Anesthetic Success Rate of Inferior Alveolar Nerve Block for Mandibular Molars with Symptomatic Irreversible Pulpitis in Women Taking Antidepressants

Abstract

Introduction The inferior alveolar nerve block (IANB) is the most routinely used technique to achieve local anesthesia in mandibular molars 1, However, clinical studies have reported a failure rate of 44%-81% for the IANB in mandibular molars with irreversible pulpitis 2-4, Some reasons have been reported for the local anesthetic failure, including anatomic causes, acute tachyphylaxis, inflammation, local tissue acidosis and central sensitization 5, 6. In addition, as a prominent features of depression, anxiety is considered a potential cause of IANB failure in patients who report pain after receiving local anesthetics 6, Anxiety and depression have been evaluated in adults and commonly women show more prevalence than men 7, Depression occurs when small amounts of serotonin neurotransmitter is available in nerve synaptic spaces. As a mediator of endogenous analgesic mechanisms in descending pain pathways, serotonin facilitates nerve signal transmission, mood regulation, sleep and a variety of brain functions 8. Selective serotonin reuptake inhibitors (SSRIs) are believed to be the first line of treatment for anxiety and depressive disorders as a relatively new generation of antidepressants 9, SSRIs inhibit the reuptake of serotonin (5-hydroxytryptamine or 5-HT) from synaptic spaces into the presynaptic cells increasing the concentration of serotonin in the synaptic space and stimulate serotonergic functions within the central nervous system. SSRIs include citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline and are the most widely prescribed class of antidepressants around the world. Table 1 presents the adult therapeutic dosages for SSRIs 10. Benzodiazepines have virtually been replaced by SSRIs worldwide 11, Given the impact of anxiety on the failure of IANB 6, it is hypothesized that anti-anxiety medications may increase the success rate of IANB. However, a review on literature provides conflicting results regarding the effects of a single dose of these medications such as benzodiazepines, on the success of IANB in patients without anxiety disorder 12-14, To the best of our knowledge the success rate of IANB in patients with anxiety disorder treated with SSRIs remains unexplored. However, it would be appropriate to evaluate the effect of taking SSRIs on the success of the IANB in patients with anxiety disorder. Therefore, this study aimed to evaluate the anesthetic success rate of the IANB for mandibular molars with symptomatic irreversible pulpitis in women treated with SSRI antidepressants. The null hypothesis was that taking SSRIs would not increase the anesthetic success rate of the IANB for mandibular molars with symptomatic irreversible pulpitis in women. © 2022, Iranian Association of Endodontics. All rights reserved.