Effect of Menstrual Phase on the Anesthetic Efficacy

The goal of this observational prospective clinical study is to learn whether the menstrual phase influences the anesthetic efficacy of inferior alveolar nerve block (IANB) in female patients aged 20-40 years with symptomatic irreversible pulpitis in mandibular molars. The main questions it aims to answer are: Does the success rate of IANB vary across different phases of the menstrual cycle? Are certain menstrual phases associated with a higher likelihood of anesthetic failure during endodontic access preparation? Researchers will compare five menstrual phase groups (menstrual, follicular, ovulatory, luteal, and premenstrual) to see if hormonal fluctuations affect anesthetic success. Participants will: Receive a standardized inferior alveolar nerve block using 2% lidocaine with 1:80,000 epinephrine Undergo cold testing and access cavity preparation to assess anesthetic success Have intraoperative pain recorded using the Heft-Parker Visual Analog Scale (HPVAS), with menstrual phase information recorded confidentially and blinded to the treating clinician