Effect of Different Concentrations of Sodium Hypochlorite on Post-Operative Pain After Primary Root Canal Treatment in Teeth Diagnosed with Irreversible Pulpitiis
DOI:
https://doi.org/10.51253/pafmj.v76i6.12921Keywords:
Antimicrobial efficacy, Cytotoxicity, Dose-dependent effects, Irreversible pulpitis, Postoperative pain, Visual Analog Scale (VAS).Abstract
Objective: To assess the impact of varying concentrations of sodium hypochlorite (NaOCl) on postoperative pain after primary root canal treatment in teeth with a diagnosis of irreversible pulpitis.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Operative Dentistry and Endodontics, Armed Forces Institute of Dentistry Rawalpindi, Pakistan, from Mar 2024 to Sep 2024.
Methodology: This study included 100 participants (18–49 years) divided into two groups: Group A (low concentration, 2% NaOCl) and Group B (high concentration, 5.25% NaOCl). Standardized Root canal treatment protocols as per American Association of Endodontists were followed, including irrigation with respective NaOCl concentrations during canal preparation. Postoperative pain was evaluated 24 hours after treatment using the Visual Analog Scale (VAS) and classified as mild, moderate, or severe.
Results: The study had total of 100 participants divided into two equal groups based on the concentration of sodium hypochlorite (NaOCl) used during root canal treatment. The high-concentration group exhibited significantly higher pain scores [median(IQR): 7.00(5.00-9.00)] compared to the low-concentration group (median(IQR): 5.00(3.00-6.00)]. Severe pain was reported by 66% of participants in the high-concentration group versus 24% in the low-concentration group (p<0.001). The findings indicate a dose-dependent relationship between NaOCl concentration and postoperative pain severity.
Conclusion: Higher concentrations of NaOCl (5.25%) lead to significantly increased postoperative pain compared to lower concentrations (2%). These results suggest that using lower NaOCl concentrations can effectively balance antimicrobial efficacy and patient comfort in root canal treatment for irreversible pulpitis. Further multicenter studies are recommended to validate these findings.
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1. Cai C, Chen X, Li Y, Jiang Q. Advances in the role of sodium hypochlorite irrigant in chemical preparation of root canal treatment. BioMed Res Int 2023; 2023(1): 8858283.
https://doi.org/10.1155/2023/8858283
2. Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Br Dent J 2014; 216(6): 299-303.
https://doi.org/10.1038/sj.bdj.2014.204
3. Szabó EV, Huszta B, Polyák M, Ruksakiet K, Bernáth R, Ghidán Á, et al. Antimicrobial efficacy of sodium hypochlorite and hyper-pure chlorine dioxide in the depth of dentin tubules in vitro. BMC Oral Health 2023; 23(1): 930.
https://doi.org/10.1186/s12903-023-03685-6
4. Xu H, Ye Z, Zhang A, Lin F, Fu J, Fok AS. Effects of concentration of sodium hypochlorite as an endodontic irrigant on the mechanical and structural properties of root dentine: A laboratory study. Int Endodont J 2022; 55(10): 1091-102.
https://doi.org/10.1111/iej.13800
5. Burns LE, Kim J, Wu Y, Alzwaideh R, McGowan R, Sigurdsson A. Outcomes of primary root canal therapy: An updated systematic review of longitudinal clinical studies published between 2003 and 2020. Int Endodont J 2022; 55(7): 714-731.
https://doi.org/10.1111/iej.13736
6. De Oliveira RA, Weissheimer T, Só GB, da Rosa RA, Souza MA, Ribeiro RG, Só MVR. Dentinal tubule penetration of sodium hypochlorite in root canals with and without mechanical preparation and different irrigant activation methods. Restorat Dent Endodont 2023; 48(1): e1.
https://doi.org/10.5395/rde.2023.48.e1
7. Zehnder M. Root canal irrigants. J Endodont 2006; 32(5): 389-398.
https://doi.org/10.1016/j.joen.2005.09.014
8. Nanda Z, Singh R, Kamble PP, Deshmukh G, Patil N, Patil AB, Banerjee S. Efficacy of Different Root Canal Irrigating Solutions in Removing Smear Layer: A Scanning Electron Microscopic Study. Cureus. 2023; 15(9): 44618.
