee University, Korea.

Corresponding Author: Gi-Woon Choi. Dept. of Conservative Dentistry, Division of Dentistry, Graduate School, Kyunghee University, 1, Hoegi Dong, Dongdaemun Gu, Seoul, Korea, 130-702. Tel: 82-2-958-9336, gwchoi@khu.ac.kr

• Received: August 23, 2005 • Revised: January 6, 2006 • Accepted: January 10, 2006

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Abstract
REFERENCES

Abstract

The purpose of this clinical study is to assess whether calcium hydroxide as an intracanal medication affects post-treatment pain in teeth especially odontogenic pain which comes from inflammation of the pulp and periradicular tissues when compared with no intracanal medication.

From 213 patients who has been treated 237 root canals due to significant pain (moderate-to-severe), we recorded their age, sex, treated tooth, degree of pain, pre-operative states of the tooth. We classified patients into 2 test group; Group 1 (not gain intracanal Ca(OH)₂), Group 2 (gain intracanal Ca(OH)₂). Through the survey from the patients, we let them write down the occurrence and degree of post-treatment pain in 4hours, 2days, 7days after treatment as none, mild, moderate or severe. The followings were evaluated; the overall incidence of flare-ups, the overall incidence of post-treatment pain in each group at each time period, the incidence of post-treatment pain in each group at each time period as related to pre-operative states of the teeth. These were compared statistically with Chi-square analysis (p < 0.05).

Under the condition of this investigation, no difference was observed in the incidence of post-treatment pain between the two groups. Therefore, Ca(OH)₂ as intracanal medication had no effect on preventing or decreasing the post-treatment pain.
Keywords: Calcium hydroxide; Post-treatment pain; Intracanal medication; Inflammation; Root canal treatment; Degree of pain

Table 1

Endodontic treatment chart for surveying the post-treatment pain

^†RCT: root canal treatment

RE: re-treatment

Table 2

The incidence of flare-ups^*

^*Not statistically significant (p > 0.05).

Table 3

The incidence of post-treatment pain at different time periods

^*Statistically significant (p < 0.05).

Table 4

The incidence of post-treatment pain related to apical lesion

^*Statistically significant (p < 0.05).

Table 5

The incidence of post-treatment pain related to pus discharge

^*Statistically significant (p < 0.05).

Table 6

The incidence of post-treatment pain related to swelling

^*Statistically significant (p < 0.05).

Table 7

The incidence of post-treatment pain related to fistula

^*Statistically significant (p < 0.05).

Table 8

The incidence of post-treatment pain related to pulpal diagnosis

^*Statistically significant (p < 0.05).

REFERENCES

1. Cohen S, Burns RB. Orofacial Dental Pain Emergencies. Pathways of the pulp. 2002;8th ed. St. Louis, USA: Mosby, Inc; 31-75.
2. Fava LR. Acute apical periodontitis: incidence of post-operative pain using two different root canal dressings. Int Endod J. 1998;31(5):343-347.Article PubMed
3. Bystrom A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol. 1985;1(5):170-175.Article PubMed
4. Orstavik D, Kerekes K, Molven O. Effects of extensive apical reaming and calcium hydroxide dressing on bacterial infection during treatment of apical periodontitis: a pilot study. Int Endod J. 1991;24(1):1-7.Article PubMed
5. Orstavik D. Antibacterial properties of endodontic materials. Int Endod J. 1988;21(2):161-169.Article PubMed
6. Chong BS, Pitt Ford TR. The role of intracanal medication in root canal treatment. Int Endod J. 1992;25(2):97-106.Article PubMed
7. Siqueira JF Jr, Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: a critical rewiew. Int Endod J. 1999;32(5):361-369.PubMed
8. Safavi KE, Nichols FC. Alteration of biological properties of bacterial lipopolysaccharide by calcium hydroxide treatment. J Endod. 1994;20(3):127-129.Article PubMed
9. Hasselgren G, Olsson B, Cvek M. Effects of calcium hydroxide and sodium hypochlorite on the dissolution of necrotic porcine muscle tissue. J Endod. 1988;14(3):125-127.Article PubMed
10. Andersen M, Lund A, Andreasen JO, Andreasen FM. In vitro solubility of pulp tissue in calcium hydroxide and sodium hypochlorite. Endod Dent Traumatol. 1992;8(3):104-108.PubMed
11. Orstavik D, Haapasalo M. Disinfection by endodontic irigants and dressings of experimentally infected dentinal tubules. Endod Dent Traumatol. 1990;6(4):142-149.PubMed
12. Kontakiotis E, Nakou M, Georgopoulou M. In vitro study of the indirect action of calcium hydroxide on the anaerobic flora of the root canal. Int Endod J. 1995;28(6):285-289.Article PubMed
13. Segura JJ, Llamas R, Rubio-Manzanares AJ, Jimenez-Planas A, Guerrero JM, Calvo JR. Calcium hydroxide inhibits substrate adherence capacity of macrophages. J Endod. 1997;23(7):444-447.Article PubMed
14. Stuart KG, Miller CH, Brown CE, Newton CW. The comparative antimicrobial effect of calcium hydroxide. Oral Surg Oral Med Oral Pathol. 1991;72(1):101-104.Article PubMed
15. Abbott PV. Medicaments: Aids to success in endodontics. Part 1. A review of the literature. Aust Dent J. 1990;35(5):438-448.Article PubMed
16. Walton RE, Holton IF, Michelich R. Calcium hydroxide as an intracanal medication: Effect on posttreatment pain. J Endod. 2003;29(10):627-629.Article PubMed
17. Allard U, Strömberg U, Stromberg T. Endodontic treatment of experimentally induced apical periodontitis in dogs. Endod Dent Traumatol. 1987;3(5):240-244.Article PubMed
18. Trope M. Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol. 1990;6(5):226-229.Article PubMed
19. Abbott PV. Emergency endodontics: part two. Endod Prac. 2001;4(1):12-15.
20. Imura N, Zuolo ML. Factors associated with endodontic flare-ups: a prospective study. Int Endod J. 1995;28(5):261-265.Article PubMed
21. De Moor RJ, De Witte AM. Periapical lesions accidentally filled with calcium hydroxide. Int Endod J. 2002;35(11):946-958.Article PubMed
22. Walton R, Fouad A. Endodontic interappointment flare-ups: A prospective study of incidence and related factors. J Endod. 1992;18(4):172-177.Article PubMed
23. Torabinejad M, Kettetring JD, McGraw JC, Cummings R, Dwyer TG, Tobias TS. Factors associated with endodontic interappointment emergency of teeth with necrotic pulps. J Endod. 1988;14(5):261-266.PubMed
24. Mor C, Rotstein I, Friedman S. Incidence of interappointment emergency assoiciated with endodontic therapy. J Endod. 1992;18(10):509-511.PubMed
25. Barnett F, Tronstad L. The incidence of flare-ups following endodontic treatment. J Endod. 1989;15(4):181-182.

