Evaluation of Local Versus Systemic Corticosteroid Therapy in Reducing Post-endodontic Pain and Inflammation

Background: Post-endodontic pain and inflammation remain common complications following root canal therapy, often leading to patient discomfort and increased analgesic consumption. Corticosteroids have been widely used to modulate inflammatory responses; however, the comparative effectiveness of locally administered versus systemically administered corticosteroids in endodontic pain control remains inadequately explored. Methods: This randomized, parallel-group clinical study included 90 patients undergoing single-visit root canal treatment for symptomatic irreversible pulpitis. Participants were randomly allocated into three groups ( n = 30 each): Group A received local intracanal dexamethasone (4 mg), Group B received oral dexamethasone (8 mg single dose), and Group C served as the control group receiving no corticosteroid therapy. Postoperative pain intensity was assessed using a Visual Analog Scale (VAS) at 6, 24, and 48 hours. Inflammatory response was evaluated using facial swelling measurements and rescue analgesic consumption. Statistical analysis was performed using one-way ANOVA and repeated-measures ANOVA with post-hoc Tukey tests. Results: Mean VAS pain scores at 24 hours were significantly lower in Group A (2.1 ± 0.9) compared to Group B (3.4 ± 1.1) and Group C (5.2 ± 1.3) ( P < 0.001). Facial swelling was minimal in the local corticosteroid group (0.6 ± 0.3 mm) compared to systemic (1.2 ± 0.4 mm) and control groups (2.1 ± 0.5 mm). Rescue analgesic use was required in 16.7% of Group A, 33.3% of Group B, and 70% of Group C patients ( P < 0.001). Conclusion: Local intracanal corticosteroid therapy demonstrated superior efficacy in reducing post-endodontic pain and inflammation compared to systemic administration, with fewer systemic effects.