Emergency Pain Management of Untreated Pulpitis during COVID-19 Lockdown by Telephonic Communication

Abstract

To evaluate the beneficial effects of orally administered corticosteroids in alleviating the pain of symptomatic pulpitis. Materials and Methods: Out of the 87 patients who contacted the expert panel telephonically during the period of COVID-19 lockdown, 55 patients complaining of moderate to severe dental pain were included in the study and thus advised to take oral tablets of paracetamol 650 mg postmeal thrice a day for 3–5 days along with a single oral dose of 4 mg of dexamethasone. The patients were asked to report their pain status after every 24 hours for at least 72 hours. In case of severe pain not controlled by these medicines even after 3 days, two tablets of dispersible ketorolac tromethamine (10 mg) were advised once on the fourth day, followed by a single tablet three times a day for another 3 days. In case the pain did not subside within 3 days of taking the second line of treatment, or there was a development of swelling/lymphadenopathy, the patient was advised to get the tooth extracted. Results: Out of 55 patients taking a single dose of dexamethasone, 47 (85.45%) patients reported a “significant” reduction of pain within 24–72 hours. The remaining eight patients (14.55%) in which severe pain was not controlled by paracetamol and dexamethasone even after 3 days, two tablets of ketorolac tromethamine (10 mg) were advised. Six patients (75%) reported a “significant” reduction in the pain, while two (25%) patients still in pain were advised tooth extraction and were referred to the emergency department of the tertiary care center. Conclusion: For the pain felt by patients diagnosed with symptomatic irreversible pulpitis, systemic corticosteroids administration is an adequate strategy in controlling pain for up to 48–72 hours, the time during which the pain is felt most.