Tables & Figures

Table 1

Endodontic treatment chart for surveying the post-treatment pain

^†RCT: root canal treatment

RE: re-treatment

Table 2

The incidence of flare-ups^*

^*Not statistically significant (p > 0.05).

Table 3

The incidence of post-treatment pain at different time periods

^*Statistically significant (p < 0.05).

Table 4

The incidence of post-treatment pain related to apical lesion

^*Statistically significant (p < 0.05).

Table 5

The incidence of post-treatment pain related to pus discharge

^*Statistically significant (p < 0.05).

Table 6

The incidence of post-treatment pain related to swelling

^*Statistically significant (p < 0.05).

Table 7

The incidence of post-treatment pain related to fistula

^*Statistically significant (p < 0.05).

Table 8

The incidence of post-treatment pain related to pulpal diagnosis

^*Statistically significant (p < 0.05).

REFERENCES

1. Cohen S, Burns RB. Orofacial Dental Pain Emergencies. Pathways of the pulp. 2002;8th ed. St. Louis, USA: Mosby, Inc; 31-75.
2. Fava LR. Acute apical periodontitis: incidence of post-operative pain using two different root canal dressings. Int Endod J. 1998;31(5):343-347.Article PubMed
3. Bystrom A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol. 1985;1(5):170-175.Article PubMed
4. Orstavik D, Kerekes K, Molven O. Effects of extensive apical reaming and calcium hydroxide dressing on bacterial infection during treatment of apical periodontitis: a pilot study. Int Endod J. 1991;24(1):1-7.Article PubMed
5. Orstavik D. Antibacterial properties of endodontic materials. Int Endod J. 1988;21(2):161-169.Article PubMed
6. Chong BS, Pitt Ford TR. The role of intracanal medication in root canal treatment. Int Endod J. 1992;25(2):97-106.Article PubMed
7. Siqueira JF Jr, Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: a critical rewiew. Int Endod J. 1999;32(5):361-369.PubMed
8. Safavi KE, Nichols FC. Alteration of biological properties of bacterial lipopolysaccharide by calcium hydroxide treatment. J Endod. 1994;20(3):127-129.Article PubMed
9. Hasselgren G, Olsson B, Cvek M. Effects of calcium hydroxide and sodium hypochlorite on the dissolution of necrotic porcine muscle tissue. J Endod. 1988;14(3):125-127.Article PubMed
10. Andersen M, Lund A, Andreasen JO, Andreasen FM. In vitro solubility of pulp tissue in calcium hydroxide and sodium hypochlorite. Endod Dent Traumatol. 1992;8(3):104-108.PubMed
11. Orstavik D, Haapasalo M. Disinfection by endodontic irigants and dressings of experimentally infected dentinal tubules. Endod Dent Traumatol. 1990;6(4):142-149.PubMed
12. Kontakiotis E, Nakou M, Georgopoulou M. In vitro study of the indirect action of calcium hydroxide on the anaerobic flora of the root canal. Int Endod J. 1995;28(6):285-289.Article PubMed
13. Segura JJ, Llamas R, Rubio-Manzanares AJ, Jimenez-Planas A, Guerrero JM, Calvo JR. Calcium hydroxide inhibits substrate adherence capacity of macrophages. J Endod. 1997;23(7):444-447.Article PubMed
14. Stuart KG, Miller CH, Brown CE, Newton CW. The comparative antimicrobial effect of calcium hydroxide. Oral Surg Oral Med Oral Pathol. 1991;72(1):101-104.Article PubMed
15. Abbott PV. Medicaments: Aids to success in endodontics. Part 1. A review of the literature. Aust Dent J. 1990;35(5):438-448.Article PubMed
16. Walton RE, Holton IF, Michelich R. Calcium hydroxide as an intracanal medication: Effect on posttreatment pain. J Endod. 2003;29(10):627-629.Article PubMed
17. Allard U, Strömberg U, Stromberg T. Endodontic treatment of experimentally induced apical periodontitis in dogs. Endod Dent Traumatol. 1987;3(5):240-244.Article PubMed
18. Trope M. Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol. 1990;6(5):226-229.Article PubMed
19. Abbott PV. Emergency endodontics: part two. Endod Prac. 2001;4(1):12-15.
20. Imura N, Zuolo ML. Factors associated with endodontic flare-ups: a prospective study. Int Endod J. 1995;28(5):261-265.Article PubMed
21. De Moor RJ, De Witte AM. Periapical lesions accidentally filled with calcium hydroxide. Int Endod J. 2002;35(11):946-958.Article PubMed
22. Walton R, Fouad A. Endodontic interappointment flare-ups: A prospective study of incidence and related factors. J Endod. 1992;18(4):172-177.Article PubMed
23. Torabinejad M, Kettetring JD, McGraw JC, Cummings R, Dwyer TG, Tobias TS. Factors associated with endodontic interappointment emergency of teeth with necrotic pulps. J Endod. 1988;14(5):261-266.PubMed
24. Mor C, Rotstein I, Friedman S. Incidence of interappointment emergency assoiciated with endodontic therapy. J Endod. 1992;18(10):509-511.PubMed
25. Barnett F, Tronstad L. The incidence of flare-ups following endodontic treatment. J Endod. 1989;15(4):181-182.

