Flare-ups in endodontics: II (Therapeutic measures)

By Seltzer S, Naidorf IJ

Date: 01/2004
Journal: JOE


Various treatment regimens for the relief of pain during endodontic therapy


Relief of Occlusion – Conflicting results on the effect of reducing occlusion on post-operative pain.

Premedication of chamber/canals – No difference noted in post-op pain in teeth with pre-medicated chamber or canals.

Establishment of Drainage – In the presence of suppuration, drainage of exudate is the most effective method of reducing pain and swelling. Leaving a tooth open following drainage increases possibility of future flare ups.

Intracanal Medicaments –

Antimicrobial agents – No relationship found between inter-appointment pain and medication use.

Irrigating solutions – Difficult to attribute a lower pain incidence specifically to the use of any particular irrigant.

Corticosteroids – Reduce pain but can interfere with phagocytosis. – can cause increase in infections.

Systemic Drugs –

Antibiotics – Only should be used in cases where systemic involvement is noted.

Corticosteroids – Significantly reduces post-operative pain

Tryptophan – reported that 3mg of tryptophan given daily produced a reduction in post operative pain.


Narcotics & NSAIDs.


Placebos are 10 times more effective in relieving pain of pathological origin than they are in relieving contrived pain – related to anxiety during pain.

Clinical Significance:

Many treatment options are available for management of flare-ups