Methodology
This study comprised of expert panel of endodontists practicing in the government and private set-ups in the northern part of India. All panel members were engaged in caring for patients with acute and chronic pain and had enough experience and training in managing patients of dental pain.
The patients who approached the expert panel telephonically were first triage by asking the following questions related to COVID-19 assessment:
1. Do you have a fever?
2. Do you have a cough or difficulty in breathing?
3. Do you have a history of international travel within 14 days?
4. Have you come into contact with a known/ confirmed COVID-19 case within 14 days?
5. Have you come into contact with any person who has been quarantined by local authorities?
If the patient replied ‘yes’ to any of the above questions, he/she was asked to contact the local health department for screening of COVID-19..
Out of the 87 patients who contacted the endodontists telephonically, none of the patients reported affirmative to the above COVID-19 designed questions. 55 out of 87 patients complaining of moderate to very severe dental pain with history of pain at night and lingering with thermal changes were suggestive of irreversible pulpitis. These 55 patients with average age 20-50 years were advised to take oral tablets of paracetamol 650 mg post-meal thrice a day for 3-5 days along with a single oral dose of 4mg of dexamethasone. Patients with known sensitivity to Dexamethasone or any medical condition which contradicted use of steroids were not included in the study . The outcomes observed were the severity of pain reported before and after giving Dexamethasone using a verbal numeric pain rating scale. The patients were asked to report the pain status after every 24 hours till 72 hours. In case of severe pain not controlled by these medicines even after 3 days, two tablets of dispersible ketorolac tromethamine (10mg) were advised once followed by single tablet three times a day for another 3 days. In case the pain did not subside within 3 days of taking the second line of treatment, or there was a development of swelling/lymphadenopathy, the patient was advised to get the tooth extracted. (Table 1 & Fig.1)