Effect of dental anxiety on the success of inferior alveolar nerve block in symptomatic irreversible pulpitis: A prospective clinical study

Successful anesthesia in symptomatic irreversible pulpitis (SIP) presents a clinical challenge, with psychological factors such as dental anxiety potentially affecting outcomes.This clinical trial aimed to evaluate dental anxiety's impact on the success of inferior alveolar nerve block (IANB) in mandibular molars diagnosed with SIP under standardized preoperative pain conditions. In total, 52 systemically healthy patients with symptomatic irreversible pulpitis in mandibular first molars were included and categorized into low (MDAS ≤10) and moderate-to-high (MDAS ≥11) anxiety groups based on modified dental anxiety scale (MDAS) scores. All participants received IANB with 1.8 mL of 4 % articaine with epinephrine (1:100,000), followed by supplemental buccal-lingual infiltration. Anesthetic success was defined as a VAS score ≤3 during access cavity preparation. Salivary cortisol concentrations, pulse rate, and oxygen saturation were also recorded. The statistical analyses included independent t-tests, Pearson correlation, binary logistic regression, and multiple correspondence analysis. Anesthesia success was significantly higher in the low anxiety group (84.2 %) than the high anxiety group (15.8 %) ( P < 0.001). The high anxiety group had elevated salivary cortisol levels and pulse rates ( P < 0.05). Logistic regression identified salivary cortisol as the only independent predictor of anesthetic failure ( P = 0.010). Dental anxiety was associated with lower success rates of local anesthesia in patients with SIP. Increased salivary cortisol levels were observed in anesthetic failures, indicating its potential relevance as a supportive biomarker; however, these findings should be interpreted with caution, considering that operator proficiency and technique also play critical roles in outcomes.