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BACKGROUND AND OBJECTIVES: Pain is the primary reason dental patients seek endodontic therapy. Post-treatment endodontic discomfort is a sequelae of periapical inflammation and anti-inflammatory drugs such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) would be reasonable therapy options. The purpose of this study was to compare and assess the efficacy of intramuscular injections of dexamethasone and ketorolac tromethamine versus placebo in reducing post-treatment endodontic pain in individuals undergoing root canal treatment. METHODOLOGY: Patients diagnosed with symptomatic irreversible pulpitis were selected. Nonsurgical endodontic therapy was carried out in a single visit. After completion of the root canal therapy, the patients were randomly assigned to one of the three groups for intramuscular drug administration. In group 1, 2 ml of sterile saline was administered, in group 2, 1 ml of 4 mg dexamethasone was administered; and in group 3, 1 ml of 30 mg ketorolac tromethamine was administered. Preoperative and postoperative pain intensity was measured by a verbal rating scale. Postoperatively, the incidence and severity of pain were recorded after four, 24, and 48 hours. RESULTS: All three groups showed a highly statistically significant reduction in pain scores when compared to preoperative levels. At the end of four hours, dexamethasone and ketorolac tromethamine showed highly significant results. Dexamethasone significantly reduced pain after 24 hours when compared to ketorolac and placebo groups. At the conclusion of 48 hours, all three groups experienced a gradual decrease in pain levels. CONCLUSION: Effective and complete debridement of infected root canal system provides predictable gradual reduction of post-endodontic pain.
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Background and objective Endodontic files, as supplied by the manufacturers to the endodontists, are not pre-sterile routinely. For both new and used equipment, rotary as well as manual, autoclaving is the standard sterilization protocol used in clinical and academic practice. In dentistry, instrument sterilization aims to safeguard patients from cross-contamination through instruments. Hence, every device should be thoroughly cleaned and sterilized. In this study, we aimed to evaluate the presence of various microorganisms in sealed and unsealed stored packs in dental offices and the probable impact of pre-sterilization procedures on the survival of these microorganisms. Materials and methods Two groups of root canal files varying in their packing method, boxes (Mani stainless steel K-files, ISO 25, length 25 mm) and blister packs (UGD, ISO 25, length 25 mm), pre-sterile, opened/unopened were chosen and stored for about two weeks in the dental office and were classified into three groups based on their storage and further classified into subgroups depending on their packing modes as follows: Group-1 (unopened and stored in shelf for two weeks), Subgroup-1A (boxes), Subgroup-1B (blister packs); Group-2 (unopened and stored on the countertop for two weeks), Subgroup-2A (boxes), Subgroup-2B (blister packs); Group-3 (opened and stored on the countertop for two weeks). After two weeks of storage, a set of three new files from each pack, both boxes and blisters, were placed in the nutrient broth to assess the turbidity and later cultured to assess the presence/absence and type of any bacterial growth. All the instruments in the three groups and subgroups were placed separately in the nutrient broth and carried to the microbiology lab for bacterial cultures. The entire procedure was carried out under the laminar flow. All these files in the nutrient broth were incubated for about 72 hours and the turbidity was assessed, and then the turbid bacteria were cultured on blood agar and MacConkey agar plates for the presence/absence and the type of bacteria in each group and subgroups. Results All specimens, both opened/unopened boxes and blister packs, after about two weeks of storage, were cultured and observed for contamination. All the tested files groups showed bacterial culture growth both on blood agar and MacConkey agar plates. Group-1 (Subgroups 1A, 1B) boxes and blister packs unopened and stored on the shelf for two weeks demonstrated aerobic spore bacilli; Group-2 (Subgroups 2A, 2B) boxes and blister packs unopened and stored on the countertop for two weeks demonstrated Gram-positive bacilli; Group-3 opened boxes and blisters stored on the countertop for two weeks demonstrated Micrococci and Gram-negative bacilli. Conclusion In the present study, all the packs, blisters and boxes, demonstrated the presence of bacterial growth irrespective of their storage in the dental office. Hence, in order to prevent any new infections from the operating field, sterilization of not only the old files but also the pre-sterilization of new files should be made mandatory.
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Aim The aim of this study was to evaluate and compare the antimicrobial activity of 2% chlorhexidine gluconate (2% CHX), Morinda citrifolia (M. citrifolia), and nisin (NI) all in gel forms against Enterococcus faecalis (E. faecalis)-infected root canals. Methodology Forty single-rooted mandibular premolars extracted for orthodontic reasons were decoronated and chemomechanical preparation of the root canal was performed. After sterilization, the samples were inoculated with E. faecalis for one week and grouped according to the medicament used namely, saline as the control group (Group-A), 2% CHX (Group-B), M. citrifolia (Group-C), and NI (Group-D). After 7days of incubation, in order to evaluate the effectiveness of the intracanal medicaments on the canal wall and its radicular dentin, the specimens dentin chips were retrieved and inoculated on brain heart infusion (BHI) blood agar plates from each tube and incubated at 37°C for 24 hours to obtain bacterial colony forming unit (CFU) count. The data was statistically analyzed using one-way ANOVA test and multiple comparisons among different groups were complemented by post hoc Tukey test. Results The CFU count indicating the number of viable bacterial colonies was found to be highest in Group-A (saline). Group-B (CHX 2%) showed the least CFUs followed by Group-D (NI) and Group-C (M. citrifolia). Conclusion In an attempt to overcome the disadvantages and toxic effects of a few commercially available intracanal medicaments and irrigants, the present study was aimed at using herbal extracts to evaluate and compare their antimicrobial efficacy with the commercially available medicaments against E. faecalis. Nisin was an effective antimicrobial agent and its action was found to be comparable with CHX.
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With the growing demand for minimally invasive dental restoration, conservative treatment options offer good aesthetic outcomes and durability with minimal tooth reduction. The use of ceramics in dental restoration has been on the rise in the past two decades due to its long-term benefits and capacity to produce a superior bond to tooth structure when used in conjunction with adhesive cement and acid-etch procedures. A ceramic onlay, which covers one or more cusps, also helps to preserve dental tissue. These materials enable the dentist to conservatively prepare the tooth for restoration while also strengthening the patient's own tooth structure. This case report discusses the preparation of a functional and aesthetic ceramic onlay for a patient with a cracked tooth.
