An Emerging Alternative for Pain Control: Mechanism and Applications of Cryotherapy in Endodontics

Pharmaceutical Science-Dentistry and endodontics

Authors

  • Swayangprabha Sarangi Department of Conservative dentistry and Endodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi, Wardha, Maharashtra, India. https://orcid.org/0000-0001-5813-2645
  • Manoj Chandak Department of Conservative dentistry and Endodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi, Wardha, Maharashtra, India.
  • Anuja Ikhar Department of Conservative dentistry and Endodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi, Wardha, Maharashtra, India.
  • Mrinal Dayanand Department of Conservative dentistry and Endodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi, Wardha, Maharashtra, India.
  • Namrata Jidewar Department of Conservative dentistry and Endodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi, Wardha, Maharashtra, India.

DOI:

https://doi.org/10.22376/ijlpr.2023.13.5.P123-P129

Keywords:

Cryotherapy, freezing, postoperative pain, endodontics, cryo-therapeutic agents.

Abstract

Patient discomfort after conventional root canal therapy remains inevitable in endodontic practices. It depends onthe clinician to lessen the postoperative pain encountered by the patient. This review article aims to get acquainted withCryotherapy, a current modality designed to reduce patients' anxiety, pain, and inflammation levels. Extensive studies have beenprovided on the applications of cryotherapy in the fraternity of medicine, but its utilization has been restricted in the Endodonticregime. Cryotherapeutic agents benefit in the regard that they eliminate the need for prescribing supplementary medications.The application of cryo-therapeutic agents is technique sensitive and requires the clinician to have thorough and correctknowledge regarding its underlying mechanism of action. Several expected outcomes can be derived after cryotherapyapplication. It is proven that intracanal application of the cryotherapeutic agent provides anodyne–like action serving as anessential tool for pain control. The concept of frozen tissues is related to ancient times, such as treating sports injuries, while itsrecent introduction into endodontics has been a boon to already practicing clinicians. Although it is a slow process requiringmultiple appointments of visits to the clinician, its long-term benefits can be a breakthrough in meeting the benefits of deliveringquality patient care. This article sheds light on its recent applications in endodontics, focusing on the chemistry behind freezingcells to newer advancements. However, significant and valid trials need to be carried out to reach evidence of certainty aboutthe therapeutic benefits and additional tools of delivery. It will pave the way for further scientific work to broaden its range ofapplications in dentistry.

References

Levin L, Amit A, Ashkenazi M. Post-operative pain and use of analgesic agents following various dental procedures. Alpa Gupta, et al. 26 J Dent Anesth Pain Med 2021 February; 21(1): 15-27. Am J Dent. 2006;19(4):245-7. PMID 16939032.

Smith EA, Marshall JG, Selph SS, Barker DR, Sedgley CM. Nonsteroidal anti-inflammatory drugs for managing postoperative endodontic pain in patients who present with preoperative pain: a systematic review and meta-analysis. J Endod. 2017;43(1):7-15. doi: 10.1016/j.joen.2016.09.010, PMID 27939729.

Fayyad DM, Abdelsalam N, Hashem N. Cryotherapy: a new treatment paradigm in endodontics. J Endod. 2020 Jul 1;46(7):936-42. doi: 10.1016/j.joen.2020.03.019, PMID 32386857.

Swenson C, Swärd L, Karlsson J. Cryotherapy in sports medicine. Scand J Med Sci Sports. 1996 Aug;6(4):193-200. doi: 10.1111/j.1600-0838.1996.tb00090.x, PMID 8896090.

Prohaska J, Jan AH. Continuing education activity.

Vera J, Ochoa-Rivera J, Vazquez-Carcaño M, Romero M, Arias A, Sleiman P. Effect of intracanal cryotherapy on reducing root surface temperature. J Endod. 2015 Nov 1;41(11):1884-7. doi: 10.1016/j.joen.2015.08.009, PMID 26433855.

Hargreaves KM. Endodontic pharmacology. Pathw Pulp. 2001:665-82.

Blicher B, Pryles RL, Lin J. Endodontics Review A Study Guide. EDUJ. 2016;4(3):45-66. doi: 10.25241/stomaeduj.2017.4(3).bookreview.4.

Hargreaves KM, Cohen S, Berman LH. Cohen’s pathways of the pulp. 10th ed. St Louis: Mosby; 2011. p. 49-70.

Parirokh M, Rekabi AR, Ashouri R, Nakhaee N, Abbott PV, Gorjestani H. Effect of occlusal reduction on postoperative pain in teeth with irreversible pulpitis and mild tenderness to percussion. J Endod. 2013 Jan 1;39(1):1-5. doi: 10.1016/j.joen.2012.08.008, PMID 23228248.

Etienney I, Beaugerie L, Viboud C, Flahault A. Non-steroidal anti-inflammatory drugs as a risk factor for acute diarrhea: a case-crossover study. Gut. 2003;52(2):260-3. doi: 10.1136/gut.52.2.260, PMID 12524410.

