Emerging role of cryotherapy and steroids in management of local anaesthetic failure
Résumé
Endodontic pain is a disruptive event to all clinicians and patients. When performing dental treatment on teeth with clinically healthy pulps, efficient and adequate local anesthesia is the fundamental basis for dental pain control. Nevertheless, when managing patients with acutely inflamed pulps, local anesthesia is actually much less efficient. Clinical trials have reported that an IANB injection of a local anesthetic solution is inefficient in 30 to 80% of patients diagnosed with acute irreversible pulpitis. Therefore, pain management of lower molars with symptomatic irreversible pulpitis is usually a challenge to the endodontist. Many efforts have been made to implement various pharmaceutical and non-pharmaceutical agents to control the inflammatory processes leading to pulpal pain. These agents chiefly included NSAIDs and synthetic steroids, along with other modalities such as cryotherapy and acupuncture. The effect of steroids and cryotherapy on the success rates on IANBs when treating lower molars with symptomatic acute pulpitis was investigated in a few studies to increase the efficiency and duration of nerve block in these cases. The goal of this review is to highlight the role of steroids and cryotherapy in increasing the success rate of IANB and to point out the clinical studies concerned with both modalities.
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