Effect of Oral Corticosteroid Premedication on the Success of Anaesthetising Mandibular Teeth With Irreversible Pulpitis: A Systematic Review With Meta-Analysis and Trial Sequential Analysis of Randomized Clinical Trials.
Nandini Suresh, Monika Arulalan, Geethanjali Ravindra Raj et al.
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In 30 seconds
This systematic review and meta-analysis of randomized clinical trials assessed whether oral corticosteroid premedication improves inferior alveolar nerve block (IANB) success in patients with mandibular teeth diagnosed with irreversible pulpitis. Eight trials were included. Compared with placebo, oral dexamethasone increased IANB success (RR = 1.80; 95% CI, 1.35-2.41); subgroup analyses suggested benefit with both 0.5 mg and 4 mg doses. Dexamethasone had a similar effect on block success to NSAIDs. The authors rated evidence as moderate for comparisons with placebo and high for comparisons with NSAIDs.
Key findings
- Across eight trials, dexamethasone increased IANB success versus placebo (RR = 1.80; 95% CI, 1.35-2.41).
- Subgroup analysis suggested that both 0.5 mg and 4 mg dexamethasone doses were effective.
- Dexamethasone and NSAIDs had similar effects on IANB success; evidence certainty was rated high for this comparison.
Why it matters
Achieving profound anaesthesia can be challenging in teeth with irreversible pulpitis. This synthesis indicates that oral dexamethasone premedication may improve IANB success compared with placebo, while showing no reported advantage over NSAIDs. The findings help frame the potential role of premedication, but do not establish that one option is preferable for every patient or clinical context.
What to keep in mind
The review included only eight trials, and the search was limited to English-language trials. The abstract does not report pooled absolute success rates.