Background & Aims

Lower premolar and molar teeth diagnosed with symptomatic irreversible pulpitis are a great challenge for the dentist in relation to the anesthetic block of the inferior alveolar nerve (IAN) and, therefore, several strategies have been investigated to increase the effectiveness of this anesthetic technique, but with a low success rate. The objective of this study was to evaluate the additive effect of transcutaneous electrical stimulation (TENS) on the effectiveness of anesthetic blockade of the IAN during emergency endodontic procedures in patients undergoing irreversible pulpitis of lower premolars and molars.

Methods

40 patients diagnosed with symptomatic irreversible pulpitis in mandibular teeth were randomly divided into two groups, TENS (n=20) and Placebo (n=20). Before endodontic procedure, all patients received the medication ketorolac 10 mg (30 minutes) and after that anesthetic blockade of the inferior alveolar nerve was carried out. The primary outcome was the success rate of inferior alveolar nerve blocks in lower premolars and molars with symptomatic irreversible pulpitis, based on the reduction in pain intensity (mild pain < 30) and the need for supplemental anesthesia during the endodontic procedure. Those individuals who presented absence or mild pain, without the need for anesthetic supplementation, were considered responders in relation to the effectiveness of IAN anesthetic blockade. For the data obtained, the chi-square test and T test (p<0.05) were performed.

Results

For the TENS group, the anesthesia success rate was 60%, while for the placebo group, the anesthesia success rate was 25%, with a statistical difference between the groups (p=0.025). For pain intensity as an isolated variable, there was no statistical difference (p=0.133) between the TENS (20.8[21.5]) and placebo (31.3[21.8]) groups.

Conclusions

The use of TENS increased the success rate of inferior alveolar nerve block anesthesia in lower premolars and molars with symptomatic irreversible pulpitis. However, it was insufficient in providing total pain relief and, therefore, in assisting the anesthetic agent to produce complete pulpal anesthesia.

References

1. Aggarwal V, Singla M, Kabi D. Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. J Endod 2010;36:375-8.
2. Elnaghy AM, Elshazli AH, Elsaka SE. Effectiveness of oral premedication of meloxicam, ketorolac, dexamethasone, and ibuprofen on the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, double-blind, randomized controlled trial. Quintessence Int 2023;54:92-9.
3. Kumar U, Rajput A, Rani N, et al. Effect of pre-operative medication with paracetamol and ketorolac on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a double-blind randomized clinical trial. J Dent Anesth Pain Med 2021;21:441-9.
4. Lapidus D, Goldberg J, Hobbs EH, et al. Effect of premedication to provide analgesia as a supplement to inferior alveolar nerve block in patients with irreversible pulpitis. J Am Dent Assoc 2016;147:427–37.
5. Nagendrababu V, Pulikkotil SJ, Veettil SK, et al. Effect of Nonsteroidal Anti-inflammatory Drug as an Oral Premedication on the Anesthetic Success of Inferior Alveolar Nerve Block in Treatment of Irreversible Pulpitis: A Systematic Review with Meta-analysis and Trial Sequential Analysis. J Endod 2018;44:914-922.e2.
6. Nagendrababu, V, Abbott, P, Pulikkotil, S, et al. Comparing the anaesthetic efficacy of 1.8 mL and 3.6 mL of anaesthetic solution for inferior alveolar nerve blocks for teeth with irreversible pulpitis: a systematic review and meta?analysis with trial sequential analysis. Int Endod J 2020;54:331-42.
7. Só GB, Silva IA, Weissheimer T, et al. Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review. Clin Oral Investig 2023;27:1885-97.
8. Topçuo?lu HS, Akp?nar B. The effect of low-level laser therapy on the success rate of inferior alveolar nerve blocks in mandibular molars with symptomatic irreversible pulpitis: A randomized clinical trial. Int Endod J 2021;54:1720-6.

Presenting Author

Yuri Martins Costa

Poster Authors

Leonardo Bonjardim

PhD

University of São Paulo

Lead Author

E-mail

Renan Furlan PhD

UNISAGRADO

Lead Author

E-mail

Paulo Souza MsC

Bauru School of Dentistry, University of São Paulo

Lead Author

E-mail

Rodrigo Vivan PhD

Bauru School of Dentistry, University of São Paulo

Lead Author

E-mail

Murilo Alcalde PhD

Bauru School of Dentistry, University of São Paulo

Lead Author

E-mail

Marco Duarte PhD

Bauru School of Dentistry, University of São Paulo

Lead Author

E-mail

Paulo Conti

University of São Paulo

Lead Author

E-mail

Yuri M. Costa. DDS

Ph.D

University of Campinas

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain