Endodontic flare-ups: comparison of incidence between single and multiple visit procedures in patients attending a Nigerian teaching hospital

BACKGROUND: Until recently the most accepted technique of doing root canal treatment stresses multiple visit procedure. Most schools also concentrated upon teaching the multi-visit concept. However, it has now been reported that the procedure of single visit treatment is advocated by at least 70% of schools in all geographical areas. It was therefore the aims of the present study to find the incidence of post-obturation flare-ups following single and multiple visit endodontic treatment procedures, and to establish the relationship between pre-operative and post-obturation pain in patients referred for endodontic therapy in a Nigerian teaching Hospital. METHODS: Data collected included pulp vitality status, the presence or absence of pre-operative, inter-appointment and post-obturation pain. Pain was recorded as none, slight, or moderate/severe. Flare-ups were defined as either patient's report of pain not controlled with over the counter medication or as increasing swelling. The patients were recalled at three specific post-obturation periods, 1(st), 7(th )and 30(th )day. The presence or absence of pain, or the appropriate degree of pain was recorded for each recall visits and the interval between visits. The compiled data were analysed using chi-square where applicable. P level ≤ 0.05 was taken as significant. RESULTS: Ten endodontic flare-ups (8.1%) were recorded in the multiple visit group compared to 19 (18.3%) flare-ups for the single visit group, P = 0.02. For both single and multiple visit procedures, there were statistically significant correlations between pre-operative and post-obturation pain (P = 0.002 and P = 0.0004 respectively). Teeth with vital pulps reported the lowest frequency of post-obturation pain (48.8%), while those with nonvital pulps were found to have the highest frequency of post-obturation pain (50.3%), P = 0.9. CONCLUSION: The present study reported higher incidences of post-obturation pain and flare-ups following the single visit procedures. However, single visit endodontic therapy has been shown to be a safe and effective alternative to multiple visit treatment, especially in communities where patients default after the first appointment at which pain is relieved

A Review on Root Canal Irrigation Solutions in Endodontics

Introduction: This paper aims to review the different characteristics of root canal irrigants including sodium hypochlorite (NaOCl), chlorhexidine (CHX), hydrogen peroxide (H2O2), iodine potassium iodide (IKI), antibiotic-based irrigants, photo-activated disinfection, electrochemically activated water, and QMix. The literature on root canal irrigation solutions in the context of endodontics up to June 2020 was reviewed using PubMed and MEDLINE. NaOCl was identified as the most likely effective irrigation solution that could be used for endodontics. Its antimicrobial activity is at least comparable or even greater than that of other common irrigants. Tetraclean was also proposed to be more effective than CHX against endodontic microorganisms. In addition, Hypoclean was suggested as the most potent and effective irrigant against Candida albicans. Similarly, IKI was introduced as a successful irrigant in killing Candida albicans and Enterococcus faecalis. MTAD is also known to be effective in smear layer removal as well as against the growth of Enterococcus faecalis. EDTA is also considered to have limited antimicrobial activity. Keywords: Chlorhexidine