Comparative Evaluation of the Effectiveness of 2% Lignocaine Mixed With Dexamethasone 4 mg vs. 2% Lignocaine (1:200,000 Epinephrine) for Pain Control During the Removal of Orthodontically Indicated Mandibular Premolars: A Randomized Controlled Trial

Background Effective pain control is paramount in dental procedures, especially during tooth extractions. While 2% lignocaine with epinephrine is the standard local anesthetic, its relatively short postoperative analgesic duration often necessitates systemic analgesics. Incorporating dexamethasone, a potent anti-inflammatory corticosteroid, into local anesthetic solutions has shown promise in enhancing anesthetic efficacy and postoperative comfort. Materials & methods This double-blind, split-mouth randomized controlled trial enrolled 30 healthy volunteers undergoing bilateral mandibular premolar extractions for orthodontic purposes. Each extraction site was randomly assigned to one of two protocols in a single session: group A (twin mix) received a mixture of 1.8 mL 2% lignocaine with 1:200,000 epinephrine plus 1 mL of 4 mg dexamethasone, while group B (standard control) received only 1.8 mL of the same lignocaine-epinephrine formulation. In total, 60 extraction sites were included, and each patient served as their own control. Results The results demonstrated that the twin mix offered clinical advantages: patients in the twin mix group reported less pain during anesthetic injection (mean: 3.57 vs. 6.43; p < 0.001), experienced faster anesthesia onset (14.0 vs. 24.3 seconds; p < 0.001), and had enhanced duration of anesthesia (111.7 vs. 73.1 minutes; p < 0.001). There was no significant difference in pain during tooth extraction (p = 0.302). Notably, 26 (86.7%) of twin mix patients required no postoperative analgesics compared to 23 (76.7%) in the control group. These findings align with prior studies showing that dexamethasone added to lignocaine accelerates the onset, prolongs anesthesia, and reduces pain and analgesic consumption. Conclusion The twin mix enhanced anesthesia by reducing injection pain, accelerating onset, prolonging the duration of action, and decreasing postoperative analgesic use, supporting its value as a superior, patient-centered option for minor oral surgery.