Comparative evaluation of anesthetic efficacy of warm, buffered and conventional 2% lignocaine for the success of inferior alveolar nerve block (IANB) in mandibular primary molars: A randomized controlled clinical trial

Background. Maintaining primary teeth in the oral cavity is of prime importance, and grossly carious teeth may require pulp therapy to this end. Pain on injection and incomplete anesthesia causes failure of the procedure, resulting in fear and anxiety. Various methods have evolved to overcome this, such as distraction, topical anesthesia, etc. A new technique gaining popularity in dentistry in recent times is the warming or buffering of the solution prior to administration. Thus the aim of this study was to compare and evaluate the anesthetic efficacy and the patient’s pain reaction to pre-warmed, buffered and conventional 2% lignocaine for the success of the inferior alveolar nerve block (IANB) technique in mandibular primary molars undergoing pulp therapy. Methods. In this randomized, split-mouth clinical trial, sixty children 6‒12 years of age, requiring pulp therapy bilaterally on mandibular primary molars, were administered conventional, buffered or pre-warmed 2% lignocaine on two separate appointments. Various parameters were assessed using objective and subjective scales. Results. Pre-warmed and buffered anesthetics resulted in less pain on injection (P<0.001, P<0.001) and during pulp therapy (P=0.001, P=0.014), faster onset of action (P=0.004, P=0.001), lower SEM Sound (P=0.035, P=0.028), Eye (P<0.001, P=0.013) and Motor (P=0.008, P=0.021) scores and shorter duration of action (P<0.001, P=0.015). No significant difference was found between the two modified solutions. Thus pre-warmed and buffered anesthetic solutions fared better than the conventional solution for all the parameters but had no advantage over each other. Conclusion. Buffering or pre-warming the anesthetic solution reduced pain on administration and during the procedures in children.