Does preoperative ibuprofen reduce pain during treatment of deep caries in children?

A COMMENTARY ON: Bilmez Selen M, Kuru B. Effect of preoperative ibuprofen on pain perception and pulse rate in paediatric patients with deep caries: a randomised controlled trial. Eur J Paediatr Dent. 2026:1. https://doi.org/10.23804/ejpd.2026.2598 . DESIGN: A prospective, parallel single-blinded randomised controlled trial aimed to evaluate the effect of pre-operative ibuprofen administration on pain control during vital pulp therapy (VPT) procedures for a mandibular molar diagnosed with reversible pulpitis. Participants were randomised through a computer-generated random sequence that was concealed in sealed envelopes. Participants received either oral ibuprofen (10 mg/kg) 40 minutes before treatment (intervention group) or no pre-operative analgesia (control group). CASE SELECTION: A total of 46 participants, aged 7-13 years, were recruited from the Department of Paediatric Dentistry at the Faculty of Dentistry in Malatya, Türkiye. The sample size was based on a power calculation, determining the estimated effect size from a prior study restoring teeth in children with MIH. One participant from each group was excluded (suspected irreversible pulpitis) prior to randomising. Inclusion criteria included no history of systemic disease, cooperative behaviour, a clinical and radiographic diagnosis of reversible pulpitis (positive cold test response and no swelling, abscess or periapical pathology), in a mandibular molar, due to dental caries (ICDAS 5-6). A standardised treatment protocol was provided and undertaken by a single paediatric dentist. The type of VPT included protective liner, direct pulp capping, partial pulpotomy, or coronal pulpotomy, and was determined by the operator and based on cavity depth and presence, or not, of a pulp exposure. DATA ANALYSIS: The primary outcome measured was intraoperative pain intensity, assessed using the visual analogue scale (VAS; 0-10) at the point of <1 mm pulpal proximity during the vital pulp therapy component of the treatment. Secondary outcomes measured include patients' intraoperative pulse rate (bpm), at baseline and at the same point as the primary outcome, and post-operative pain, using VAS, post-operatively at days 1, 3, and 7. Data were collected by an independent investigator, who was blinded to the randomisation. Data were tested for normality, and statistically analysed, using appropriate non-parametric tests. RESULTS: A total of 44 patients (30 girls, 14 boys) diagnosed with hyperaemic pulp were included in the study, with a mean age of 9.45 ± 1.76 years. The mean intraoperative VAS score was significantly lower in the intervention group (0.64 ± 1.14) compared to the control group (5.05 ± 3.51) [mean difference = -4.41; 95% confidence interval (CI): -5.78 to -3.04], p < 0.001. There was no statistically significant difference in postoperative VAS scores between the groups on days 1, 3 or 7. Pulse rate increased significantly in both groups during pulp proximity; however, the increase was significantly lower in the intervention group. No statistically significant differences were observed in VAS scores between individuals with open and closed apices in either the intervention group (p = 0.49) or the control group (p = 0.69) (Table 4). CONCLUSIONS: The study concluded that preoperative ibuprofen significantly improved intraoperative pain control and reduced stress responses during VPT in children. It was suggested that preoperative ibuprofen should be incorporated into routine practice for paediatric patients with reversible pulpitis as it will improve cooperation, reduce stress, and enhance overall treatment efficiency.