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Oral squamous cell carcinoma (OSCC) is a malignant disease in the world which has a profound effect on human health and life quality. According to tumor stage and pathological diagnosis, OSCC is mainly treated by combinations of surgery, radiotherapy and chemotherapy. However, traditional treatment methods suffer from some limitations, such as systemic toxicity, limited therapeutic effect and drug resistance. With the rapid development of nanotechnology, nanodrug delivery systems (DDSs) and intelligent DDSs have been widely used in targeted therapy for OSCC. Meanwhile, the newly developed therapeutic techniques such as immunotherapy, gene therapy and bionic technology provide the possibility to realize the active targeted therapy. Here, the latest advances of target therapy for OSCC are reviewed, and their therapeutic remarks, current limits and future prospects are also systematically interpreted. It is believed that active and passive targeted therapies have great potentials for clinical transformation and application of OSCC, which will greatly improve human quality of life.

Background Streptococcus anginosus (S. anginosus) was reported increased in oral squamous cell carcinoma (OSCC) tissue. The aim of this study was to investigate the response of oral cancer cells in the biological characteristics evoked by the S. anginosus and investigate its potential mechanisms. Methods The growth curve and concentration standard curve of S. anginosus were determined, and a series of concentrations of S. anginosus supernatant were applied to OSCC cell lines SCC15, then selected an optimal time and concentration by CCK-8 assay. Then autophagic response, proliferative activity, cell cycle and apoptosis, invasion and migration abilities were evaluated in SCC15. Results The results showed that when the ratio of S. anginosus supernatant to cell culture medium was 1:1 and the co-culture time was 16 h, the inhibitory effect on SCC15 was the most obvious; Furthermore, the supernatant of Streptococcus upregulated the autophagy activity of SCC15, thus significantly inhibiting its proliferation, migration and invasion ability. Compared with control groups, the cell cycle showed G1 arrest, S and G2/M phases decreased, and the percentage of apoptotic cells relatively increased (P Conclusion S. anginosus reduced the proliferation, migration and invasion of SCC15 cells and promoted cell apoptosis; Moreover, autophagy may be one of the mechanisms in this process.

Background Due to their prevalence, dental caries ranks first among all diseases endangering human health. Therefore, the prevention of caries is of great significance, as caries have become a serious public health problem worldwide. Currently, using nanoscale drug delivery systems to prevent caries has received increased attention. However, the preventive efficacy of these systems is substantially limited due to the unique physiological structure of cariogenic biofilms. Thus, novel strategies aimed at combating cariogenic biofilms to improve preventive efficiency against caries are meaningful and very necessary. Herein, inspired by cell membrane coating technology and Lactobacillus strains, we coated triclosan (TCS)-loaded poly(lactic-co-glycolic acid) (PLGA) nanoparticles (TCS@PLGA-NPs) with an envelope of Lactobacillus (LA/TCS@PLGA-NPs) and investigated their potential as a nanoparticle delivery system against cariogenic biofilms and dental caries. Results LA/TCS@PLGA-NPs were successfully prepared with favorable properties, including a coated envelope, controllable size, negative charge, sustained drug-release kinetics and so on. The LA/TCS@PLGA-NPs inherited native properties from the source cell surface, thus the LA/TCS@PLGA-NPs adhered to S. mutans, integrated into the S. mutans biofilm, and interfered with the biofilm formation of S. mutans. The nanoparticles significantly inhibited the activity, biomass and virulence gene expression of S. mutans biofilms in vitro. Additionally, LA/TCS@PLGA-NPs exhibited a long-lasting inhibitory effect on the progression of caries in vivo. The safety performance of the nanoparticles is also favorable. Conclusions Our findings reveal that the antibiofilm effect of LA/TCS@PLGA-NPs relies not only on the inheritance of native properties from the Lactobacillus cell surface but also on the inhibitory effect on the activity, biomass and virulence of S. mutans biofilms. Thus, these nanoparticles could be considered feasible candidates for a new class of effective drug delivery systems for the prevention of caries. Furthermore, this work provides new insights into cell membrane coating technology and presents a novel strategy to combat bacterial biofilms and associated infections. Graphical Abstract

Dental Caries is a kind of chronic oral disease that greatly threaten human being’s health. Though dentists and researchers struggled for decades to combat this oral disease, the incidence and prevalence of dental caries remain quite high. Therefore, improving the disease management is a key issue for the whole population and life cycle management of dental caries. So clinical difficulty assessment system of caries prevention and management is established based on dental caries diagnosis and classification. Dentists should perform oral examination and establish dental records at each visit. When treatment plan is made on the base of caries risk assessment and carious lesion activity, we need to work out patient‑centered and personalized treatment planning to regain oral microecological balance, to control caries progression and to restore the structure and function of the carious teeth. And the follow-up visits are made based on personalized caries management. This expert consensus mainly discusses caries risk assessment, caries treatment difficulty assessment and dental caries treatment plan, which are the most important parts of caries management in the whole life cycle.

