Effect of Oral Corticosteroid Premedication on the Success of Anaesthetising Mandibular Teeth With Irreversible Pulpitis: A Systematic Review With Meta‐Analysis and Trial Sequential Analysis of Randomized Clinical Trials

OBJECTIVES: This systematic review with meta-analysis and trial sequential analysis (TSA) was conducted with the objective of evaluating the effectiveness of oral corticosteroid premedication to achieve profound mandibular anaesthesia in teeth diagnosed with irreversible pulpitis. METHODS: An electronic search was conducted in PubMed/MEDLINE, Cochrane Library, Embase, Scopus and Web of Science to identify randomized clinical trials that evaluated the effect of oral corticosteroid premedication on the success of mandibular anaesthesia in patients with irreversible pulpitis. The search was performed without date restrictions and limited to trials in English. The risk of bias was assessed using the Cochrane risk of bias tool for randomized trials (RoB 2.0). A random-effects meta-analysis was used to calculate pooled effect risk ratios (RRs) with 95% confidence intervals (CIs). The primary meta-analysis was conducted by including all the trials whilst sensitivity analyses were conducted only on trials with a low risk of bias. Sub-group analyses were performed to assess the dose-response effect. A TSA was performed to evaluate the risks of random errors in the meta-analysis. The overall certainty of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: A total of 8 trials were included in the review. The primary meta-analysis demonstrated that oral premedication with dexamethasone significantly increased the success rate of inferior alveolar nerve blocks (IANB) compared with a placebo (RR = 1.80; 95% CI, 1.35-2.41). The sensitivity analysis demonstrated a similar result compared to the primary analysis. The sub-group analysis suggested that doses of both 0.5 mg and 4 mg were effective. Oral premedication with dexamethasone had the same effect on IANB success rates when compared to NSAIDs. The TSA confirmed that the evidence for a beneficial effect of oral dexamethasone premedication when compared to placebo for enhancing the anaesthetic efficacy of IANB in teeth with irreversible pulpitis was conclusive. The GRADE was rated as 'moderate' and 'high' when oral corticosteroids were compared with placebo and NSAID, respectively. CONCLUSION: Oral corticosteroid premedication improves the efficacy of IANB compared to placebo and has a similar effect when compared to NSAIDs in mandibular teeth diagnosed with irreversible pulpitis. CLINICAL REGISTRATION: PROSPERO (CRD42024508463).