Comparison of Effect of Oral Premedication with Ibuprofen or Dexamethasone on Anesthetic Efficacy of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind Study

Abstract

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of preoperative oral administration of ibuprofen or dexamethasone on the success rate of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Seventy-eight patients with irreversible pulpitis were randomly divided into 3 groups (26 per group) and given one of the following at 1 hr prior to performing local anesthesia: a placebo; 400 mg ibuprofen; or 4 mg dexamethasone. Each patient recorded their pain level on a visual analog scale before taking the medication or placebo, at 15 min after completion of IANB, and during treatment if pain occurred. The success of the anesthesia was defined as no or mild pain at any stage during the endodontic procedure. The success rate of the IANB was 38.5, 73.1, and 80.8% with the placebo, ibuprofen, and dexamethasone, respectively. Both ibuprofen and dexamethasone were significantly more effective than the placebo. No significant difference was observed, however, between the two experimental medications in terms of effectiveness. The results of the present study suggest that premedication with ibuprofen or dexamethasone increases the success rate of an IANB in patients with symptomatic irreversible pulpitis in the mandibular molars.

The effect of pre‐operative submucosal administration of dexamethasone, tramadol, articaine on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: A randomized, double‐blind placebo‐controlled clinical trial

“…Aggarwal et al (2021) reported an anaesthesia success rate of 73% with intraligamentary dexamethasone injection applied in addition to standard IANBs using lidocaine in mandibular molars with SIP. Bidar et al (2017) registered a success rate of 80.8% using a pre-operative oral dose of 4 mg dexamethasone, which increased the pulpal anaesthesia success rate significantly in comparison to the control group. In the present study, with the pre-operative submucosal use of 8 mg dexamethasone, the pulpal anaesthesia success rate (47%) was higher than the control group (37%) and lower than the tramadol (57%) and articaine (63%) groups.…”

“…One of the methods used for increasing pulpal anaesthetic effectiveness is submucosal injection that is administered to the buccal of the affected tooth (Aksoy & Ege, 2020b;Isiordia-Espinoza et al, 2012). This study investigated the effectiveness of pre-operative articaine (whose anaesthetic activity is well-known), tramadol (Ege et al, 2018) and dexamethasone (Bidar et al, 2017;Shahi et al, 2013), which are generally used for post-operative pain management but have recently been reported to increase the anaesthetic activity of standard IANBs.…”

“…Previous studies have shown that submucosal (Aksoy & Ege, 2020b) and supraperiosteal (Mehrvarzfar et al, 2008) infiltration of dexamethasone and the oral administration of its capsule form (Shahi et al, 2013) reduced pain significantly in patients with SIP. Studies have also demonstrated that, in addition to its analgesic activity, dexamethasone applied to patients with SIP also increased the effectiveness of IANB anaesthesia (Aggarwal et al, 2011;Bidar et al, 2017;Kumar et al, 2021;Shahi et al, 2013). A systematic review and network meta-analysis reported that, in comparison with the placebo, oral doses of dexamethasone increased the duration of anaesthesia.…”

Effect of Premedication on the Success of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Systematic Review of the Literature

“…Nevertheless, it is apparent from these studies that no matter which type of medication is used, standardization with respect to dosage as well as initial diagnosis is essential in these types of studies to obtain more reliable results. A recent study also compared the use of ibuprofen with dexamethasone and concluded that both medications increased the success rate of IANB; however there were no significant differences between the two [67]. Their findings on the success of ibuprofen were contradictory to those reported by Aggarwal et al [37], Oleson et al [44], and Shahi et al [31] where ibuprofen was found to have no significant effect.…”

Endodontic Epidemiology: A Systematic Review and Meta-Analysis

“…Literature suggests and advocates for multiple visits so as to reduce the microbes in the canal much as there is no statistical significance in the number of visits [3,5]. Pain and flare-up occurs post-operatively warranting the use of analgesics pre-operatively in some cases such as ibuprofen and at times dexamethasone post-operatively [6]. Moreover, pain being a subjective phenomenon occurs post-operatively after instrumentation regardless of whether it was done in a single or multiple sitting.…”