Comparison effect of pretreatment with Cox2 inhibitor (Celecoxib) and Placebo in pain reduction of post endodontic treatment: double blind clinical trial

Pain control in dentistry especially endodontics is particularly important. Endodontic pain following root canal therapy (RCT) of vital teeth is closely correlated with inflammatory reactions. Increased level of prostaglandins has been reported in acute inflammatory reactions. Thus, cyclooxygenase-inhibiting drugs have a significant effect on reducing pain and inflammation. COX enzyme has two isoforms of COX-1 and COX-2. The conventional anti-inflammatory drugs inhibit both isoforms. In the recent years, COX-2 specific inhibitors have been the subject of extensive investigations. These inhibitors block the pain-inducing inflammatory mediators that are mostly derived from COX-2. The aim of this study was to compare the efficacy of prophylactic Celecoxib and a placebo in reducing post-endodontic pain using Visual Analog Scale (VAS). This double blind clinical trial was conducted on 30 patients with a mean age of 18 to 57 yrs. complaining of severe pain based on VAS. The subjects were randomly assigned to two groups of 400mg Celecoxib and the placebo. Drugs were administered 30 min prior to root canal therapy. Patients were asked to keep a pain diary and mark their degree of pain on a VAS chart before the initiation of treatment, immediately after treatment and at 4, 8, 12, 24 and 48 hours post-treatment. No significant difference was found between the analgesic effects of prophylactic Celecoxib and the placebo in any of the understudy time points (P>0.05). Considering the absence of a significant difference between the two groups, prophylactic Celecoxib is not recommended for post-endodontic pain reduction especially in cases with gastrointestinal (GI) problems.