Abstract
Background Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various methodologies have been advocated one of which is administration of premedication prior to anesthesia. Despite the considerable number of reports, the topic yet deserves more clarification. This systematic review was conducted to provide an oversight on the effectiveness of premedication prior to IANB in mandibular teeth. Methods A PubMed and Cochrane Database search was conducted by using MeSH terms inferior alveolar nerve block + pulpitis and mandibular anesthesia+pulpitis. Two reviewers independently performed the screening, selection of papers, and data extraction. Papers in English language that included randomized clinical studies on the impact of different medications on the success of inferior alveolar block anesthesia in irreversible pulpitis were included. Additionally, relevant supporting literature was also used where necessary. Results Initially, 118 papers were selected from PubMed and 68 were selected from Cochrane. Five additional articles were retrieved from Google Search. Following the elimination of duplicates and irrelevant articles, 35 studies were selected meeting the criteria. It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of mandibular anesthetic effect in irreversible pulpitis. Conclusion Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification.
Highlights
One of the primary challenges faced by the clinician during endodontic therapy of mandibular teeth is the accomplishment of a successful anesthesia in patients with irreversible pulpitis using the inferior alveolar nerve block (IANB)
The hyperalgesia triggered by the inflammatory process leading to alteration of neural response [4], raised levels of prostaglandins and activation of nociceptors [1], lowered pH which hampers the ability of the anesthetic to penetrate the membrane [1, 5], tetrodotoxin resistant sodium channels shown in human symptomatic dental pulp and trigeminal ganglion [6], the sprouting of the nerve fibers [7], and increase in neuropeptides such as Substance P and calcitonin gene-related peptide (CGRP) resulting in the expression of inflammatory mediators [8] are some suggestions made to explain the reason of anesthetic failure associated with acute symptomatic teeth
This article intended to make a general overview of studies performed on premedication for the stimulation of inferior alveolar nerve block anesthesia (IANB) anesthesia in patients with irreversible pulpitis
Summary
One of the primary challenges faced by the clinician during endodontic therapy of mandibular teeth is the accomplishment of a successful anesthesia in patients with irreversible pulpitis using the inferior alveolar nerve block (IANB). This poses major difficulty from a clinical point of view as an inadequately anesthetized hot tooth with severe pain will lead to elevation of apprehension by the patient and cause distress in the practicing clinician. Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification
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