Submitted 6 December 2021 Accepted 16 April 2022 Published 13 May 2022 Corresponding authors Ajinkya M. Pawar, ajinkya@drpawars.com Dian Agustin Wahjuningrum, dian-agustin-w@fkg.unair.ac.id Academic editor Shivam Mehta Additional Information and Declarations can be found on page 12 DOI 10.7717/peerj.13397 Copyright 2022 Singh et al. Distributed under Creative Commons CC-BY 4.0 OPEN ACCESS Comparative evaluation of the effect of two pulpal medicaments on pain and bleeding status of mandibular molars with irreversible pulpitis post-failure of inferior alveolar nerve block: a double-blind, randomized, clinical trial Naomi Ranjan Singh 1 , Lora Mishra 1 , Ajinkya M. Pawar 2 , Nike Kurniawati 3 and Dian Agustin Wahjuningrum 3 1 Department of Conservative Dentistry and Endoodntics, Institute of Dental Sciences, Bhubaneswar, Odisha, India 2 Department of Conservative Dentistry and Endoodntics, Nair Hospital Dental College, Mumbai, Maharashtra, India 3 Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya City, East Java, Indonesia ABSTRACT Background. Complete relief of pain due to irreversible pulpitis is challenging to obtain with analgesic medications. The high incidence of an inferior alveolar nerve block (IANB) failure makes it difficult for practitioners to perform endodontic treatment without implementing other anesthetic techniques, especially mandibular molars. The aim of this study was to compare efficacies of two different quantities of paraformaldehyde based pulpal medicaments to relieve the pain and control hyperemic pulp post-failure of IANB and supplementary technique in patients experiencing this symptomatic irreversible pulpitis in the permanent mandibular tooth. Method. Eighty-two participants with severe pain pre-operatively (Heft Parker Visual Analogue Scale, VAS > 114 mm) were enrolled, and pain responses were recorded at different time intervals using the Heft Parker visual analogue scale. To the patients experiencing pain even after the administration of the standard IANB and supplemental intraligamentary injection, one of the two paraformaldehyde based pulpal medicaments was placed in the pulp chamber and sealed. Participants were recalled after 24–48 h (second visit) to assess pain and bleeding reduction. Results. Results showed a significant decrease in pain severity and bleeding score post medicament placement (p <.05). Hence judicious use within a recommended period, pulpal medicaments can be considered safe. Conclusion. Paraformaldehyde based pulpal medicament can be used as an alternative to manage pain in patients having severe irreversible pulpitis and hyperalgesia. How to cite this article Singh NR, Mishra L, Pawar AM, Kurniawati N, Wahjuningrum DA. 2022. Comparative evaluation of the effect of two pulpal medicaments on pain and bleeding status of mandibular molars with irreversible pulpitis post-failure of inferior alveolar nerve block: a double-blind, randomized, clinical trial. PeerJ 10:e13397 http://doi.org/10.7717/peerj.13397