Microorganisms are confirmed to be closely related to the occurrence and development of cancers in human beings. However, there has been no published report detailing relationships between the oral microbiota and salivary adenoid cystic carcinoma (SACC). In this study, unstimulated saliva was collected from 13 SACC patients and 10 healthy controls. The microbial diversities, compositions and functions were comprehensively analyzed after 16S rRNA sequencing and whole-genome shotgun metagenomic sequencing. The alpha diversity showed no significant difference between SACC patients and healthy controls, while beta diversity showed a separation trend. The SACC patients showed higher abundances of Streptococcus and Rothia, while Prevotella and Alloprevotella were more abundant in healthy controls. The prevalent KEGG pathways, carbohydrate-active enzymes, antibiotic resistances and virulence factors as well as the biomarkers in SACC were determined by functional gene analysis. Our study preliminarily investigated the salivary microbiome of SACC patients compared with healthy controls and might be the basis for further studies on novel diagnostic and treatment strategies.

The objectives of this study were to investigate the effects of a novel method using flavonoids to inhibit Streptococcus mutans (S. mutans), Candida albicans (C. albicans) and dual-species biofilms and to protect enamel hardness in a biofilm-based caries model for the first time. Several flavonoids, including baicalein, naringenin and catechin, were tested. Gold-standard chlorhexidine (CHX) and untreated (UC) groups served as controls. Optimal concentrations were determined by cytotoxicity assay. Biofilm MTT, colony-forming-units (CFUs), biofilm biomass, lactic acid and polysaccharide production were evaluated. Real-time-polymerase-chain reaction (qRT-PCR) was used to determine gene expressions in biofilms. Demineralization of human enamel was induced via S. mutans-C. albicans biofilms, and enamel hardness was measured. Compared to CHX and UC groups, the baicalein group achieved the greatest reduction in S. mutans, C. albicans and S. mutans-C. albicans biofilms, yielding the least metabolic activity, polysaccharide synthesis and lactic acid production (p < 0.05). The biofilm CFU was decreased in baicalein group by 5 logs, 4 logs, 5 logs, for S. mutans, C. albicans and S. mutans-C. albicans biofilms, respectively, compared to UC group. When tested in a S. mutans-C. albicans in vitro caries model, the baicalein group substantially reduced enamel demineralization under biofilms, yielding an enamel hardness that was 2.75 times greater than that of UC group. Hence, the novel baicalein method is promising to inhibit dental caries by reducing biofilm formation and protecting enamel hardness.

To investigate the effect of chlorhexidine (CHX)-loaded carboxyl-terminated poly (amido amine) dendrimer (CHX-PAMAM-COOH) on matrix metalloproteinase (MMP) activities and remineralization in human dentin, CHX-PAMAM-COOH was prepared and characterized by Fourier-transform infrared spectroscopy. The inhibitory effects of CHX, PAMAM-COOH, and CHX-PAMAM-COOH on soluble recombinant human matrix metalloproteinase (rhMMP-2) and dentin-bound endogenous MMP activity were measured using an MMP Activity Assay Kit. In situ zymography was performed to evaluate the gelatinase activity in dentin pretreated with CHX, PAMAM-COOH, and CHX-PAMAM-COOH. The remineralization of etched dentin pretreated with CHX, PAMAM-COOH, and CHX-PAMAM-COOH was evaluated by field emission-scanning electron microscopy (SEM) and energy disperse spectroscopy (EDS) after incubation in artificial saliva for 14 days. The results of the rhMMP-2 activity assay showed that the MMP-2 activity in the CHX-PAMAM-COOH group and the CHX group decreased significantly to 5.58 ± 0.85% (P 0.05) and 4.86 ± 1.12% (P 0.05), respectively, but that in the PAMAM-COOH group increased significantly to 213.38 ± 0.11% (P 0.05). The results of total MMP activity and in situ zymography showed a significant reduction in endogenous gelatinase activity in dentin in the CHX-PAMAM-COOH group and the CHX group. The SEM and EDS results showed that rod-like crystals were formed on the etched dentin surface in the PAMAM-COOH group and the CHX-PAMAM-COOH group, and their Ca/P ratios were 1.73 and 1.71, respectively. In conclusion, CHX-PAMAM-COOH can inhibit dentin-bound endogenous MMPs and induce remineralization in etched dentin simultaneously. However, it is important to note that the catalytic role of PAMAM dendrimers may have an undesired excitatory effect on MMP activity, which cannot be ignored if PAMAM dendrimers were used alone in the oral environment.

