The efficacy of pain control following nonsurgical root canal treatment using ibuprofen or a combination of ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled study K. A. Menhinick 1 , J. L. Gutmann 2 , J. D. Regan 3 , S. E. Taylor 4 & P. H. Buschang 5 1 Private Practice Limited to Endodontics, Washington, DC, USA; 2 Private Practice Limited to Endodontics, Dallas, TX, USA; 3 Department of Endodontics; 4 Oral and Maxillofacial Surgery/Pharmacology Department; and 5 Department of Orthodontics, Baylor College of Dentistry, Texas A&M University System Health Science Centre, TX, USA Abstract Menhinick KA, Gutmann JL, Regan JD, Taylor SE, Buschang PH. The efficacy of pain control following non- surgical root canal treatment using ibuprofen or a combination of ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled study. International Endodontic Journal, 37, 531–541, 2004. Aim To compare ibuprofen, to an ibuprofen/acetami- nophen combination in managing postoperative pain following root canal treatment. It is hypothesized that the drug combination will provide more postoperative pain relief than the placebo or ibuprofen alone. Methodology Patients presenting at the Texas A&M Baylor College of Dentistry’s graduate endodontic clinic, experiencing moderate to severe pain, were considered potential candidates. Fifty-seven patients were included based on established criteria. Following administration of local anaesthesia, a pulpectomy was performed. The patients were administered a single dose of either: (i) placebo; (ii) 600 mg ibuprofen; or (iii) 600 mg ibuprofen and 1000 mg of acetamino- phen. Patients recorded pain intensity following treatment on a visual analogue scale and a baseline four-point category pain scale as well as pain relief every hour for the first 4 h then every 2 h thereafter for a total of 8 h. A general linear model (GLM) analysis was used to analyse the outcome. Results Based upon the GLM analysis, there was a significant difference between the ibuprofen and the combination drug group, and between placebo and combination drug groups. There was no significant difference between the placebo and the ibuprofen. Conclusion The results demonstrate that the com- bination of ibuprofen with acetaminophen may be more effective than ibuprofen alone for the manage- ment of postoperative endodontic pain. Keywords: acetaminophen, ibuprofen, nonsurgical root canal treatment, postoperative pain control. Received 2 April 2003; accepted 17 March 2004 Introduction Alleviating pain is of utmost importance when treating dental patients, as it is prevalent and has far reaching effects for both the patient and the clinician alike. Lipton et al. (1993) demonstrated that 12% of the 45 000 households surveyed in the United States experienced at least one occurrence of tooth pain within the previous 6 months. In the UK a random sample of 4000 adults aged 18–65, with a 74% response rate showed an overall prevalence of orofacial pain of 26%. Forty-six per cent of the participants sought treatment and 17% had to take time off work (Macfarlane et al. 2002). O’Keefe (1976) showed a significant relationship in endodontic patients between preoperative, operative, and postoperative pain levels. Patients presenting with extreme preoperative discomfort were more likely to Correspondence: Dr James L. Gutmann, 1416 Spenwick Terrace Dallas, TX 75204, USA (e-mail: jlgutmann@ earthlink.net). ª 2004 International Endodontic Journal International Endodontic Journal, 37, 531–541, 2004 531