The efficacy of orally administered dexamethasone in the management of symptomatic irreversible pulpitis without performing pulpotomy : An open clinical trial

Description :

Patients suffering from acute pain due to symptomatic irreversible pulpitis on a lower mandibular molar will be included . The participant will receive verbal description of the study design . Demographic information, medical and dental history, relevant clinical examination, and periapical radiographs will be taken, and all data (including age, sex, pulpal status, pain intensity, and duration of pain) will be recorded on the patient chart. Before the injection, the method that will be used to measure preoperative pain intensity will be the Visual Analog Scale (VAS) on a scale of 0 (no pain) to 100 (worst pain imaginable). All patients will receive standard injections using 2 mL 4 % bupivacaine (long acting anesthetic) with 1: 200000 epinephrine. Standard IANB injections using long needles will be performed and all available techniques of additional injections will be performed. The anesthesia procedures will be performed to all patients by the same operator. After the anesthesia, we will proceed to the realization of the access cavity. If during this stage and after all available techniques of anesthesia have been done, the patient still feels acute pain and we find ourselves in an impossibility to initiate an access cavity, 4mg of oral dexamethasone will be administered. The patient will be asked to take immediately the corticosteroid tablet that will be provided. Each patient will receive one oral dose of dexamethasone (4 mg) during the emergency visit and will be advised to take 4 mg after 8 hours. The patient will then be dismissed. The patient will be contacted by telephone to evaluate the incidence of pain during the same day and until pain relief. Any adverse events or symptoms will be recorded at this time. The method used to measure postoperative pain intensity will be the Visual Analog Scale (VAS). The patient will be instructed to complete the pain diary on the VAS. The pain VAS will be measured 4 times / 1- at baseline, 2- right before the second dose (8 hours after the first dose at office), 3- 12 hours after the first dose, 4- 24 hours after. A list of analgesics that the patient is entitled to take in case of pain will be provided. A second visit will be programmed with each patient to perform pulpotomy or endodontic treatment. The 2nd visit will be programmed 3 to 5 days after the date of the initial visit.