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. 2012 Sep 10;20(1):30.
doi: 10.1186/2008-2231-20-30.

The role of prophylactic ibuprofen and N-acetylcysteine on the level of cytokines in periapical exudates and the post-treatment pain

Maryam Ehsani  1 , Ali-Akbar Moghadamnia, Samir Zahedpasha, Ghorban Maliji, Sina Haghanifar, Seyyed Mohsen Aghajanpour Mir, Narges Mousavi Kani
Affiliations

The role of prophylactic ibuprofen and N-acetylcysteine on the level of cytokines in periapical exudates and the post-treatment pain

Maryam Ehsani et al. Daru. .

Abstract

Background: Periapical lesions are inflammatory diseases that result in periapical bone destruction because of host defensive-microbial disturbances.

Objective: To evaluate the role of prophylactic ibuprofen and N-acetylcysteine (NAC) on the levels of tumor necrosis factor alpha (TNF- α), interleukin- 6(IL-6) and IL-17 and post-treatment pain level in chronic periapical lesions.

Materials and methods: Eighty patients with chronic apical lesions less than 1 cm were randomly assigned to receive NAC tablets (400 mg), ibuprofen tablets (400 mg), NAC (400 mg)/ibuprofen (200 mg) combination and placebo 90 minutes prior to sampling. Periapical exudates were collected from root canals. TNF- α, IL-6 and IL-17 levels were determined by ELISA and post-treatment pain was assessed using a visual analog scale (VAS).

Results: There was a significant difference in IL-6 level between ibuprofen group and placebo (p = 0.019). Significant difference in IL-17 level was observed between NAC/ibuprofen combination group and placebo (p = 0.043). Four hours after treatment, a significant difference was observed in VAS pain score between ibuprofen group and placebo (p = 0.017). Eight hours post-treatment, VAS pain score for NAC group was statistically lower than placebo group (p = 0.033). After 12 hours VAS pain score showed a significant decrease in NAC group compared to placebo (p = 0.049).

Conclusion: The prophylactic ibuprofen and NAC failed to clearly reflect their effect on cytokines levels in exudates of chronic periapical lesions. On the other hand it seems that NAC can be a substitute for ibuprofen in the management of post endodontic pain.

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Figures

Figure 1
Figure 1
Mean ± SEM of TNF- α concentration (pg ml-1) in the four study groups (n = 20). No significant differences were seen between treatment groups compared to placebo. NAC; N-acetyl cysteine, Ibu; ibuprofen.
Figure 2
Figure 2
Mean ± SEM of IL-6 concentration (pg ml-1) in the four study groups (with significant differerence between ibuprofen and placebo groups).
Figure 3
Figure 3
Mean ± SEM of IL-17 concentration (pg ml-1) in the four study groups (with significant difference between NAC/Ibu and placebo groups).
Figure 4
Figure 4
Mean of VAS score changes by time (h) in four study groups (n = 20). NAC; N-acetyl cysteine, Ibu; ibuprofen. The score for NAC group tends to zero after 24 hours post administration in comparison with other treatments.
See this image and copyright information in PMC

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