Efficacy of Oral Prednisolone on Pain Reduction in Emergency Care of Acute Irreversible Pulpitis
Status:
Completed
Trial end date:
2018-12-03
Target enrollment:
Participant gender:
Summary
Irreversible pulpitis is an inflammatory condition of the dental pulp, highly painful,
representing one of the main reasons for consulting dental emergency. The recommended
emergency care is a partial endodontic treatment under local and/or locoregional anesthesia.
The purpose of the emergency partial endodontic treatment is to stop the pain of pulpitis by
removing a portion of the pulp. The final endodontic treatment is ideally performed 72 hours
after. The literature reports major difficulty in obtaining adequate anesthesia in the
mandible to perform partial endodontic treatment, especially for the mandibular molars. This
results in a very painful care for the patient. The management of this type of emergency is
costly in terms of equipment and time for health facilities. Patient comfort, cost saving and
rationalization of the care time justify the search for an alternative to emergency partial
endodontic treatment. In current practice, the short course oral corticotherapy is used in
the management of oral pain from inflammatory origin. Glucocorticoids, thanks to their
anti-inflammatory action, can neutralize the inflammatory mediators and thus pain. The pulp
inflammation can be treated with this molecule: the effectiveness of intraosseous local
steroid injection for irreversible pulpitis of mandibular molars has already been shown but
results in local comorbidities and requires specific device. Oral administration of
short-course prednisolone is simple and safe but its effectiveness to manage pain caused by
irreversible pulpitis has not yet been demonstrated. Per-os administration of prednisolone
has a very high (90%) and rapid (≤ 4 hours) bioavailability. No difference in effectiveness
between intravenous and oral administration of this molecule was reported. This oral
treatment could limit comorbidities and technical difficulties related to intraosseous
injection and could delay the endodontic treatment to 72 hours in optimal conditions of
anesthesia for the patient. Despite the difficulties described for the partial endodontic
treatment, it is very effective in pain reduction and can reach 100% of success. Therefore a
non-inferiority design was chosen to compare the effect of a short-course oral corticotherapy
to a partial endodontic treatment for the reduction of pain at the emergency care of the
irreversible pulpitis in mandibular molars. The intervention arm will receive an oral dose of
prednisolone (1 mg/kg) during the emergency visit followed-up by one morning dose by day
during three days and the reference arm will have partial endodontic treatment. Both groups
will have planned complete endodontic treatment 72 hours after enrolment.