AIM To establish a 3D model for screening the biocompatibility of dental materials/drugs on dental pulp cells and tissue. METHODOLOGY Human dental pulp cells (hDPC) and endothelial cells (EC) were mixed with or without human dental pulp derived extracellular matrix (hDP-ECM) according to several protocols and cultured in 3D plates to fabricate 3D organoids. Cell viability and proliferation in organoids were evaluated using Live/Dead cell viability assay and ATPase assay. Organoids were fixed, cut and stained with a H&E staining kit. The expressions of DSPP, DMP-1, CD31, vWF and COL1A in 3D organoids were evaluated using immunofluorescence. To assess the feasibility of 3D organoids on drug/material toxicity screening, the organoids were treated with lipopolysaccharides (LPS) or iRoot BP. Then, cell viability and apoptosis were assessed. The expressions of IL-6, TNF-α, and IL-1β were compared in LPS-treated and non-treated organoids. Alizarin Red S staining was used to evaluate calcium deposit formation in organoids. Data were analysed using one-way anova followed by Tukey's post hoc comparison. RESULTS The 3D spheres/organoids were formed at day 1 or day 2. Cells in 3D organoids maintained a high viability rate and low proliferation activity. The level of CD31 increased significantly (p

BACKGROUND We investigated the root canal curvature and morphology of maxillary posterior teeth in Guizhou, China, to provide references for clinical practice. MATERIAL AND METHODS We collected 274 maxillary posterior teeth in Guizhou Province, China. The root canal curvature was observed by X-ray film measurement. Two hundred teeth were selected to make transparent tooth models, and root canal configuration was recorded according to Vertucci classification criteria. The position of the MB2 root canal orifice and the mesiobuccal root canal configuration were observed by micro-computed tomographic (micro-CT) scanning. The t test and the chi-square test were used for statistical analysis. RESULTS The root canals of the maxillary posterior teeth showed more significant curvature in the mesiodistal direction than in the buccolingual direction (P

Objective: To evaluate the caries-predictive validity of a screening Cariogram model without saliva tests in Chinese young adults with past caries experience. Methods: Two-hundred and fifteen Chinese young adults seeking dental care were included in this observational study, with informed consent obtained. All participants were 18–29 years of age and with past caries experience. A caries risk assessment was made at baseline using a full-blown Cariogram model and a screening Cariogram model without saliva tests; this assessment included bacterial count, saliva secretion and buffer capacity. Participants were divided into five risk groups according to ‘the chance of avoiding caries’ expressed in Cariogram software with two models. Each participant was required to receive re-examination after 2 years and then the actual caries increment (ΔDMFS) was calculated. The correlation between ΔDMFS and the ratings of caries risk was analysed using Spearman rank correlation. Differences between the full-blown and screening models were expressed as area under the receiver–operating characteristics (ROC) curve (AUC). Results: One-hundred and ninety-two participants finished the 2-year follow-up study, after 23 dropped out. The mean 2-year caries increment was 0.67 ± 1.03. Both Cariogram models displayed a statistically significant relationship with caries development (P < 0.001): more new caries was found among those assessed with high risk compared with those assessed with low risk. No statistically significant difference of the AUC was found between the two Cariogram models (P > 0.05). Conclusions: The Cariogram model without saliva tests does not significantly decrease the caries-predictive ability in young adults with a history of caries. This screening model is a potential tool for rapid caries risk assessment for such populations.

