aim:Effect of dexamethasone as a supplemental buccal infiltration of the posterior teeth after an inferior alveolar nerve block, on during and post treatment pain, in patients with symptomatic irreversible pulpitis, Study design: Randomized, double-blind, placebo-controlled main criteria for inclusion: a lack of medication to work, the tooth in response to cold and electrical tests have long-term positive response, radiographic signs of any the presence of radiolucent not have, exclusion criteria: pregnancy or lactation, age less than 18 years, having any kind of infectious disease or endocrine disease, allergy to dexamethasone sample size: 60 patients studied interventions: dexamethasone , normal saline, The main outcome variable: reducing pain and discomfort