The efficacy comparison of ibuprofen, acetaminophen-codeine, and placebo premedication therapy on the depth of anesthesia during treatment of inflamed teeth

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Sep;102(3):399-403. doi: 10.1016/j.tripleo.2005.10.053. Epub 2006 Jun 27.


The purpose of this study was to elucidate whether premedication therapy with acetaminophen-codeine or ibuprofen is able to increase the depth of anesthesia in inflamed teeth. Sixty patients with the diagnosis of irreversible pulpitis in 1 mandibular tooth requiring root canal therapy (RCT) were selected. Two other teeth in the same quadrant were selected as controls. An electric pulp tester (EPT) was used to evaluate pulp sensitivity at the baseline and after drug administration and anesthesia injection. The subjects were divided into 3 groups randomly, and in each group 1 of the 3 drugs including acetaminophen-codeine, ibuprofen, and placebo were administered 1 hour before anesthesia delivery. After 1 hour, anesthesia was injected and after a waiting period, the EPT measurement was recorded. The reversed EPT scale was used to evaluate the depth of anesthesia achieved during RCT. Data were analyzed to statistically compare the results before and after intervention in cases and controls of each group and among different groups. Significanly lower tooth sensitivity levels (TSLs) were observed after intervention in acetaminophen-codeine and ibuprofen groups, which was more significant in the ibuprofen group. The comparison of inflamed teeth TSLs in the acetaminophen-codeine group and the placebo group after anesthesia and drug administration showed significant differences (P = .001). This comparison between ibuprofen and placebo groups also showed significant differences (P approximately 0). Also, significantly lower TSL of inflamed teeth was observed in the ibuprofen group in comparison with the acetaminophen-codeine group (P = .002). This study reflected preoperative administration of ibuprofen, if not contraindicated, as a drug of choice 1 hour before local anesthesia injection as an effective method for achieving a deep anesthesia during RCT of teeth with irreversible pulpitis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / administration & dosage*
  • Administration, Oral
  • Analgesics / administration & dosage*
  • Analysis of Variance
  • Anesthesia, Dental / methods*
  • Anesthesia, Local / methods
  • Codeine / administration & dosage*
  • Dental Pulp Necrosis / therapy
  • Dental Pulp Test
  • Double-Blind Method
  • Drug Combinations
  • Humans
  • Ibuprofen / administration & dosage*
  • Preanesthetic Medication / methods*
  • Pulpitis / therapy
  • Root Canal Therapy / methods*
  • Statistics, Nonparametric


  • Analgesics
  • Drug Combinations
  • Acetaminophen
  • Codeine
  • Ibuprofen