Clinical strategies for managing endodontic pain

Although many clinicians focus on drugs for pain management, this is only one aspect of the clinician’s armamentarium for managing endodontic pain. Numerous studies indicate that various clinical treatments provide substantial benefit for relief of odontogenic pain. These clinical treatment options include pulpotomy, pulpectomy, incision and drainage, trephination, and occlusal adjustment for specific situations. Anxiety reduction is another important factor in reducing intraoperative and postoperative pain (1). Most often the decision, concerning how best to relieve pain, is made empirically based on a clinician’s experience. Attributing success or failure to a particular clinical technique or procedure is often problematic. It is not unusual for clinicians to review cases seemingly similar in nature that respond differently to the same clinical approach. In contrast, similar cases may respond well to different clinical approaches. What may seem to be a direct cause and effect clinical relationship may actually be a result of a variety of independent and dependent variables that were not recognized or recognized, but not fully appreciated. This article will review procedures used to treat endodontic emergencies in the context of relevant controlled clinical trials and their underlying biological principles.