title: Effect of preoperative oral analgesics on pulpal anesthesia in patients with irreversible pulpitis-a systematic review and meta-analysis.
abstract: OBJECTIVE
  The objectives of this study were to assess the efficacy of preemptive oral administration of single dose of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen on the local anesthetic success in adults with irreversible pulpitis and to find the possible covariates that could predict treatment effect.
  
  
  METHODS
  A systematic search using electronic databases up to March 2015 was conducted. Odds ratio (OR) and 95% confidence intervals (CIs) were estimated using random and fixed-effect inverse variance method. Subgroup and meta-regression analyses were conducted to assess the potential source of heterogeneity.
  
  
  RESULTS
  Results showed that preemptive analgesics are more effective than placebo in increasing anesthetic success (OR = 0.30, CI% 0.24-0.39, p = 0.000) [Q = 55.860 (p = 0.001)]. In the subgroup analysis, administration of NSAIDs as monotherapy, ibuprofen as mono- vs. combination therapy, oxicam type drugs as monotherapy, and acetaminophen as combination therapy were significantly more effective in increasing anesthetic success OR = 0.25, CI% 0.16-0.38, p = 0.00, Q = 40.539 (p = 0.003); OR = 0.44, CI% 0.26-0.75, p = 0.00, Q = 12.833 (p = 0.011); OR = 0.48, CI% 0.30-0.74, p = 0.002, Q = 15.898 (p = 0.14); OR = 0.30, CI% 0.16-0.38, p = 0.001, Q = 7.506 (p = 0.02); OR = 0.10, CI% 0.16 0.38, p = 0.001, Q = 5.075 (p = 0.07), respectively. However, there was no significant difference in increasing anesthetic success between treatment and placebo arms when acetaminophen was administrated alone. In meta-regression analysis, an association between different types of NSAIDs (indomethacin, diclofenac potassium, and oxicam-type drugs) and articaine with treatment effect was observed.
  
  
  CONCLUSIONS
  The administration of preemptive analgesics can induce superior intraoperative analgesia for patients with irreversible pulpitis. However, strategies such as co-administration of certain types of analgesics and anesthetic solution might be predictors of treatment effect. Additionally, there was no association between different timing and dosage of analgesics and treatment effect.
  
  
  CONCLUSIONS
  When compared to placebo, preemptive oral analgesics are superior in achieving anesthetic success in inflamed pulp.
authors.affiliation: Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
authors.forename: Armin
authors.initials: A
authors.lastname: Shirvani
authors.affiliation: Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Evin, Tehran, 1983963113, Iran. saynashams@gmail.com.
authors.forename: Sayna
authors.initials: S
authors.lastname: Shamszadeh
authors.affiliation: Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Evin, Tehran, 1983963113, Iran.
authors.forename: Mohammad Jafar
authors.initials: MJ
authors.lastname: Eghbal
authors.affiliation: Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Evin, Tehran, 1983963113, Iran.
authors.forename: Laleh Alim
authors.initials: LA
authors.lastname: Marvasti
authors.affiliation: Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Asgary
mesh_terms: D000284:Administration, Oral; D000700:Analgesics / Q000008:administration & dosage*; D000766:Anesthesia, Dental / Q000379:methods*; D003782:Dental Pulp / Q000187:drug effects*; D006801:Humans; D059408:Pain Management / Q000379:methods*; D011300:Preoperative Care; D011671:Pulpitis / Q000601:surgery*
chemical_list: D000700:Analgesics
keywords: Analgesics; Irreversible pulpitis; Local anesthesia; Meta-analysis; Systematic review