Does Acetaminophen/Hydrocodone Affect Cold Pulpal Testing in Patients with Symptomatic Irreversible Pulpitis? A Prospective, Randomized, Double-blind, Placebo-controlled Study

doi:10.1016/j.joen.2014.09.008

Journal of Endodontics

Volume 40, Issue 12, December 2014, Pages 1958-1960

https://doi.org/10.1016/j.joen.2014.09.008 Get rights and content

Abstract

Introduction

The purpose of this prospective randomized, double-blind, placebo-controlled study was to determine the effects of a combination dose of 1000 mg acetaminophen/10 mg hydrocodone on cold pulpal testing in patients experiencing symptomatic irreversible pulpitis.

Methods

One hundred emergency patients in moderate to severe pain diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, identical capsules of either a combination of 1000 mg acetaminophen/10 hydrocodone or placebo. Cold testing with Endo-Ice (1,1,1,2 tetrafluoroethane; Hygenic Corp, Akron, OH) was performed at baseline and every 10 minutes for 60 minutes. Pain to cold testing was recorded by the patient using a Heft-Parker visual analog scale. Patients' reaction to the cold application was also rated.

Results

Cold testing at baseline and at 10 minutes resulted in severe pain for both the acetaminophen/hydrocodone and placebo groups. Although pain ratings decreased from 20–60 minutes, the ratings still resulted in moderate pain. Patient reaction to cold testing showed that 56%–62% had a severe reaction. Although the reactions decreased in severity over the 60 minutes, 20%–34% still had severe reactions at 60 minutes. Regarding pain and patients' reactions to cold testing, there were no significant differences between the combination acetaminophen/hydrocodone and placebo groups at any time period.

Conclusions

A combination dose of 1000 mg of acetaminophen/10 mg of hydrocodone did not statistically affect cold pulpal testing in patients presenting with symptomatic irreversible pulpitis. Patients experienced moderate to severe pain and reactions to cold testing.

Section snippets

Materials and Methods

One hundred adult patients participated in this study. All were emergency patients of the College of Dentistry, The Ohio State University, Columbus, OH, and were in good health as determined by a health history and oral questioning. Exclusion criteria were as follows: subjects who were younger than 18 years, had a history of significant medical problem, had taken central nervous system depressants or any analgesic medication within the last 6 hours, were pregnant or lactating, or were unable to

Results

For the acetaminophen/hydrocodone group, 31 women and 19 men ranging in age from 20–67 with a mean age of 35 ± 12 years participated in this study. For the placebo, 23 women and 27 men ranging in age from 18–61 with a mean age of 36 ± 13 years participated. There was no significant difference between the 2 groups regarding sex (P = .1085) or age (P = .7750).

The initial preoperative pain, mean Corah Dental Anxiety Scale ratings, and tooth type are presented in Table 1. There were no significant

Discussion

There were no statistically significant differences for the effect of age, initial pain, Corah Dental Anxiety Scale ratings, sex, or tooth type so these variables would be minimized between the 2 groups. Cold testing with Endo-Ice at baseline (minute 0) and at 10 minutes resulted in severe pain for both groups (Table 2). Although the pain ratings decreased from 20 minutes to 60 minutes, the ratings still resulted in moderate pain. It is likely that patients adapted to the cold testing procedure

Acknowledgments

Sara Fowler compiled the data, analyzed the results, and helped write the manuscript. Spencer Fullmer completed a portion of this study for a Master of Science degree. Melissa Drum and Al Reader contributed to the study design, institutional review board submission, statistical analysis, and served on the Masters Examination Committee.

The authors thank Dr Mike Beck for the statistical analysis of the data.

The authors deny any conflicts of interest related to this study.

References (14)

D.D. Peters et al.
Adult pulpal diagnosis. I. Evaluation of the positive and negative responses to cold and electrical pulp tests
J Endod
(1994)
E. Chen et al.
Evaluation of accuracy, reliability, and repeatability of five dental pulp tests
J Endod
(2011)
L.G. Levin
Pulp and periradicular testing
J Endod
(2013)
C.E. Villa-Chavez et al.
Predictive values of thermal and electrical dental pulp tests: a clinical study
J Endod
(2013)
A.C. Kardelis et al.
Effect of narcotic pain reliever on pulp tests in women
J Endod
(2002)
J.J. Jespersen et al.
Evaluation of dental sensibility tests in a clinical setting
J Endod
(2014)
M. Heft et al.
An experimental basis for revising the graphic rating scale for pain
Pain
(1984)

There are more references available in the full text version of this article.

