Addition of 2 mg dexamethasone to improve the anesthetic efficacy of 2% lidocaine with 1:80,000 epinephrine administered for inferior alveolar nerve block to patients with symptomatic irreversible pulpitis in the mandibular molars: a randomized double-blind clinical trial

Methods@#In a double-blinded setup, 124 patients randomly received either of the following injections: 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, or plain 2% lidocaine mixed with 2 mg dexamethasone, which were injected as a primary IANB. Ten minutes after injection, patients with profound lip numbness underwent electric and thermal pulp sensibility tests. Patients who responded positively to the tests were categorized as “failed” anesthesia and received supplemental anesthesia. The remaining patients underwent endodontic treatment using a rubber dam. Anesthetic success was defined as “no pain or faint/weak/mild pain” during endodontic access preparation and instrumentation (HP visual analog scale score < 55 mm). The effect of the anesthetic solutions on the maximum change in heart rate was also evaluated. The Pearson chi-square test at 5% and 1% significance was used to analyze anesthetic success rates. @*Results@#The 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, and plain 2% lidocaine mixed with 2 mg dexamethasone groups had anesthetic success rates of 34%, 59%, and 29%, respectively. The addition of dexamethasone resulted in significantly better results (P < 0.001, χ 2 = 9.07, df = 2). @*Conclusions@#The addition of dexamethasone to 2% lidocaine with epinephrine, administered as an IANB, can improve the anesthetic success rates during the endodontic management of symptomatic mandibular molars with irreversible pulpitis.

Post-endodontic pain: factors involved and analgesics

Despite significant advances in dentistry, pain after root canal therapy is still of concern for both patients and dentists. Although the pain does not necessarily indicate endodontic failure, relief of this pain is very important for the patient. In addition, the ability to prevent or control this pain is an important factor for a dentist's professional success. Pain in endodontics is usually due to a periapical inflammatory reaction, which occurs before, during, or following various endodontic procedures. The severity of the inflammatory response is variable, depending on local and systemic factors. The cause of pain and/or swelling in endodontic therapy is not always clear. There are numerous factors accounting for endodontic pain, suggested by researchers. These factors may be classified into three main groups: latrogenic factors, patient factors, and intracanal factors. The most important factor in controlling post-endodontic pain is to have sufficient knowledge about the causes of the problem and to prevent them. The aim of this review article is to discuss factors involved in post-endodontic pain and offer techniques, including the use of analgesics, to prevent or relieve the pain

apical sealing ability of AH26, AH Plus and ZOE root canal sealers

It has been established that success of the root canal treatment depends on the quality of root canal obturation. The aim of this study was to compare the apical sealing ability of three root canal sealers. The apical sealing ability of root canal sealers AH26, AH Plus and zinc-oxide eugenol [ZOE] were tested on 100 single-rooted teeth. The coronal part of each tooth was removed about 2mm above the cementoenamal junction. Root canals were instrumented using the "Step-Back" technique using hand files and Gates Glidden drills and irrigated with 2.5% sodium hypochlorite. The teeth were divided into three groups of 30 teeth each and filled with test sealers and gutta-percha points by the cold lateral condensation technique. Ten teeth were used as control groups [five served as negative and five as positive controls]. The teeth were immersed in 2% methylene blue for 3 days. The teeth were then longitudinally sectioned and evaluated for linear apical dye penetration. The differences in leakage among AH26 [2.08mm;SD 0.215], AH Plus [3.64mm;SD 0.182] and ZOE [5.41mm;SD 0.274] were statistically significant [P<0.05].Under the conditions of this study, all three sealers allowed some leakage to occur. Significantly less leakage occurred with both epoxy resin sealers [AH26, AH Plus] than ZOE. Leakage with AH26 was significantly less than AH Plus