Page 19 - GP Spring 2020

venience and ease of delivering anesthetic Efficiency of antibiotics alone in con- On comparison of the 4 experimental
solution. Oral dosing and patient compli- trolling pain and inflammation is still con- groups, intraosseous injection of methyl
ance are eliminated by this system and pre- troversial, even though some studies have prenisolone acetate produced significant
vious research has shown that this system shown that tetracyclines and macrolide reduction in pain and percussion pain (p<
has rapid onset of action. This was proved antibiotics were effective in controlling 0.0001) over the 7 day observation period
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to be more successful than periodontal liga- inflammation. Studies showed antibiotics when compared to control group saline, an-
ment injection due to the increased delivery are not useful in controlling pain in acute tibiotic group and emergency pulpectomy
of anesthetic solution. The advantages of irreversible pulpitis, necrotic pulps and lo- group. Pulp testing on seventh day showed
this method are minimal lingering numb- calized abcesses (Fouad et al.,Nagle et al., that 92% of patients of group I had vital
ness, more successful than IAN block for and Agnihotry et al.). Hence, administra- pulp. On day seven in group I when pulpec-
the teeth with acute irreversible pulpitis tion of oral antibiotics was included as an tomy was performed under nerve block all
and the possibility to perform bilateral experimental group in this study to evalu- the patients were pain-free, which may be
mandibular anesthesia due to the absence ate their ability in reducing pain associated due to the anti-inflammatory effect of cor-
of lip and tongue anesthesia in this tech- with acute irreversible pulpitis. ticosteroids.
nique, lesser volume of anesthetic solution
is enough, the anesthetic solution can be Wallace et al. demonstrated that the local On day seven, 92% of the patients in the
added through the already produced perfo- anesthetic agents are not sufficient to pre- methyl prednisolone acetate group (De-
ration, if more amount of anesthesia need- vent impulse transmission as a result of po-Medrol group), 80% of patients in the
ed. The Stabident system has inexpensive their lower excitability thresholds in cases saline group and 85% in the antibiotic
start-up costs, disposable costs, ease of op- of acute irreversible pulpitis. There are few group had vital pulp and had haemorrhag-
,
eration and availability and is mostly sup- factors that led to the increased failure rate ic vital tissue on coronal access. These
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ported by peer-reviewed research (Gallatin of local anesthesia in acute irreversible pul- differences were not of much statistical
et al., Brahmy et al.) as effective. pitis. significance and the teeth may have re-

mained vital due to the anti-inflammatory
Previous research has shown that high dos- 1) The central core theory states that the effects of methyl prednisolone acetate( De-
es of Methyl prednisolone acetate regimens nerve on the outside of the nerve bundle po-Medrol) in group I. 20% of patients (4
when used with precautions are safe in rou- supply molar teeth while the nerve on the patients) in the saline group (group II) test-
tine treatment. Methyl prednisolone is a inner supply the anterior teeth. ed negative to vitality testing since the pulp
slow-releasing acetate form which is usu- had undergone necrosis. However, the re-
ally administered for acute dermatitis and 2) Local acidosis (lowering of pH) due to maining 80% of patients (16 patients) had
other diseases because of its prolonged an- tissue inflammation causes trapping of vital pulp. 85% of patients in the antibiotic
ti-inflammatory effect in single high dose ions in local anesthetic molecules. As a re- group (group III) had vital pulp since an-
of 80-120mg, which can be repeated every sult, the local anesthetic molecules which tibiotics do not reduce the pain associated
5 to 10 days, if necessary. Since methyl cross the nerve membrane reduces. There with symptomatic irreversible pulpitis, in
prednisolone is a slow-releasing acetate is less of the ionized form within the nerve the absence of any systemic involvement.
form, the 40mg dose used in this study is to achieve anesthesia. The polymicrobial nature of the infection,
considered very safe. The other reason for and the empirically prescribed antibiotic
using the 40mg dose in this study was be- 3) Activation of nociceptors by inflamma- (Amoxicillin 500mg), a broad spectrum an-
cause this is the amount available in 1ml, tory mediators can be another reason for tibiotic not eliminating the infection could
and is an appropriate intraosseous dose. anesthetic failure. be the reasons for persistent infection. It
Also, at this dose effective anti-inflamma- is assumed that irreversibly damaged pulp
tory effects can be achieved. 4) Central sensitization, which is the in- will continue to degenerate until the pulp
creased excitability of central neurons and becomes necrotic if this condition is not
Intraosseous injection can be used as pri- is a major central mechanism, can lead to endodontically treated.
mary anesthetic technique to achieve ad- hyperalgesia. The suggested hypotheses for
equate pulpal anesthesia in both healthy reduction in mechanical pain thresholds in The number of analgesics taken by all the
and inflamed pulp. Intra-osseous injection teeth with irreversible pulpitis includes: patients was recorded. Over the 7 day peri-
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when used as a primary anesthetic tech- od, no patients in the methyl prednisolone
nique in non-inflamed teeth provides ade- • Sensitization of pulpal mechano- group took any analgesics. On day one, 18
quate pulpal anesthesia in 75% of mandib- receptors patients in the saline group, 13 patients in
ular molars and 93% of maxillary molars. the antibiotic group and 10 patients in the
• Sensitization of peri-radicular lidocaine group required analgesics for
In a survey conducted by Bangerter et al. mechanoreceptors pain control. These patients continued to
of U.S. endodontists, the most common use take analgesics over the 7 day period. On
of intraosseous injection was 62.19% for • Result of central sensitization day seven, 7 patients in the saline group,
symptomatic irreversible pulpitis followed Anatomical factors, thickness and density 7 patients in the antibiotic group and 3 pa-
by 11.04% for reversible pulpitis, 7.06% for of alveolar bone, decreased pain thresh- tients in the lignocaine group still required
normal pulp and 4.91% for necrotic pulp. old, action of inflammatory mediators like analgesics. Reduction in pain in these
Intraosseous anesthesia was used most in bradykinin and prostaglandins, incomplete groups over 7 day period is attributed to the
the posterior mandible (48.04%) followed blockage of impulse transmission due to usage of analgesics.
by the posterior maxilla (21.12%), anteri- central sensitization are other accepted rea-
or mandible (16.85%) and anterior maxilla sons for anesthetic failures. 8
(13.98%).

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