Endodontic Pharmacotherapeutics

Abstract

Managing dental pain of endodontic origin is complicated by the multiple bio-logical mechanisms that contribute to several distinct painful clinical entities including dentinal hypersensitivity, pulpitis pain, periapical pain, postoperative pain, and persistent posttreatment pain. In general pain of endodontic origin is best managed by initiating endodontic treatment, during which time the source of inflammation is mostly removed. In order to successfully perform endodontic treatment, the affected pulpal tissues and adjacent periodontal tissues must be completely anesthetized using local anesthetics. This is complicated by the fact that inflammation reduces the efficacy of local anesthetics. Strategies for obtain-ing successful pulpal anesthesia so that endodontic treatment can be adminis-tered with minimal or no discomfort to the patient are discussed. Postoperative endodontic pain is common and can be severe, and clinicians need to utilize anti-inflammatory analgesics to manage their patient's symptoms. Occasionally antibiotics are required to manage a spreading infection. In summary, successful endodontic treatment requires the wise use of pharmacotherapeutics before, dur-ing, and after clinical treatment. This chapter provides a review of the evidence and practical guidance for the use of pharmacotherapeutics with the overall goal to improve the prognosis of eliminating endodontic pain for our patients.