Non-steroidal anti-inflammatory drugs as adjuncts to local anesthesia and peri-endodontic pain management: a focused clinical review

Pain control is an integral part of endodontic treatment, from diagnosis of the painful tooth to local anesthesia and management of postoperative pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are used at several of these stages, although their purpose is not the same in each situation. This focused narrative review considers the use of NSAIDs in nonsurgical endodontic treatment before, during, and after treatment, including their effect on anesthetic success and the limitations imposed by patient-related factors. Available evidence suggests that an oral NSAID given before treatment may improve inferior alveolar nerve block (IANB) success in mandibular molars with symptomatic irreversible pulpitis. However, differences in the drugs and doses studied and in the assessment of anesthetic success do not allow one regimen to be recommended for all patients. NSAIDs, alone or with acetaminophen, can also reduce postoperative pain during the first 6–24 hours, whereas benefit beyond 48 hours is less clear. Their use requires consideration of gastrointestinal, renal, cardiovascular, hepatic, and bleeding risks, together with allergy, pregnancy, and interactions with other medication. NSAIDs can therefore be useful adjuncts in selected patients, but effective pain management still requires accurate diagnosis, adequate local anesthesia and definitive treatment, with reassessment when symptoms persist.