Background Oral microbiome and salivary proteins play a critical role in the occurrence and development of caries. In this study, we used metagenomic and metaproteomic analyses to explore the microbiological and proteinic biomarkers and investigate the etiology of caries in 6–8 years old children. Our study aims to offer a better comprehension of these factors and the relationship with caries, and these findings might facilitate caries risk assessment and provide a basis for future prevention strategies. Methods Children 6 to 8 years old living in rural isolated areas including 40 caries-active subjects and 40 caries-free subjects were recruited. Supragingival plaque and unstimulated saliva were collected for 16S rDNA pyrosequencing and isobaric tags for relative and absolute quantitation (iTRAQ) technique coupled with quantitative nano-flow liquid chromatography-tandem mass spectrometry (LC-MS/MS), respectively. Results We found 6 phyla and 13 genera predominant in all the samples, and differences in relative abundances can be observed. The Alpha diversity analysis demonstrated that the richness and diversity of the bacterial communities were similar between children with caries-free and caries-active groups; LEfSe detected differences in the bacterial community including Dialister, Selenomonas, Actinomyces, and Mogibacterium in the caries-active group (P P Conclusions The diversity of the microbial community has little effect on caries but some bacteria with different relative abundance between the caries-active and caries-free group could be considered as potential biomarkers for children with caries. In addition, as a critical host factor of caries, the salivary proteins are different in caries-free and caries-active groups.

OBJECTIVE: To compare the esthetic improvement between postorthodontic white-spot lesions (WSLs) treated by resin infiltration and microabrasion for 12 months. MATERIALS AND METHODS: A total of 20 patients with 128 teeth with postorthodontic WSLs were recruited. A simple randomized, split-mouth, positive controlled design was used to allocate patients to resin infiltration or microabrasion groups. The lesion area ratio (R value) was calculated between the area of a WSL and the labial surface of the corresponding tooth based on standardized clinical photographs. The color change (ΔE) of each tooth was measured with a Crystaleye spectrophotometer (Olympus, Tokyo, Japan). Every measurement was taken before treatment (T0) and at different time points after treatment: 1 week (T1), 6 months (T6), and 12 months (T12). RESULTS: A total of 16 patients with 108 trial teeth were available at T12. Each group had 54 trial teeth. In both groups, there was a significant decrease in R value and ΔE between T1 and T0 (P < .0001). In the infiltration group, the R value and ΔE had no significant changes over time from T1 to T12. In the microabrasion group, the R value and ΔE decreased significantly from T1 to T6. The R value of resin infiltration was lower when compared with microabrasion at every recall point (P < .001). The ΔE had no significant differences between the two groups at any timepoint. CONCLUSIONS: Resin infiltration and microabrasion improved the esthetic appearance of WSLs and showed sufficient durability for 12 months. Resin infiltration showed a better esthetic improvement effect when compared with microabrasion at 12 months.

With the aging of the population, dental caries in the elderly has received increasing attention. A comprehensive study of the oral microbiome is required to understand its polymicrobial etiology. The results of previous studies are limited and remain controversial. In this study, subjects 60 years and older with and without caries were recruited. Unstimulated saliva and dental plaque were collected from each subject and the bacterial 16S rDNA was amplified using PCR and sequenced by Illumina MiSeq high-throughput sequencing. A total of 92 samples were collected from 24 caries patients and 22 healthy controls. Sequences clustered into 147,531 OTUs, representing 16 phyla, 29 classes, 49 orders, 79 families, 149 genera, and 305 species. All predominant phyla, including Proteobacteria, Bacteroidetes, Firmicutes, Fusobacteria, Actinobacteria, and Saccharibacteria, were largely consistent in different groups, but different relative abundances could be observed. The core microbiome was defined with 246 shared species among groups, which occupied 80.7% of all the species detected. Alpha diversity showed no significant differences in bacterial richness or diversity between caries patients and healthy controls, but distinction existed between samples collected from dental plaque and saliva. Beta diversity analysis was performed by PCoA and hierarchical clustering analysis, showing similar results that microorganisms vary between the two niches. The biomarkers of different groups were defined by LEfSe analysis to identify potential caries-related and health-related bacteria. The co-occurrence analysis of the predominant genera revealed significant interactions among oral microbiota and exhibited more complex and aggregated bacterial correlations in caries-free groups. Finally, the functional prediction of the microbiota present in oral samples was performed by PICRUSt, indicating vigorous microbial metabolism in the oral bacterial community. Our study provides thorough knowledge of the microbiological etiology of elderly individuals with caries and is expected to provide novel methods for its prevention and treatment.

