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Supporting Your Practice

Endo Management of Mandibular Molars with Symptomatic Irreversible Pulpitis

Dr. Mary Dabuleanu
Endodontist, Toronto

Even at the best of times, alveolar nerve blocks are not 100% effective. Despite modern anesthetic skills, a “hot tooth” can still be hard to freeze. But a recent randomized, double-blind clinical trial, published in the Journal of Endodontics, has shown that a pre-operative intraligamentary injection of dexamethasone can significantly improve anesthetic success. It is the first study of its kind to use dexamethasone as a PDL injection.

In this episode of CDA Oasis Live, Dr. John O’Keefe, Director of Knowledge Networks CDA, invites Dr. Mary Dabuleanu, an endodontist from Toronto, to respond to the study and offer her learned opinion as to how this strategy holds much promise in enhancing a mandibular nerve block.

Here are the key takeaways from the conversation:

  • Anatomical variations in patients, along with inflammatory mediators associated with a hot tooth, can affect the success of a nerve block.
  • The article shows that you can significantly improve the success of an anesthetic by preoperatively injecting dexamethasone into the PDL.
  • The injection was administered 30mins prior to giving the inferior alveolar nerve block.
  • Based on the results of the study, dexamethasone is effective. Studies where dexamethasone was given as an oral dose have also shown it to be effective. Other studies have shown that the injection of dexamethasone into the vestibular space around the hot tooth is not effective.
  • It is important that this strategy is used on the right patient. Dexamethasone cannot be used on everybody. Contraindications include:
    • Patients who have had active tuberculosis
    • Ocular herpes/herpetic simplex
    • Hypertension
    • Diabetes
    • Patients with low thyroid hormone
    • Osteoporosis
  • This approach warrants further discussion and research. Backed up by high-grade clinical studies, dexamethasone may be a good tool to use on the right patient.

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team


Full Conversation (11.44")


  1. Brian Jafine July 8, 2021

    where and when was this article published on dexamethasone and improved anesthesia success rates

    1. Mary Dabuleanu July 14, 2021

      It was published in the February 2021 issue of the JOE.

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