Medicamentos de elección para el tratamiento del dolor agudo en endodoncia: Actualización de revisión de literatura

Abstract

Background: Pain is an "unpleasant sensory and emotional experience associated with actual or potential tissue damage" (WHO, Gehbart 2000). Pain occurs in approximately 90% to 97% of cases in patients with pulpal pathology, the most frequent diagnosis being pulpitis, which accounts for 40% of cases. The treatment of endodontic pain can be local or systemic through the use of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, opioids and paracetamol. Objective: To provide updated information on the most effective pharmacological therapies in the management of acute endodontic pain such as symptomatic irreversible pulpitis and symptomatic apical periodontitis. Methods: A bibliographic search was carried out in Pubmed, Lilacs, Cochrane and Embase databases from 2010 to 2022, in English and Spanish, based on inclusion and exclusion criteria. The recommendations of the 2019 PRISMA guidelines were followed. 3 authors evaluated the identified records, if there are doubts, the decision was made by consensus. The assessment of methodological quality used the Prisma, Consort, Strobe guidelines. The risk of bias analysis used the Cochrane tool (RoB2) and NewCastle-Otawa Scale. Results: Thirty-six articles evaluating the efficacy of drugs for the management of acute pain in endodontics were selected in the present review. Of these, 7 were systematic reviews, 26 randomized clinical trials and 3 cross-sectional studies in which corticosteroids were observed to be drugs with anti-inflammatory property. NSAIDs have a significant effect in decreasing pre- and post-endodontic pain and the option of multimodal therapy should be considered for the treatment of moderate to severe pain. Conclusions: The findings of this review report that the recommended pharmacologic therapy for acute pain management in endodontics is the ibuprofen/paracetamol combination recognized as the "Gold standard".