This randomized, double-blind clinical trial aimed at the evaluation of the effect of adding dexamethasone to 2% lidocaine, given as inferior alveolar nerve block in the endodontic management of symptomatic irreversible pulpitis. One hundred and twenty four patients received one of the three IANB injections before the endodontic treatment: 2% lidocaine with 1:80 000 epinephrine; 2% lidocaine with 1:80 000 epinephrine mixed with 2mg dexamethasone; and plain 2% lidocaine mixed with 2mg dexamethasone. The anesthetia was considered successful if the patients experienced no pain or faint/weak/mild pain during root canal access preparation and instrumentation (HP VAS score <55 mm). The effect of intraligamentary injections on maximum heart rates was also recorded.

Inclusion Criteria:

• absence of any periapical radiolucency on radiographs, except for a widened periodontal ligament
• active pain in a mandibular molar
• prolonged response to cold testing with an ice stick and an electric pulp tester
• vital coronal pulp on access opening and ability to understand the use of pain scales

Exclusion Criteria:

• a history of known or suspected drug abuse
• history of active peptic ulcer within the preceding 12 months
• history of bleeding problems or anticoagulant use within the last month
• known allergy, sensitivity, or contraindications to any opioid or nonopioid analgesic including aspirin or NSAIDs
• patients who had taken NSAIDs within 12 h before administration of the study drugs
• patients who were pregnant or breast-feeding

Immediately after publication

Immediately after publication