Khan AZ, George K, Defriend DJ. Nonsteroidal anti-inflammatory drug-induced colonic stenosis: an unusual cause of a right-sided colonic mass: report of a case. Dis Colon Rectum. 2003;46(3):403-5. doi: 10.1007/s10350-004-6562-9, PMID 12626918.

Püspök A, Kiener HP, Oberhuber G. Clinical, endoscopic, and histologic spectrum of nonsteroidal anti–inflammatory drug–induced lesions in the colon. Dis Colon Rectum. 2000;43(5):685-91. doi: 10.1007/BF02235589, PMID 10826432

Peuhkuri K, Nevala R, Vapaatalo H, Moilanen E, Korpela R. Ibuprofen augments gastrointestinal symptoms in lactose maldigestion during a lactose tolerance test. Aliment Pharmacol Ther. 1999 Sep 1;13(9):1227-33. doi: 10.1046/j.1365-2036.1999.00608.x, PMID 10468706.

Fernandes IA, Armond ACV, Falci SGM. The effectiveness of cold therapy (cryotherapy) in the management of inflammatory parameters after removal of mandibular third molars: a meta–analysis. Int Arch Otorhinolaryngol. 2019;23(2):221-8. doi: 10.1055/s-0039-1677755, PMID 30956709.

Salmassy DA, Pogrel MA. Liquid nitrogen cryosurgery and immediate bone grafting in the management of aggressive primary jaw lesions. J Oral Maxillofac Surg. 1995;53(7):784-90. doi: 10.1016/0278-2391(95)90333-x, PMID 7595793.

Johnson JM, Yen TC, Zhao K, Kosiba WA. Sympathetic, sensory, and nonneuronal contributions to the cutaneous vasoconstrictor response to local cooling. Am J Physiol Heart Circ Physiol. 2005;288(4):H1573-9. doi: 10.1152/ajpheart.00849.2004. PMID 15576441.

Sahuquillo J, Vilalta A. Cooling the injured brain: how does moderate hypothermia influence the pathophysiology of traumatic brain injury. Curr Pharm Des. 2007;13(22):2310-22. doi: 10.2174/138161207781368756, PMID 17692002.

Vera J, Ochoa J, Romero M, Vazquez-Carcaño M, Ramos-Gregorio CO, Aguilar RR et al. Intracanal cryotherapy reduces postoperative pain in teeth with symptomatic apical periodontitis: a randomized multicenter clinical trial. J Endod. 2018 Jan 1;44(1):4-8. doi: 10.1016/j.joen.2017.08.038, PMID 29079057.

Laureano Filho JR, de Oliveira e Silva ED, Batista CI, Gouveia FM. The influence of cryotherapy on reduction of swelling, pain, and trismus after third-molar extraction: a preliminary study. J Am Dent Assoc. 2005;136(6):774-8; quiz 807. doi: 10.14219/jada.archive.2005.0261, PMID 16022042.

Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold, and pain tolerance. Br J Sports Med. 2007;41(6):365-9; discussion 369. doi: 10.1136/bj.2006.031237, PMID 17224445.

Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther. 2010;90(4):581-91. doi: 10.2522/pt.20090131, PMID 20185615.

Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage. 1994;9(1):56-9. doi: 10.1016/0885-3924(94)90150-3, PMID 8169463.

Franz DN, Iggo A. Conduction failure in myelinated and non-myelinated axons at low temperatures. J Physiol. 1968;199(2):319-45. doi: 10.1113/jphysiol.1968.sp008656, PMID 5723515.

Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971-9. doi: 10.1126/science.150.3699.971, PMID 5320816.

Fields HL, Basbaum AI. Brainstem control of spinal pain–transmission neurons. Annu Rev Physiol. 1978;40:217-48. doi: 10.1146/annurev.ph.40.030178.001245, PMID 205165.

Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Phys. 2004;7(3):395-9. PMID 16858479.

Ho SS, Coel MN, Kagawa R, Richardson AB. The effects of ice on blood flow and bone metabolism in knees. Am J Sports Med. 1994;22(4):537-40. doi: 10.1177/036354659402200417, PMID 7943521.

Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65. doi: 10.1080/00325481.2015.992719, PMID 25526231.

Watkins AA, Johnson TV, Shrewsberry AB, Nourparvar P, Madni T, Watkins CJ et al. Ice packs reduce postoperative midline incision pain and narcotic use: a randomized controlled trial. J Am Coll Surg. 2014 Sep 1;219(3):511-7. doi: 10.1016/j.jamcollsurg.2014.03.057, PMID 25081937.

Andrews MD. Cryosurgery for common skin conditions. I am Fam Physician. 2004 May 15;69(10):2365-72. PMID 15168956.

Jacobs KM, Oliver TP. Cryotherapy. Diagn Manag Lameness Horse. 2011:869-72.