Background The aim is to investigate the prevalence of dental anxiety and its association with pain and other related factors in adult patients with irreversible pulpitis. Methods One hundred and thirty patients with irreversible pulpitis were included in this cross-sectional study. Participants were asked to fill out an information table and a battery of questionnaires to assess their level of dental anxiety, pain at their first and most recent dental experience, and pain intensity before/during the present endodontic treatment. The level of anxiety that participants displayed during the present treatment was also evaluated by the dentists using an anxiety rating scale. Data were analyzed by t-test, ANOVA, and Spearman correlation tests. Results 83.1% of participants suffered from moderate or high dental anxiety, and 16.2% met criteria for specific phobia. Subjects who had higher MDAS scores were more likely to postpone their dental visits (P

BACKGROUND The mixed dentition is an important transition period from primary teeth to permanent teeth. However, the caries prevalence of first permanent molar in mixed dentitions was about 30%, which almost represent the caries rate of permanent teeth in this period of time. Therefore, we assessed the oral bacterial profiles in young children (age 6-8) with mixed dentition with or without first molar caries for providing the research basis of caries etiology. METHODS We collected samples of supragingival plaque and saliva from the children living in Guizhou, a rural isolated province in China. Then, we performed DNA extraction and purification followed by 454 pyrosequencing of the V1-V3 hypervariable regions of the 16S rRNA and compared our results with those of previous research. RESULTS (i) We analyzed 48,320 unique sequences that represented 18 phyla, 29 classes, 44 orders, 74 families, 129 genera, 15,003 species-level OUT in plaque and saliva samples; (ii) longitudinally, there was the "healthy core microbiome" between healthy deciduous dentition and early mixed dentition, for example, Neisseria, Porphyromonas, Selenomonas etc.; (iii) horizontally, there also existed the "healthy core microbiome" in early mixed dentition, for example, Neisseria, Streptococcus, Prevotella etc.; (iv) the dominant bacteria detected by Lefse in caries group including Actinomycetaceae, Streptobacillus (p

This study was to investigate root anatomy and root canal morphology of mandibular first premolars in a Chinese population. 178 human permanent mandibular first premolars extracted from a native Chinese population were collected, scanned using micro-computed tomography and reconstructed three-dimensionally. The number of roots and canals, canal configuration and radicular grooves were investigated. The root canal morphology was categorized according to Vertucci’s criteria. The radicular grooves were scored according to the Arizona State University dental anthropology scoring system (ASUDAS), and the correlation between scores for radicular grooves and root canal morphology was analyzed. Almost all the samples were single-rooted (99.4%). 64.04% of teeth possessed type I canal systems, whilst 34.27% had two canals and 1.69% had three canals. According to ASUDAS, the scores of radicualr grooves were 56.74%, 16.85%, 12.36%, 10.11%, 3.37% and 0.56% respectively from grade 0 to grade 5. The roots with radicular grooves (grade 3 or 4) were defined as Tome’s anomalous root and these roots have a high incidence of C-shape configurations (66.67%) and multiple-canal systems (100%). There is complicated variation of the root anatomy and canal morphology of mandibular first premolars in southwestern Chinese population, which needs special attention and careful assessment for endodontic treatment.

To evaluate root canal morphology of permanent mandibular incisor teeth in a Chinese population using cone-beam computed tomography (CBCT).CBCT images of Chinese patients were collected and 1553 permanent mandibular incisors in the images were included. The following observations on the included teeth were to determine the number of roots, root morphology and canal configuration. The root canal configurations were classified. The effect of gender on the incidence of the second canal was investigated.Of permanent mandibular incisors, 86.8% had a single root with single canal. Mandibular lateral incisors (17.5%) had a higher incidence of a second canal compared with mandibular central incisors (8.9%) (p = 0.000). A slightly higher percentage of incidence of a second canal was found in males (14.6%) than in females (11.9%) (p = 0.129).Permanent mandibular incisors with two canals had a relatively low incidence in this Chinese population. The incidence of a second canal did not differ between males and females. CBCT is a valuable aid during root canal treatment.

Purposes: To study the occurrence of ocular surface diseases on coal miners working under wells and to investigate the relation between xerophthalmia occurrence and coal dust contiguity. Methods: To observe the influence of coal dust to ocular surface by using Schirme to detect lacrimal gland secreting function, and breakup time of tear film (BUT)to evaluate the stability of lacrimal film and the quantity of lisozyma in lacrimal fluid. Results: These values were lower for underground coal miners than other workers no contacting coal dust, and showed negative correlation to period of their services. Conclusions: Conditions in coal miners were worse than that of other workers. Coal dust exposure plays an important role in the development of dry eye.

