Discussion
pulpitis, Pain, anxiety, toxicity, hypoxia, pain, intraoperative pain, teeth, tissue damage
PULPITIS, HYPOXIA, INFLAMMATION, ADVERSE EFFECTS, SECONDARY, COLD
Limited data are available regarding the IANB's efficacy to anesthetize the mandibular permanent teeth with SIP in patients younger than 18 years. The null hypothesis (For the sake of standardization, only patients with closed mandibular first permanent molar apexes suffering from SIP were included in the trial. Ice packs for candidates in the experimental group were applied for 5 min unless a burning sensation or cold intolerance was reported. Our findings showed no adverse effects after cryotherapy application for 5 min. A similar application time was adopted in a previous study [Several studies have stressed the positive association between the intensity of preoperative pain and intraoperative pain during endodontic treatment [To control other factors that could influence the participant’s intraoperative pain, including operator factors, two pediatric dentists were responsible for IANB injection and ice pack placement independently, and a single experienced operator accredited to perform endodontic treatment and adopting identical preoperative restrictive inclusion standards were applied. To control patient- and teeth-related factors such as the preoperative pulp condition, the thermal and the EPT and patients without preoperative analgesic intake within the previous 12 h were exclusively included [The average onset of pulpal anesthesia following IANB and 4% articaine with 1:100,000 epinephrine was varied. Some articles reported an average onset of 4.2 min [Before determining the volume of local anesthesia, two main considerations have been taken into account. First, patients with a minimum weight of 35 kg were included. This guaranteed not exceeding the maximum dose recommended by the American Academy of Pediatric Dentistry (AAPD) and avoiding systemic toxicity [Pain intensity was measured using the VAS, which was accredited in the current study because of its adequate psychometric properties. The VAS is easily applied in clinical practice with excellent inter-observer and test–retest reliability, repeatability, acceptability, responsiveness, and validity [Pain intensity in the cryotherapy group was significantly less than that in the control group. Our overall success rate in the cryotherapy group was 59.2%. This was in line with the overall success rate reported by Topçuoglu et al. [The mechanism of action of cryotherapy when applied to the mucosal soft tissues is to include vasoconstriction that lowers the cellular oxygen demand (i.e., hypoxia) and subsequently diminishes cellular metabolism, leading to less tissue damage [Our findings showed that the greater the extent of pulp inflammation, the lesser the efficacy of the IANB technique. The application of cryotherapy failed to enhance the efficacy of IANB when preoperative pain scores were severe. The difference between the two groups was insignificant. In the case of SIP, peripheral and central sensitization were exaggerated, resulting in higher pain thresholds than in normal pulp tissues [The reported success rates of IANB in the mandibular teeth with SIP in patients below the age of 18 were varied. Chompu-inwai et al. [Regarding the secondary outcome results, the need for supplementary ILI was still mandatory in both groups. Meanwhile, it occurred significantly less frequently in the cryotherapy group than in the control group. The low success rate of routine IANB among teeth diagnosed with irreversible pulpitis increases the demand for supplementary anesthesia [The main strengths of this study were the adequate sample size and the rigorous measures to ensure higher standardization qualities. The study’s limitation was the lack of subject masking of the nature of the treatment. Another problem could arise from the complex nature of pain. Some factors, including preoperative anxiety and different pain thresholds, may influence the subjective scoring system. However, the randomization process ensured equal distribution of different determinants. Finally, most of the available data, especially those related to cryotherapy, were related to adults’ teeth older than 18 years, therefore comparing our results to previously published data has to be taken into consideration. To cover this point, further prospective clinical trials need to be conducted with the same age group.