title: Unmasking the Effect of Analgesics on Endodontic Diagnosis Using a Novel Bite Force Sensor Device: A Prospective, Randomized Clinical Trial.
abstract: BACKGROUND
  A definitive diagnosis is of primary importance before initiating any endodontic treatment; yet, there are occasions when the dental professional is unable to accurately reproduce the patient's chief complaint, as it can pose a dilemma and may require consideration of multiple variables in order to reach an accurate diagnosis. So to overcome this problem, a methodical approach in providing endodontic treatment should be implemented which includes diagnosis, definitive dental treatment and adjunctive drug therapy, known as the "3D" strategy.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the possible "masking" effect of these analgesics on endodontic diagnosis using a novel bite force sensor device.
  
  
  METHODS
  A total of 90 patients with endodontic pain were selected and they were given either a placebo or 400 mg ibuprofen (brufen) or 50mg diclofenac sodium (voveron). Both patients and operators were completely blinded to the drugs administered. Bite force tolerance values were noted before and one hour after administration of medication using the self designed bite force sensor.
  
  
  RESULTS
  The pre- and post-bite force tolerance values were tabulated for both contralateral and affected tooth. For the affected tooth, there was statistically significant difference between pre- and post-bite force tolerance values in Group I (i.e., ibuprofen) and Group II (i.e., diclofenac sodium) (p<0.05) with no significant difference observed in Group III (placebo).
  
  
  CONCLUSIONS
  The easily available over the counter self administered analgesics in addition to providing symptomatic relief to patients suffering from symptomatic apical periodontitis may also cloud the definitive diagnosis of the clinician, thus jeopardising the treatment plan. The self designed bite force sensor was effective in arriving at a definitive diagnosis in teeth with chronic irreversible pulpitis with symptomatic apical periodontitis, where the allodynia has been camouflaged by the use of analgesics like ibuprofen and diclofenac sodium.
authors.affiliation: Postgradutae Student, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India .
authors.forename: Sushil
authors.initials: S
authors.lastname: Kishnani
authors.affiliation: Professor and Head of Department, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India .
authors.forename: Suparna Ganguly
authors.initials: SG
authors.lastname: Saha
authors.affiliation: Reader, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India .
authors.forename: Anuj
authors.initials: A
authors.lastname: Bhardwaj
authors.affiliation: Senior Lecturer, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India .
authors.forename: Sandeep
authors.initials: S
authors.lastname: Dubey
authors.affiliation: Professor and Head of Department, Department of Prosthodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India .
authors.forename: Mainak
authors.initials: M
authors.lastname: Saha
authors.affiliation: Senior Lecturer, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India .
authors.forename: Shubham
authors.initials: S
authors.lastname: Kala
authors.affiliation: Postgraduate Student, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India .
authors.forename: Sohini
authors.initials: S
authors.lastname: Jain
authors.affiliation: Postgraduate Student, Department of Prosthodontics, People's Dental Academy , Bhopal, Madhya Pradesh, India .
authors.forename: Shweta
authors.initials: S
authors.lastname: Narwani
keywords: Diclofenac sodium; Ibuprofen; Pain; Placebo