What is the Effect of No Endodontic Debridement on Postoperative Pain for Symptomatic Teeth with Pulpal Necrosis?

INTRODUCTION Patients without a dentist or access to care may present to emergency rooms with pain. They are often prescribed medications until they can be treated. There are no studies to show if emergency endodontic debridement is better than giving medications during this symptomatic period. The purpose of this prospective, randomized study was to compare debridement versus no debridement on postoperative pain in emergency patients with symptomatic teeth, a pulpal diagnosis of necrosis, and a periapical radiolucency. METHODS Ninety-five patients presenting with moderate to severe pain were analyzed. The patients were randomly divided into 2 groups: group 1 received anesthesia and endodontic debridement, and group 2 received anesthesia but no debridement. At the end of the appointment, all patients were given ibuprofen/acetaminophen. If needed, they could receive an escape medication. Patients received a 5-day diary to record their pain levels and medication taken. Success was defined as no or mild postoperative pain and no use of escape medication. Success data were analyzed using a logistic regression. RESULTS Both groups had a decrease in postoperative pain and medication use over the 5 days. The debridement group had a significantly higher success rate than the no debridement group. There was no significant difference between the 2 groups with respect to escape drug use. CONCLUSIONS Patients receiving debridement or no debridement had a decrease in postoperative pain over the 5 days. Debridement resulted in a statistically higher success rate, but there was no significant difference in the need for escape medication.