Sublingual Triazolam's Effect on Intraosseous Injection Pain with Irreversible Pulpitis

Objectives: The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of sublingual triazolam (Halcion) on the pain of the supplemental intraosseous injection in patients with irreversible pulpitis.

Methods: Fifty-eight emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, randomly received either a 0.25 mg triazolam lozenge (30 patients) or a placebo lozenge (28 patients) which was placed sublingually 30 minutes prior to initiation of endodontic treatment. A registered pharmacist compounded the lozenges and assigned random numbers to blind the investigator and patients to the content of the lozenges. The Corah Dental Anxiety Scale was used to measure anxiety. Twenty-nine patients received an inferior alveolar nerve block and had failure (moderate to severe pain) when endodontic access or initial instrumentation was performed. The Stabident intraosseous injection was then administered using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. Patients were asked to rate the pain experienced during perforation and solution deposition using a Heft-Parker visual analog scale (VAS).

Results: Moderate-to-severe pain was experienced by 59% of the triazolam patients and 42% of the placebo patients for perforation and by 35% and 25%, respectively, for solution deposition. As analyzed by a Tukey-Kramer test, there was no significant difference between the triazolam and placebo patients.

Conclusion: Conscious sedation with triazolam, when compared to a placebo, did not statistically decrease the pain of the supplemental intraosseous injection in patients with irreversible pulpitis.