Cited by (5)

Evaluation of the Effect of Common Analgesics on Pulpal Sensibility Tests: A Clinical Trial
2023, Journal of Endodontics
Accurate diagnosis is one of the most important steps before endodontic treatment. The aim of this study was to assess the effect of 2 commonly used analgesics namely ibuprofen and acetaminophen on the cold and electric pulp test (EPT) results in participants with symptomatic irreversible pulpitis (SIP).
This clinical trial evaluated 41 participants with pain due to SIP. The cold test and EPT were performed for teeth with SIP, and also for the corresponding tooth with healthy pulp in the contralateral quadrant. The participants then received 500 mg acetaminophen, 400 mg ibuprofen, or the placebo in the 3 groups. The cold test and EPT were repeated at 20, 40, and 60 minutes after medication intake, and the results were compared with the pretreatment values.
In the acetaminophen group, the results of cold test significantly decreased 40 (P < .05), and 60 (P < .05) minutes after analgesic intake in teeth with SIP and after 40 minutes (P < .05) in the corresponding contralateral teeth with healthy pulp. In the ibuprofen group, the cold test results significantly decreased at 20 (P < .05), 40 (P < .05), and 60 (P < .05) minutes after analgesic intake in teeth with SIP and after 40 minutes (P < .05) in the corresponding contralateral teeth with healthy pulp. The EPT results were not significantly affected by the studied analgesics at any time point (P > .05). There was no significant difference among the study groups regarding sex (P > .05).
It appears that both acetaminophen and ibuprofen can affect the pulpal response to the cold sensibility test. However, the studied medications had no significant effect on the EPT results. Therefore, dental clinicians should be aware of the possible effects of such medications on the cold test response.
Comparison of Pulp Sensibility Tests Responses in Type 2 Diabetes Patients and Healthy Individuals
2020, Journal of Endodontics
Citation Excerpt :
Patients were excluded if they had a systemic disease including other types of diabetes, uncontrolled diabetes, prediabetes, or any diseases that could affect the results (eg, hypertension [patients were considered to be hypertensive if their blood pressure was ≥140 mm Hg systolic or 90 mm Hg diastolic]7, hyperparathyroidism, hyperthyroidism, chronic renal disease, or hepatic disease). In addition, patients were excluded if they had diseases that could cause injury to the head and neck nervous system (stroke, multiple sclerosis, and so on)3,4,6,7,11,21 as well as other conditions that might affect the results such as cancer; pregnancy; or taking corticosteroids, ibuprofen, opium, or other medications such as gabapentin or phenytoin22. Further reasons for exclusion were trauma history, severe periodontal disease, orthodontic brackets or recent history of orthodontic treatment, extensive caries or restorations, apical periodontitis, teeth that had root canal treatment, and teeth with crowns5,14,23,24.
Diabetes is a common disease that may have some influence on sensory nerves. The aim of this study was to evaluate dental pulp responses to 2 pulp sensibility tests (ie, cold and electric) in patients with type 2 diabetes compared with healthy individuals.
Three hundred twenty-two premolar teeth in 51 patients who had type 2 diabetes and 347 premolar teeth in 53 individuals with no medical conditions were investigated. The patients with type 2 diabetes were unified and had fasting plasma glucose <300, hemoglobin A1C <10, less than a 10-year history of diabetes mellitus, and no history of hypertension. Electric and cold pulp sensibility tests were performed for all teeth. The cold test results were recorded by the Heft-Parker visual analog scale, and the electric pulp test results were recorded based on the pulp tester's grade that evoked a response.
There was no statistically significant difference between upper and lower premolar teeth in healthy individuals compared with the patients with diabetes in response to the cold and electric pulp tests (P > .05). In the patients with diabetes, the response of their upper premolars to the cold test was significantly reduced in diabetic patients >45 years of age (β = −1.15, P = .013). However, there was no significant correlation between the cold test and age in the lower premolars of both diabetic and nondiabetic participants (P > .05). There was also no significant correlation between the need for a higher number of the electric pulp test current to evoke a response in maxillary and mandibular premolars of the patients with diabetes and nondiabetic participants with age (P > .05).
There was a significant correlation between the reduction of maxillary premolar teeth responses to the cold test in diabetes patients >45 years of age.
A combination of acetaminophen/hydrocodone may not affect cold pulpal testing in patients with symptomatic irreversible pulpitis
2015, Journal of Evidence-Based Dental Practice
Does acetaminophen/hydrocodone affect cold pulpal testing in patients with symptomatic irreversible pulpitis? A prospective, randomized, double-blind, placebo-controlled study.
Fowler S, Fullmer S, Drum M, Reader A.
J Endod 2014;40(12):1958–60.
Anne E. Williamson, DDS, MS
The authors attempted to determine if pre-operative dosing with acetaminophen (1000 mg)/hydrocodone (10 mg) affected pulpal sensibility testing with cold in a tooth with symptomatic irreversible pulpitis.
Funding source is not available.
Randomized controlled trial
Level 1: Good-quality, patient-oriented evidence
Not applicable
Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: An observational clinical study
2021, Bioscience Journal
Ancillary factors in the treatment of orofacial pain: A topical narrative review
2019, Journal of Oral Rehabilitation

View full text

Clinical ResearchDoes Acetaminophen/Hydrocodone Affect Cold Pulpal Testing in Patients with Symptomatic Irreversible Pulpitis? A Prospective, Randomized, Double-blind, Placebo-controlled Study

Abstract

Introduction

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Acknowledgments

J Endod

J Endod

J Endod

J Endod

J Endod

J Endod

Pain

Clinical Research
Does Acetaminophen/Hydrocodone Affect Cold Pulpal Testing in Patients with Symptomatic Irreversible Pulpitis? A Prospective, Randomized, Double-blind, Placebo-controlled Study