Effect of Buffered Lidocaine on painless anesthesia in patients with painful teeth

INTERVENTION: The procedure will be started by administering buccal infiltration with Sodium Bicarbonate mixed with 1% Lidocaine and Epinephrine in one group. Buffering of the local anesthetic will be performed with a hand mixing protocol. A 1ml sterile syringe will be used to withdraw 0.18 ml of local anesthetic solution from the 1.8 ml carpule followed by injection of 0.18 ml of sodium bicarbonate 8.4% solution into the carpule obtaining a ratio of 9:1 between the local anesthetic solution and the sodium bicarbonate. Every patient will be administered a buffered lidocaine carpule according to their wight. For every kg of weight, a 0.18ml buffered lidocaine solution will be used. After 15 minutes, lip numbness will be checked by asking the patient and if present, an inferior alveolar nerve block will be administered using 1% Lidocaine with 1:1000,000 Epinephrine. After another 15 minutes lip and tongue numbness will be confirmed again by asking the patient, and access cavity will be prepared. The treatment will be completed within 1 hour, and patient will be given a VAS to confirm their level of pain. VAS readings of 0 will be taken as ‘no pain’, 1‐3 as ‘mild pain’, 4‐7 as ‘moderate pain’ and 8‐10 as ‘severe pain’. The total duration of the intervention will be 1 hour. The medical records will be reviewed to check if the patient follows regular appointments. CONDITION: Anaesthesiology ‐ Anaesthetics Oral and Gastrointestinal ‐ Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon Oral Anesthesia;Symptomatic Irreversible Pulpitis; ; Oral Anesthesia ; Symptomatic Irreversible Pulpitis PRIMARY OUTCOME: Pain and anesthesia effect of buffered lidocaine after administering Inferior Alveolar Nerve Block and this will be assessed as a composite outcome.[Visual Analogue Scale Pain will be assessed 15 minutes after administering inferior alveolar nerve block] SECONDARY OUTCOME: nil[nil nil] INCLUSION CRITERIA: 1. Patients aged 18–60 years. 2. Symptomatic irreversible pulpitis in mandibular 1st Molar teeth. 3. No periapical radiolucency on radiograph. 4. Vital pulp confirmed upon access. 5. No previously root canal treated tooth