https://doi.org/10.7759/cureus.44618
9. Sabino-Silva R, Cardoso IV, Vitali FC, Alves AMH, Souza BDM, Bortoluzzi EA, et al. Prevalence of postoperative pain after endodontic treatment using low and high concentrations of sodium hypochlorite: a systematic review and meta-analysis. Clin Oral Invest 2023; 27(8): 4157-4171.
https://doi.org/10.1007/s00784-023-05151-7
10. Samir P, Mahapatra N, Dutta B, Bagchi A, Dhull KS, Verma RK. A Correlation between Clinical Classification of Dental Pulp and Periapical Diseases with its Patho Physiology and Pain Pathway. Int J Clin Pediatr Dent 2023; 16(4): 639.
https://doi.org/10.5005/jp-journals-10005-2636
11. Laslami K, Khaldoune S, Sy A, Drouri S, Benkiran I. Apical Extrusion: Is It an Inherent Occurrence During Every Endodontic Treatment? Cureus. 2023; 15(9): 45211.
https://doi.org/10.7759/cureus.45211
12. Karatas E, Kirici DO, Arslan H. Postoperative pain after the use of sodium hypochlorite gel and solution forms: a randomized clinical study. Eur Endodont J 2021; 6(1): 34.
https://doi.org/10.14744/eej.2020.08370
13. Tanomaru Filho M, Leonardo MR, Aníbal F, Faccioli L. Inflammatory response to different endodontic irrigating solutions. Int Endodont J 2002; 35(9): 544.
https://doi.org/10.1046/j.1365-2591.2002.00544.x
14. Pontes F, Pontes H, Adachi P, Rodini C, Almeida D, Pinto Jr D. Gingival and bone necrosis caused by accidental sodium hypochlorite injection instead of anaesthetic solution. Int Endodont J 2008; 41(3): 267-270.
https://doi.org/10.1111/j.1365-2591.2007.01340.x
15. Radcliffe C, Potouridou L, Qureshi R, Habahbeh N, Qualtrough A, Worthington H, et al. Antimicrobial activity of varying concentrations of sodium hypochlorite on the endodontic microorganisms Actinomyces israelii, A. naeslundii, Candida albicans and Enterococcus faecalis. Int Endodont J 2004; 37(7): 438-446.
https://doi.org/10.1111/j.1365-2591.2004.00752.x
16. Verma N, Sangwan P, Tewari S, Duhan J. Effect of different concentrations of sodium hypochlorite on outcome of primary root canal treatment: a randomized controlled trial. J Endodont 2019; 45(4): 357-363.
https://doi.org/10.1016/j.joen.2019.01.003
17. Konadu AB, Ampofo PC, Akyeh ML, Hewlett SA, Osei-Tutu K, Nyako EA. Comparative evaluation of selected concentrations of sodium hypochlorite on the outcome of endodontic therapy among Ghanaians. PLoS One 2024; 19(7): e0306693.
https://doi.org/10.1371/journal.pone.0306693
18. Mokhtari H, Milani AS, Zand V, Shakuie S, Nazari L. The effect of different concentrations and temperatures of sodium hypochlorite irrigation on pain intensity following endodontic treatment of mandibular molars with irreversible pulpitis: A randomized, double‐blind clinical trial. Clin Exp Dent Res 2023; 9(5): 859-867. https://doi.org/10.1002/cre2.754
19. Mostafa M, El‐Shrief Y, Anous W, Hassan M, Salamah F, El Boghdadi R, et al. Postoperative pain following endodontic irrigation using 1.3% versus 5.25% sodium hypochlorite in mandibular molars with necrotic pulps: a randomized double‐blind clinical trial. Int Endodont J 2020; 53(2): 154-166.
https://doi.org/10.1111/iej.13222
20. Demenech LS, de Freitas JV, Tomazinho FSF, Baratto-Filho F, Gabardo MCL. Postoperative pain after endodontic treatment under irrigation with 8.25% sodium hypochlorite and other solutions: a randomized clinical trial. J Endodont 2021; 47(5): 696-704. https://doi.org/10.1016/j.joen.2021.02.004
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Copyright (c) 2026 Syed Shan E Haider Naqvi, Hafiz Rabbi ul Ehsan, Shumaila Maryum, Talha Khurshid, Muhammad Hamza Asif, Naseem Azad

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