Firnhaber JM. Diagnosis and treatment of basal cell and squamous cell carcinoma. I am Fam Physician. 2012;86(2):161-8. PMID 22962928.

Korpan NN. Cryosurgery in the 21st Century. Basics Cryosurgery. 2001:3-8.

Orengo I, Salasche SJ. Surgical pearl: the cotton-tipped applicator–the ever-ready, multipurpose superstar. J Am Acad Dermatol. 1994;31(4):658-60. doi: 10.1016/s0190-9622(08)81732-x, PMID 8089294.

van Leeuwen MC, Bulstra AE, van Leeuwen PA, Niessen FB. A new argon gas-based device for the treatment of keloid scars with the use of intralesional cryotherapy. J Plast Reconstr Aesthet Surg. 2014 Dec 1;67(12):1703-10. doi: 10.1016/j.bjps.2014.08.046, PMID 25257046.

Bosch G, Klein WR. Superficial keratectomy and cryosurgery as therapy for limbal neoplasms in 13 horses. Vet Ophthalmol. 2005;8(4):241-6. doi: 10.1111/j.1463-5224.2005.00395.x, PMID 16008703.

Knottenbelt DC. The equine sarcoid: why are there so many treatment options? Vet Clin North Am Equine Pract. 2019;35(2):243-62. doi: 10.1016/j.cveq.2019.03.006, PMID 31097356.

Graham GF. Cryosurgery. Clin Plast Surg. 1993;20(1):131-47. doi: 10.1016/S1040-0486(03)00077-2. PMID 8420702.

Cooper SM, Dawber RP. The history of cryosurgery. J R Soc Med. 2001;94(4):196-201. doi: 10.1177/014107680109400416, PMID 11317629.

Vera J, Ochoa-Rivera J, Vazquez-Carcaño M, Romero M, Arias A, Sleiman P. Effect of intracanal cryotherapy on reducing root surface temperature. J Endod. 2015 Nov 1;41(11):1884-7. doi: 10.1016/j.joen.2015.08.009, PMID 26433855.

Vieyra JP, J Enriquez FJ, Acosta FO, Guardado JA. Reduction of post-endodontic pain after one-visit root canal treatment using three irrigating regimens with different temperatures. Niger J Clin Pract. 2019;22(1):34-40. doi: 10.4103/njcp.njcp_349_18, PMID 30666017.

Al-Nahlawi T, Hatab TA, Alrazak MA, Al-Abdullah A. Effect of intracanal cryotherapy and negative irrigation technique on postendodontic pain. J Contemp Dent Pract. 2016;17(12):990-6. doi: 10.5005/jp-journals-10024-1969, PMID 27965485.

Jain A, Davis D, Bahuguna R, Agrawal A, Singh S, Ramachandran R, et al. Role of cryotherapy in reducing postoperative pain in patients with irreversible pulpitis; an in-vivo study. Int J Dent Sci Res. 2018;2:43-9.

Bahcall J, Johnson B, Xie Q, et al. Introduction to vital pulp cryotherapy. Endod Pract US. 2019;1:14.

Topçuoglu HS, Arslan H, Topçuoglu G, Demirbuga S. The effect of cryotherapy application on the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. J Endod. 2019;45(8):965-9. doi: 10.1016/j.joen.2019.05.001, PMID 31204040.

Chaudhari PS, Chandak MG, Relan KN, Chandak PG, Rathi CH, Chandak MS, et al. Lasers in diagnosis, interception, and management of white spot lesions and dental caries - a review. J Evol. 2021;10(9):624-31. doi: 10.14260/jemds/2021/134.

Motwani NM, Ikhar A, Nikhade P, Chandak M, Khatod S, Rathi S, et al. Dentinal pre-treatment in restorative dentistry. J Evol. 2020;9(10):804-9. doi: 10.14260/jemds/2020/174.

Deshmukh S, Singh S, Jawade S, Madke B, Singh AL. Treatment of Genital warts with a combination of cryotherapy and 5% imiquimod. J Clin Diagn Res. 2020;14. doi: 10.7860/JCDR/2020/42799.13470.

Chandak PG, Ghanshyamdasj M, Chandak C, Relan KN, Chandak M, Rathi C et al. Nanoparticles in endodontics - a review. J Evol. 2021;10(13):976-82. doi: 10.14260/jemds/2021/209.

Published

2023-09-01

How to Cite

Sarangi, S., Chandak, M., Ikhar, A. ., Dayanand, M., & Jidewar, N. (2023). An Emerging Alternative for Pain Control: Mechanism and Applications of Cryotherapy in Endodontics: Pharmaceutical Science-Dentistry and endodontics. International Journal of Life Science and Pharma Research, 13(5), P123-P129. https://doi.org/10.22376/ijlpr.2023.13.5.P123-P129

Issue

Section

Review Articles