The role of prophylactic ibuprofen and N-acetylcysteine on the level of cytokines in periapical exudates and the post-treatment pain

To evaluate the role of prophylactic ibuprofen and N-acetylcysteine (NAC) on the levels of tumor necrosis factor alpha (TNF- α), interleukin- 6(IL-6) and IL-17 and post-treatment pain level in chronic periapical lesions.Eighty patients with chronic apical lesions less than 1？cm were randomly assigned to receive NAC tablets (400？mg), ibuprofen tablets (400？mg), NAC (400？mg)/ibuprofen (200？mg) combination and placebo 90 minutes prior to sampling. Periapical exudates were collected from root canals. TNF- α, IL-6 and IL-17 levels were determined by ELISA and post-treatment pain was assessed using a visual analog scale (VAS).There was a significant difference in IL-6 level between ibuprofen group and placebo (p？=？0.019). Significant difference in IL-17 level was observed between NAC/ibuprofen combination group and placebo (p？=？0.043). Four hours after treatment, a significant difference was observed in VAS pain score between ibuprofen group and placebo (p？=？0.017). Eight hours post-treatment, VAS pain score for NAC group was statistically lower than placebo group (p？=？0.033). After 12 hours VAS pain score showed a significant decrease in NAC group compared to placebo (p？=？0.049).The prophylactic ibuprofen and NAC failed to clearly reflect their effect on cytokines levels in exudates of chronic periapical lesions. On the other hand it seems that NAC can be a substitute for ibuprofen in the management of post endodontic pain.Periapical lesions are inflammatory diseases that develop as result of root canal bacterial infections and may result in periapical bone destruction because of host defensive–microbial disturbances [1,2]. Neutrophil granulocytes, among infiltrating leukocytes, are the first line of defense which stimulate the migration of monocytes and lymphocytes [3]. Infiltrates of mononuclear cell, composed of antigen-presenting cells, T and B lymphocytes and their effectors are characteristic of chronic periapical processes [3]. Cytokines are low-weight messenger m