Do oral steroids or painkillersNon steriodal anti inflammatory drugs (NSAID’S) help dentists numb lower back teeth better in patients with severe toothache?
Comparing preoperative oral steroids to Non steriodal anti inflammatory drugs (NSAIDs)on anesthetic success of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis
Dr Fawad Ali shah- Khyber college of dentistry
60 participants
Jun 2, 2025
Interventional
Conditions
Summary
Providing effective pulpal anesthesia in mandibular molars with symptomatic irreversible pulpitis (SIP) remains a clinical challenge due to high failure rates of inferior alveolar nerve block (IANB). Inflammation-induced sensitization of peripheral nociceptors is considered a key factor reducing anesthetic success in such cases. Various adjunctive techniques and premedications have been explored to improve outcomes, including NSAIDs, steroids, and other agents. Dexamethasone and ketorolac, through their anti-inflammatory mechanisms, may enhance anesthetic efficacy when administered orally before IANB. This study aims to compare the effectiveness of preoperative oral dexamethasone (4 mg) and ketorolac (10 mg) in improving IANB success in mandibular molars with SIP.
Eligibility
Inclusion Criteria3
- Patients classified as ASA class 1, who are systemically healthy and aged between 18 and 60 years, diagnosed with irreversible pulpitis of a mandibular molar.
- The radiographic image shows no evidence of changes in the periapical region.
- Participants capable of comprehending the utilization of a pain scale.
Exclusion Criteria2
- Teeth presenting a history of trauma, immature apices, or necrotic pulps post-access opening.
- Immune deficiencies, pregnancy, previous allergic reactions to local anesthetic solutions or any of the experimental drugs, recent intake (within twelve hours) of antibiotics, analgesics, or sedatives prior to endodontic treatment as part of the study, and prolonged medication use.
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Interventions
Participants will be consecutively recruited and allocated into intervention groups using a non-randomised, consecutive allocation method determined by investigator discretion. 1. Dexamethasone group (Dexa group): Participants will receive a single oral dose of dexamethasone 4 mg, concealed in a coded container, administered one hour before the procedure. 2. Ketorolac group (Keto group): Participants will receive a single oral dose of ketorolac 10 mg, concealed in a coded container, administered one hour before the procedure. The assigned medication will be administered one hour prior to the inferior alveolar nerve block (IANB) procedure. One hour after drug intake, local anesthesia containing 2% lidocaine will be administered using the standard IANB technique. Participants will be asked to report the onset of lip numbness. Pulpal anesthesia will be assessed using electric pulp testing (EPT) at 10 minutes and 15 minutes post-anesthesia. Two consecutive negative EPT responses will confirm pulpal anesthesia. Endodontic access cavity preparation will then be initiated under rubber dam isolation. The presence or absence of pain during access or instrumentation will be recorded. Anesthetic success will be defined as absence of pain during the procedure.
Locations(1)
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ACTRN12626000147381