The Efficacy of Oral Dexamethasone in the Management of Symptomatic Irreversible Pulpitis Without Pulpotomy: A Non-Randomized Clinical Trial

Background: Irreversible pulpitis is a severe inflammation of the dental pulp. The purpose of this clinical trial was to evaluate the effectiveness of an inferior alveolar nerve block (IANB) injection followed by oral dexamethasone administration in reducing the pain associated with symptomatic irreversible pulpitis (SIP) in mandibular molars, without performing conventional pulpotomy. Methods: A sample of 80 subjects suffering from acute pain due to SIP on a mandibular molar were assigned to the dexamethasone group, who received an IANB injection followed by one oral dose of 4 mg of dexamethasone during the emergency visit followed by one dose of 4 mg after 8 h, or the control group, who received a conventional pulpotomy. Both groups received complete endodontic treatment after five to six days. The intensity of the preoperative pain and pain levels were measured in both groups at different times after each intervention. The Mann–Whitney U test was used to compare the pain scores between the groups at the same time point, while Friedman’s test was used to compare the pain scores between the four time points within the same intervention group, followed by the Bonferroni correction for multiple pairwise comparisons. Success was determined when the pain score on the visual analogue scale (VAS) was 20 or lower. Results: A survival analysis was conducted, where the event was considered as the disappearance of symptoms (or success: pain score ≤ 20). For both groups, the pain significantly decreased 8 h postoperatively (p < 0.05). The success rates at 8 and 12 h were significantly higher in the dexamethasone group compared to the control group (p = 0.05). However, the pain scores at 24 h remained comparable. Conclusions: An IANB injection followed by 8 mg of oral dexamethasone could reduce pain significantly in patients with SIP without performing conventional pulpotomy. The oral administration of dexamethasone could therefore be a valuable strategy to temporarily alleviate SIP symptoms until definitive treatment becomes feasible. Dexamethasone is a temporary pain management strategy rather than a replacement for pulpotomy.