title: Effect of Sodium Bicarbonate Buccal Infiltration on the Success of Inferior Alveolar Nerve Block in Mandibular First Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Double-blind Study.
abstract: BACKGROUND
  The purpose of this prospective, randomized, double-blind study was to evaluate the effect of a buccal infiltration of sodium bicarbonate on the anesthetic success of the inferior alveolar nerve block (IANB) for mandibular first molars in patients with symptomatic irreversible pulpitis.
  
  
  METHODS
  One hundred patients diagnosed with symptomatic irreversible pulpitis of a mandibular first molar were selected. The patients randomly received a buccal infiltration injection of either 0.7 mL 8.4% sodium bicarbonate with 0.3 mL 2% lidocaine containing 1:80,000 epinephrine or 0.7 mL sterile distilled water with 0.3 mL 2% lidocaine containing 1:80,000 epinephrine in a double-blind manner. After 15 minutes, all the patients received conventional IANB injection using 3.6 mL 2% lidocaine with 1:80,000 epinephrine. Access cavity preparation was initiated 15 minutes after the IANB injection. Lip numbness was a requisite for all the patients. Success was determined as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed using the t, chi-square and Mann-Whitney U tests.
  
  
  RESULTS
  The success rate after the buccal infiltration of sodium bicarbonate was 78%, whereas without the buccal infiltration of sodium bicarbonate it was 44% (P < .001).
  
  
  CONCLUSIONS
  A buccal infiltration of 0.7 mL 8.4% sodium bicarbonate increased the success rate of IANBs in mandibular first molars with symptomatic irreversible pulpitis.
authors: Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Masoud
authors: M
authors: Saatchi
authors: Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Ali Reza
authors: AR
authors: Farhad
authors: Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: naghmeh.shenasa@gmail.com.
authors: Naghmeh
authors: N
authors: Shenasa
authors: Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Saeideh Karimi
authors: SK
authors: Haghighi
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000278:Administration, Buccal; D000293:Adolescent; D000328:Adult; D000766:Anesthesia, Dental / Q000379:methods; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects*; D008875:Middle Aged; D008963:Molar / Q000187:drug effects*; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D011446:Prospective Studies; D011671:Pulpitis / Q000188:drug therapy / Q000503:physiopathology*; D018915:Root Canal Preparation / Q000379:methods; D017693:Sodium Bicarbonate / Q000008:administration & dosage* / Q000493:pharmacokinetics; D055815:Young Adult
chemical_list: D000759:Adjuvants, Anesthesia; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D017693:Sodium Bicarbonate
keywords: Acid-sensing ion channel; inferior alveolar nerve block; irreversible pulpitis; local anesthesia; transient receptor potential vanilloid receptor type 1