GRADUATE ENDODONTOLOGY
CLASSIC LITERATURE REVIEW SEMINAR
ANALGESICS: NARCOTICS, NSAIDS, STEROIDS
WINTER 2007

GENERAL OBJECTIVE:  The purpose of these seminars is to review in depth analgesics as they relate to the specialty of Endodontics.

SPECIFIC OBJECTIVES:  Upon completion of this section of literature the endodontic gaduate student must be able to: (With appropriate citation of the literature)

• Describe the mechanism of action of the non-steroidal anti-inflammatory drugs.
• Describe the mechanism of action of the narcotic analgesics.
• Describe the anti-inflammatory mechanism of action of corticosteroids.
• Describe the indications and contra-indications of the various analgesic agents.
• List the indicated effective doses for the analgesic agents.
• List the side effects for the various analgesic agents.

Text: Ingle’s Endodontics  eds: Ingle J, Bakland L, Baumgartner JC.  BC Decker,
Hamilton, Ont, Canada. 2008; pp 721-727        

Dionne RA, Wirdzek PR, Fox PC, Dubner R.  Suppression of postoperative pain
by the combination of a nonsteroidal anti-inflammatory drug, flurbiprofen, and a
long-acting local anesthetic, etidocaine.  J Am Dent Assoc. 1984;108:598-601

Flath RK, Hicks ML, Dionne RA, Pelleu GB.  Pain suppression after pulpectomy
with preoperative flurbiprofen.  J Endodon 1987;13:339-347

Troullos ES, Hargreaves KM, Butler DP, Dionne RA.  Comparison of nonsteroidal
anti-inflammatory drugs, ibuprofen and flurbiprofen, with methylprednisolone and
placebo for acute pain, swelling, and trismus. J Oral Maxillofac Surg
1990;48:945-52

Liesinger, A, Marshall, FJ, Marshall JG.  Effect of variable doses of
dexamethasone on posttreatment  endodontic pain.  J Endodon 1993;19:35-39

Curtis PC, Gartman LA, Green DB. Utilization of ketorolac tromethamine for
control of severe odontogenic pain. J Endodon 1994;20:457-9

Uhle RA, Reader A, Nist R, Weaver J, Beck M, Meyers WJ.  Peripheral Opioid
analgesia in teeth with symptomatic inflamed pulps.  Anesth Prog 1997;44:90-95

Doroschak AM, Bowles WR, Hargreaves KM.  Evaluation of the combination of
flurbiprofen and tramadol for management of endodontic pain.  J Endodon
1999;25:660-663

Hargreaves KM, Keiser K.  Development of new pain management strategies.  J
Dent Ed 2002;66:113-121

Holstein A, Hargreaves KM, Niederman R.  Evaluation of NSAIDs for
treating post-endodontic pain Endo Topics 2002;3:3-13

Marshall JG.  Considerations of steroid for endodontic pain.  Endo Topics
2002;3:41-52

Gopikrishna V, Parameswaran A.  Effectiveness of prophylactic use of rofecoxib
in comparison with ibuprofen on postendodontic pain.  J Endod 2003;62-64

Nekoofar MH, Sadeghipanah M, Dehpour AR.  Evaluation of meloxicam (a cox-2
inhibitor) for management of postoperative endodontic pain: a double-blind
placebo-controlled study.  J Endod 2003;634-637

Savage MG, Henry MA.  Preoperative nonsteroidal anti-inflammatory
agents: review of the literature.  Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2004;98:146-52

Dionne RA, Hayes D, Brahim JS, Rowan JS, Guivarc’h P.  Analgesic effect of
sustained-release flurbiprofen administered at the site of tissue injury in the oral
surgery model.  J Clin Pharmacol 2004;1418-1424

Mudie AS, Holland GR.  Local opioids in the inflamed dental pulp.  J Endodon
2006;32:319-323

Litkowski LJ, Christensen SE, Adamson DN, Van Dyke T, Han SH, Newman KB. 
Analgesic efficacy and tolerability of oxycodone 5 mg/ibuprofen 400 mg
compared with those of oxycodone 5 mg/acetaminophen 325 mg and
hydrocodone 7.5 mg/acetaminophen  500 mg in patients with moderate to severe
postoperative pain: A randomized. Double-blind, placebo-controlled, single-
dose, parallel-group study in a dental pain model.  Clin Therap 2005;27:418-429

Lin S, Levin L, Emdi o, El-Naaj IA, Peled M.  Etodolac versus dexamethasone
effect in reduction of postoperative symptoms following surgical endodontic
treatment: A double-blind study.  Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2006;101:814-817

Srisawasdi S, Pavasant P.  Different roles of dexamethasone on transforming
growth factor-B1-induced fibronectin and nerve growth factor expression in
dental pulp cells.  J Endodon 2007;33:10057-1060

Benedetti F. Mechanisms of placebo and placebo-related effects across
diseases and treatments.  Annu Rev Pharmacol Toxicol 2008;48:33-60

Dionne RA, Campbell RA, Cooper SA, Hall DL, Buckingham B.  Suppression of postoperative pain by preoperative administration of ibuprofen in comparison to placebo, acetominophen , and acetominophen plus codeine. J Clin Pharmacol.1983;23:37-43

