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Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review

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Abstract

Introduction

The aim of the present umbrella review was to answer the following question: “Does the use of NSAIDs as premedication increase the efficacy of the standard inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?”

Material and methods

Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were searched in six electronic databases (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Grey Literature Reports), without the restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies.

Results

Twelve systematic reviews were included. Only one did not perform a meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high. In general, the main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with acetaminophen, and ketorolac) increased the success rate of the inferior alveolar nerve block.

Conclusions

From the “very low” to “high”–quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenase pathways and block the synthesis of specific prostaglandins that complicate the mechanism of action of the anesthesia, improving its success rate.

Clinical relevance

Non-steroidal anti-inflammatory drugs can increase the success rate of the anesthetic technique of inferior alveolar nerve block efficacy in situations of mandibular molars with symptomatic irreversible pulpitis.

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Authors and Affiliations

  1. Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil

    Gabriel Barcelos Só, Isadora Ames Silva, Theodoro Weissheimer, Tathiane Larissa Lenzi, Marcus Vinicius Reis Só & Ricardo Abreu da Rosa

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  1. Gabriel Barcelos Só
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  2. Isadora Ames Silva
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  3. Theodoro Weissheimer
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  4. Tathiane Larissa Lenzi
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Contributions

Gabriel Barcelos Só: investigation, writing—original draft

Isadora Ames Silva: investigation, writing—original draft

Theodoro Weissheimer: investigation, methodology, data curation, writing—review and editing

Tathiane Larissa Lenzi: methodology, formal analysis, validation

Marcus Vinícius Reis Só: visualization, formal analysis, writing—review and editing

Ricardo Abreu da Rosa: concept, supervision, project administration

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Correspondence to Ricardo Abreu da Rosa.

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Só, G.B., Silva, I.A., Weissheimer, T. et al. Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review. Clin Oral Invest 27, 1885–1897 (2023). https://doi.org/10.1007/s00784-023-04979-3

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