OBJECTIVE: To explore the relationship between salivary proteome and dental caries and to promote the biomarker studies of dental caries susceptibility by comparing the salivary proteome of caries-active children and caries-free children with electrospray ionization ion-trap tandem mass spectrometry (ESI-MS/MS). METHODS: Ten caries-active children and ten caries-free children were sampled. The salivary proteome of the two groups was studied, and the differential protein between the two groups was analyzed by ESI-MS/MS after sodium dodecyl sulfate polyacrylamide gel electrophoresis, filter-aided sample preparation, and liquid chromatography. RESULTS: The concentration of salivary protein was higher in the caries-active group than in the caries-free group. The polypeptide counts of thecaries-active and caries-free groups were 602 and 481, which belonged to 286 and 227 proteins, respectively. The differential polypeptide count of the two groups was 361, and the differential protein count was 118. The detected proteins included matrix metalloproteinase-9 (MMP9), mucin-7 (MUC7), lactotransferrin (LTF), carbonic anhydrase 6 (CA6), azurocidin (AZU), and cold agglutinin. CONCLUSION: The total salivary protein was higher in the caries-active group than in the caries-free group. The preliminary detection of differential proteins (MMP9, MUC7, LTF, CA6, AZU, and cold agglutinin) may lay some foundation for biomarker research of dental caries susceptibility.

The aim of this systematic review is to investigate the effect of an additional lingual infiltration on the pulpal anesthesia of mandibular teeth.Prospective clinical trials were searched from Medline, EMBASE, Cochrane Library, Pubmed, SCI, and the China National Knowledge Infrastructure. Papers that met the inclusion criteria were accepted. Data was extracted by two investigators using a designed extraction form. The anesthetic efficacy of an additional lingual infiltration on the pulpal anesthesia of mandibular teeth was analyzed.Seven prospective randomized controlled trials were included. All subjects of these studies were volunteers with healthy pulps, without patients with pulpitis. Compared to buccal infiltration alone, an additional lingual infiltration following buccal infiltration is more likely to achieve a successful pulpal anesthesia in the mandibular incisor area, with a relative risk for success of 2.00 [1.08, 3.72] for 2% lidocaine and 1.32 [1.15, 1.51] for 4% articaine. For mandibular canines and premolars, the additional lingual infiltration following inferior alveolar nerve block did not enhance the anesthetic efficacy. In the mandibular molar area, no significant difference was found after an additional lingual infiltration with either 2% lidocaine or 4% articaine.An additional lingual infiltration following buccal infiltration can enhance the anesthetic efficacy compared with buccal infiltration alone in the mandibular incisor area. For mandibular canines, premolars, and molars, an additional lingual infiltration is not recommended, since no data exist to support such usage. Lingual infiltration of articaine in the mandibular teeth with pulpitis should be studied further.

Aim To investigate the effect of supplemental lingual infiltration (LI) of mandibular molars following an inferior alveolar nerve block (IANB) plus buccal infiltration (BI) in patients with irreversible pulpitis. Methodology Eighty adult patients diagnosed with irreversible pulpitis participated in this prospective study. All patients received standard IANB via injection of 4 mL of 2% lidocaine with 1 : 100 000 epinephrine. Ten minutes after the IANB, patients with numbness of the lower lip were randomly divided into two groups. In the BI group, 40 patients received supplemental BI of 0.9 mL of 4% articaine with 1 : 100 000 epinephrine. In the buccal plus lingual infiltration (BLI) group, 40 patients received supplemental BI of 0.9 mL of 4% articaine with 1 : 100 000 epinephrine and, subsequently, LIs with the same anaesthetic solution and dose. Endodontic access cavity preparation began 15 min after the IANB. Pain during treatment was recorded using a Heft–Parker visual analogue scale. Success was defined when pain was ‘none’ or ‘mild’ on endodontic access and initial instrumentation. The pain was estimated and statistically analysed by the chi-squared test (α = 0.05). Results The success rates for the BI and BLI groups were 70% and 62.5%, respectively. No statistical difference was found between the two groups (P = 0.478). Conclusions Supplemental LIs are not recommended for administration in mandibular molars with irreversible pulpitis, because they do not improve the anaesthetic success after IANB plus BI.