Citations

Citations to this article as recorded by

Calcium hydroxide intracanal medication effects on pain and flare-up: a systematic review and meta-analysis
Ahmed Mohamed Ibrahim, Siza Yacoub Zakhary, Suzan Abdul Wanees Amin
Restorative Dentistry & Endodontics.2020;[Epub] CrossRef
Intra-canal medication containing silver nanoparticle versus calcium hydroxide in reducing postoperative pain: A randomized clinical trial
Fatma El Zahraa El Abbasy, Salsabyl Ibrahim, Olfat Shaker, Geraldine Ahmed
F1000Research.2018; 7: 1949. CrossRef
A Comparison of the irrigation systems in calcium hydroxide removal
Jae-Seung Eun, Se-Hee Park, Kyung-Mo Cho, Jin-Woo Kim
Journal of Korean Academy of Conservative Dentistry.2009; 34(6): 508. CrossRef

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The effect of calcium hydroxide on post-treatment pain

J Korean Acad Conserv Dent. 2006;31(2):86-95. Published online March 31, 2006

DOI: https://doi.org/10.5395/JKACD.2006.31.2.086

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The effect of calcium hydroxide on post-treatment pain

Table 1

Endodontic treatment chart for surveying the post-treatment pain

^†RCT: root canal treatment

RE: re-treatment

Table 2

The incidence of flare-ups^*

^*Not statistically significant (p > 0.05).

Table 3

The incidence of post-treatment pain at different time periods

^*Statistically significant (p < 0.05).

Table 4

The incidence of post-treatment pain related to apical lesion

^*Statistically significant (p < 0.05).

Table 5

The incidence of post-treatment pain related to pus discharge

^*Statistically significant (p < 0.05).

Table 6

The incidence of post-treatment pain related to swelling

^*Statistically significant (p < 0.05).

Table 7

The incidence of post-treatment pain related to fistula

^*Statistically significant (p < 0.05).

Table 8

The incidence of post-treatment pain related to pulpal diagnosis

^*Statistically significant (p < 0.05).

Table 1 Endodontic treatment chart for surveying the post-treatment pain

^†RCT: root canal treatment

RE: re-treatment

Table 2 The incidence of flare-ups*

^*Not statistically significant (p > 0.05).

Table 3 The incidence of post-treatment pain at different time periods

^*Statistically significant (p < 0.05).

Table 4 The incidence of post-treatment pain related to apical lesion

^*Statistically significant (p < 0.05).

Table 5 The incidence of post-treatment pain related to pus discharge

^*Statistically significant (p < 0.05).

Table 6 The incidence of post-treatment pain related to swelling

^*Statistically significant (p < 0.05).

Table 7 The incidence of post-treatment pain related to fistula

^*Statistically significant (p < 0.05).

Table 8 The incidence of post-treatment pain related to pulpal diagnosis

^*Statistically significant (p < 0.05).