Mardirossian G, Cooper SA. Comparison of the analgesic efficacy of flurbiprofen and aspirin for postsurgical dental pain.  J Oral Maxillofac Surg 1985;43:106-9

Krasner P, Jackson E.  Management of posttreatment endodontic pain with oral dexamethasone:A double-blind study. Oral Surg  1986;62:187-90

Goldstein IM. Agents that interfere with arachidonic acid metabolism. Inflammation:Basic Principles and Clinical Correlates  Ed. Gailin JI, Goldstein IM, Snyderman R. Raven Press, New York 1988 pp 935-42

Glassman G, Krasner P, Morse DR, Rankow H, Lang H, Furst ML.  A     prospective randomized double-blind trial on efficacy of dexamethasone for endodontic interappointment pain in teeth with asymptomatic inflamed pulps.  Oral Surg. 1989;67:96-100

Frame JW, Evans CRH, Flaum GR, Langford R, Rout PGJ. A comparison of ibuprofen and dihydrocodeine in relieving pain following wisdom teeth removal. Br Dent J 1989;66:121-4

Patten JR, Patten J, Hutchins MO. Adjunct use of dexamethasone in postoperative dental pain control. Compend Contin Educ Dent 1992;13:580-9

Saxen MA. The clinical pharmacology of ketorolac. Compend Contin Educ Dent 1992:13:504-9

Fusco BM, Giacovazzo M.  Peppers and pain: the promise of capsaicin. Drugs     1997;53:909-914

Marshall JG, Walton RE.  The effect of intramuscular injection of steroid on posttreatment endodontic pain.  J Endodon  1984;10:584-8

Di Rosa M, Calignano A, Carnuccio R, Ialenti A, Sautebin L. Multiple control of inflammation by glucocorticoids.  Agents Actions 1985;17:284-9

Hargreaves KM, Schmidt EA, Mueller GP, Dionne RA.  Dexamethasone alters plasma levels of beta-methasone and postoperative pain. Clin Pharmacol Ther 1987;42:601-7

Hargreaves KM, Costello A. Glucocortocoids suppress levels of immunoreactive bradykinin in inflamed tissue as evaluated by microdialysis probes. Clin Pharmacol Ther 1990;48:168-78

Stubhaug A, Grimstad J, Breivik H.  Lack of analgesic effect of 50 and 100 mg oral tramadol after orthopaedic surgery: a randomized, double-blind, placebo and standard active drug comparison.  Pain 1995;62:111-18

Cherny NI.  Opiod Analgesics:  Comparative features and prescribing guidelines.  Drugs 1996;51:713-737

Cooper SA. Treating acute pain: Do’s and don’ts, pros and cons.  J Endodon1990;16:85-91

Wynn RL.  Narcotic analgesics for dental pain: Available products, strengths, and formulations.  Gen Dent 2001;126-

Jaber L, Swaim WD, Dionne RA.  Immunohistochemical localization of µ-opioid recepctors in human dental pulp.  J Endodon 2003;29:108-110 

Moore PA, Hersh EV.  Celecoxib and rofecoxib: the role of cox-2 inhibitors in dental practice.  J Am Dent Assoc 2001;132:451-456

Sadeghein A, Shahidi N, Dehpour AR.  A comparison of ketorolac tromethamine and acetaminophen codeine in the management of acute apical periodontitis.  J Endodon 25;25:257-259

Hargreaves KM, Swift JQ, Roszkowski MT, Bowles W, Garry MG, Jackson DL. Pharmacology of peripheral neuropeptide and inflammatory mediator release. Oral Surg Oral med Oral Pathol 1194;78503-10

Hersh EV. The efficacy and safety of ketoprofen in postsurgical dental pain. Compend Contin Educ Dent 1991;12:234-42

Cooper SA, Beaver WT. A model to evaluate mild analgesics in oral surgery out patients. Clin Pharm Therap. 1977;20:241-50

Beck FM. Placebos in dentistry: Their profound potential effects. J Am Dent  Assoc. 1977;95:1122-6

Cooper SA, Precheur H, Rauch D, Rosenheck A, Ladov M, Engel J. Evaluation of oxycodone and acetominophen in treatment of postoperative dental pain. Oral Surg.  1980;50:496-501

Forbes JA, Bowser MW, Calderazzo JP, Foor VM.  An evaluation of the analgesic efficacy of three opioid-analgesic combinations in postoperative oral surgery pain.  J Oral Surg  1981;39:108-12

Wideman GL, Keffer M, Morris E, Doyle RT, Jiang JG, Beaver WT.  Analgesic efficacy of a combination of hydrocodone with ibuprofen in postoperative pain.    Clin Pharmacol Ther 1999;65:66-76

Menke ER, Jackson CR, Bagby MD, Tracy TS.  The effectiveness of prophylactic etodolac on postendodontic pain.  J Endod 2000;712-715

Sessle BJ, Recent insights into brainstem mechanisms underlying craniofacial pain.  J Dent Ed  2002;66:108-112

Jackson DL, Moore PA, Hargreaves KM. Preoperative nonsteroidal anti-    inflammatory medication for the prevention of postoperative dental pain. J Am Dent Assoc.  1989;119:641-7